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Öğe Effects of sevoflurane, isoflurane and propofol infusions on post-operative recovery criteria in geriatric patients(Sage Publications Ltd, 2005) Arar, C; Kaya, G; Karamanlioglu, B; Pamakçu, Z; Turan, NWe compared the effects of sevoflurane, isoflurane and propofol infusions on postoperative recovery criteria in geriatric patients. Sixty patients aged > 65 years, classified as American Society of Anesthesiologists (ASA) group 1 or 2 and undergoing gynaecological or urological procedures were randomized equally into three groups. Group 1 received 1 minimum alveolar concentration (MAC) sevoflurane in a 50% O-2/N2O mixture and group 2 received I MAC isoflurane in a 50% O-2/N2O mixture. Group 3 received a 50% O-2/N2O mixture plus propofol total intravenous anaesthesia (8 mg/kg for the first 30 min, followed by 6 mg/kg for maintenance). Recovery criteria comprising the times to spontaneous eye opening, extubation, response to verbal stimuli and orientation were recorded following the discontinuation of anaesthesia. Recovery times were significantly shorter in groups 1 and 3 compared with group 2. We conclude that sevoflurane and propofol had similar effects on recovery criteria and were associated with a faster recovery than isoflurane.Öğe The importance of aprotinin and pentoxifylline in preventing leukocyte sequestration and lung injury caused by protamine at the end of cardiopulmonary bypass surgery(Georg Thieme Verlag Kg, 2004) Ege, T; Arar, C; Canbaz, S; Cikirikcioglu, M; Sunar, H; Yuksel, V; Duran, EBackground: Protamine has adverse effects on pulmonary gas exchange during the postoperative period. The objective of this study was to investigate the importance of aprotinin and pentoxifylline in preventing the leukocyte sequestration and lung injury caused by protamine administered after the termination of cardiopulmonary bypass (CPB). Methods: Participants (n = 39) were allocated into three groups at the termination of CPB: Group 1, (control group, n = 16); Group 2 (aprotinin group, n = 12), who received protamine + aprotinin (15 000 IU/kg); and Group 3 (Pentoxifylline group, n = 11), who received protamine + pentoxifylline (10 mg/kg). Leukocyte counts in pulmonary and radial arteries were determined after the termination of CPB and before any drug was given (t(1)), and 5 minutes (t(2)), 2 hours (t(3)), 6 hours (t(4)) and 12 hours (t(s)) after the administration of protamine. Alveolar-arterial O-2 gradient (A-aO(2)) and dynamic pulmonary compliance were measured at t(1), t(2) and t(3). Results: In the control group, an increase in pulmonary leukocyte sequestration was observed 5 minutes and 2 hours after protamine administration, after which this difference disappeared. No significant degree of pulmonary sequestration was detected in any measurements after protamine was administered in the aprotinin and pentoxifylline (PTX) groups. Dynamic lung compliance was 50.1, 45.2 and 47.2 ml/cm H2O in the control group, 49.2, 61.1 and 56.3 ml/ cm H2O in the aprotinin group, and 49.5, 54.5 and 50.4 ml/cm H2O in the PTX group. The A-aO(2) gradient was 212.2, 263.3 and 254.3 mmHg in the control group, 209.4, 257.1 and 217.3 mmHg in the aprotinin group, and 211.3, 260.8 and 219.2 mmHg in the PTX group. Conclusion: Aprotinin and PTX treatments have favourable effects on lung function by reducing protamine-induced leukocyte sequestration into lungs at the end of CPB.Öğe The importance of pulmonary artery circulation during cardiopulmonary bypass(Cambridge Med Publ, 2003) Ege, T; Canbaz, S; Cikirikcioglu, M; Arar, C; Edis, M; Duran, EThis study sought to determine changes in transpulmonary difference in blood cells and alveolar-arterial oxygen (A-aO(2)) gradient when pulmonary artery circulation was obstructed in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Eighteen patients were divided into group A (control group; X-clamp placed on aorta, n = 9) and group B (pulmonary ischaemia group; X-clamp placed on aorta and pulmonary artery, n = 9). Haematological parameters were compared before CPB and up to 90 min after declamping. A-aO(2) gradient differences were compared before and 2 h and 6 h after declamping. A transpulmonary increase in leucocyte levels normalized after 60 min in group A but remained higher in group B. A transpulmonary increase in neutrophils normalized after 60 min in group A and 90 min in group B. Increased lymphocyte levels normalized after 30 min in group A and 90 min in group B. A-aO(2), gradient was determined as: group A (294.8 +/- 74.3) and group B (321.2 +/- 73.3) before X-clamping; group A (132.7 +/- 22.7) and group B (236.6 +/- 41.5) 2 h after declamping; and group A (72.2 +/- 22.7) and group B (189.4 +/- 88.9) 6 h after declamping. When pulmonary artery circulation was obstructed during the X-clamping period, leucocyte, neutrophil and lymphocyte sequestration within both lungs increased, and an increased A-aO(2) gradient was observed because of tissue damage. To prevent post-operative complications, precautions to maintain normal pulmonary artery circulation are recommended.Öğe Importance of pulmonary artery perfusion in cardiac surgery(W B Saunders Co-Elsevier Inc, 2004) Ege, T; Huseyin, G; Yalcin, O; Us, MH; Arar, C; Duran, EObjective: To investigate the importance of pulmonary artery perfusion in cardiac surgery. Design: Prospective randomized study. Setting: University hospital. Participants: Patients undergoing cardiac surgery. Interventions: Patients in whom the cross-clamp was applied only to the aorta were defined as group 1 (n = 11) and patients in whom the cross-clamp was applied to both the aorta and pulmonary artery were defined as group 2 (n = 11). Measurement and Results: Tissue samples obtained from the lower lobe of the left lung before CPB, 20 minutes after cross-clamping, and 20 minutes after declamping were examined under light and electron microscopes. Electron microscopic examination revealed changes in the blood-air barrier, epithelia[ cells, pneumocytes, and basal membrane were more prominent in group 2. Changes in the leukocyte, neutrophil, and lymphocyte counts of blood samples obtained from the right atrium and right superior pulmonary vein before CPB and 5, 30, 60, and 90 minutes after the removal of clamp were also investigated. The transpulmonary difference was statistically significant at 5 and 30 minutes after declamping in group 1. In group 2, transpulmonary differences continued to be significant at 5, 30, 60, and 90 minutes after declamping. There was no difference between groups in terms of PaO2/F1O2 ratio before CPB (group 1: 342.0 +/- 80.0 mmHg, group 2: 349.0 +/- 67.0 mmHg); however, a statistically significant difference was found between the groups 2 hours after declamping (group 1: 418.0 +/- 87.0 mmHg and group 2: 290.0 +/- 110.0 mmHg; p = 0.007). Conclusion: Pulmonary artery perfusion was found to be important in cardiac surgery. (C) 2004 Elsevier Inc. All rights reserved.Öğe Preoperative oral celecoxib versus preoperative oral rofecoxib for pain relief after thyroid surgery(Lippincott Williams & Wilkins, 2003) Karamanlioglu, B; Arar, C; Alagöl, A; Çolak, A; Gemlik, I; Süt, NBackground and objective: The study compared the analgesic efficacy and safety of two preoperatively administered cyclo-oxygenase-2 inhibitors, celecoxib and rofecoxib. Methods: Ninety adult patients undergoing thyroid surgery were divided into three groups (each n = 30). They were given a single oral dose of placebo, celecoxib 200 mg or rofecoxib 5 0 mg 1 h before induction of anaesthesia. All patients received a standard anaesthetic. Intraoperative blood loss was measured. Pain scores, sedation scores, heart rate, mean arterial pressure and respiratory rate were noted at 0, 1, 2, 4, 6, 12 and 24 h postoperatively. Analgesic (meperidine) requirements and adverse effects were recorded during the first postoperative 24 h. Results: Compared with placebo, pain scores were significantly lower with rofecoxib at all time points (P < 0.05) and were significantly lower with celecoxib (P < 0.05) during the first 4 h. Pain scores were significantly lower with rofecoxib compared with celecoxib at 6, 12 and 24 h (P < 0.05). The average cumulative 24 h meperidine dose was significantly lower with both celecoxib (54.9 +/- 34.4 mg) and rofecoxib (42.8 +/- 40.9 mg) compared with placebo (76.8 +/- 6.2 mg) (P < 0.01 and P < 0.001, respectively). There were no differences in the intraoperative blood loss, heart rate, mean arterial pressure, respiratory rate, sedation scores and incidence of adverse effects among groups. Conclusions: The preoperative administration of rofecoxib 50 mg and less so of celecoxib 200 mg provide a significant analgesic benefit with regard to postoperative pain relief and decrease in additional opioid requirements after thyroid surgery.