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    Half-Dose Sugammadex After Neostigmine Versus Neostigmine as a Routine Reversal Agent: A Pilot Randomized Trial
    (Elsevier Science Inc, 2022) Baysal, Ayse; Sagiroglu, Gonul; Dogukan, Mevlut; Ozkaynak, Ismail
    Purpose: The use of sugammadex at a lower dose after a routine reversal dose of neostigmine may prevent residual neuromuscular blockade (rNMB). Our goal was to investigate the effects of the use of half-dose sugammadex for reversing rNMB after administration of neostigmine, and compare these effects to a routine full-dose of neostigmine. Design: Prospective, single-blinded, randomized trial. Methods: Ninety-eight patients having lower abdominal tumor resection surgery under general anesthesia were randomized into two groups. Group N (Neostigmine) (n = 48) patients received standard reversal dose of intravenous neostigmine 0.05 mg/kg and atropine 0.02 mg/kg before extubationl Group N + S (Neostigmine + Sugammadex) (n = 50) patients received 1 mg/kg of intravenous sugammadex three minutes after a standard neostigmine reversal dose. The primary end-point was the incidence of a train-of-four (TOF) ratio less than 0.9 at tracheal extubation. Secondary end-points were periods between the start of administration of reversal agents and extubation or operating room discharge in minutes to achieve recovery of TOF ratio < 0.9 to 0.7 and TOF ratio >= 0.9. Findings: The demographic data were not different between the two groups (P >.005). The incidence of rNMB presented as TOF ratio < 0.9 to 0.7 was present in 52% of Group N patients compared to 8% in Group N + S patients (P <.0001). The time to recovery between administering reversal and extubation as well as operating room discharge in Group N were; 18.52 +/- 6.34 minutes and 23.27 +/- 6.95 minutes, respectively, whereas; in Group N + S, they were; 12.86 +/- 5.05 and 17.82 +/- 4.99 minutes, respectively. (P <.0001, P <.0001, respectively). Adverse events were similar between groups (P >.05). Conclusions: A half-dose sugammadex (1 mg/kg) after full-dose reversal of neostigmine provides a lower incidence of rNMB and shorter recovery times as compared to full-dose neostigmine reversal agent. This practice is safe and effective in case of rNMB. (C) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
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    'Half-Dose Sugammadex After Neostigmine Versus Neostigmine as a Routine Reversal Agent: A Pilot Randomized Trial' Response
    (Elsevier Science Inc, 2022) Baysal, Ayse; Sagiroglu, Gonul; Dogukan, Mevlut; Ozkaynak, Ismail
    dose after neostigmine a routine reversal may prevent residual neuoutcome parameter of incidence of rNMB with other clinical studies may show external validity issues. In the Letter to the Editor, the authors have a request to explain these comparisons with other clinical studies; (3) The Letter to the Editor suggested that although their primary endpoint was the incidence of a train-of-four (TOF) ratio less than 0.9 at tracheal extubation, Baysal and her colleagues did not use TOF monitoring for extubation of the patients in their clinical study. They used only clinically apparent diaphragmatic movements for extubation. The authors of the Letter to the Editor, Neira-Somoza the administration of a lower dose of sugammadex to displace the use of neostigmine with a lower dose and earlier administration of sugammadex which is another future investigation of neuromuscular reversal agents.
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    Investigation of Risk Factors Related to the Development of Hepatic Dysfunction in Patients with a Low and Moderate Cardiac Risk During Open-Heart Surgeries
    (Soc Brasil Cirurgia Cardiovasc, 2021) Baysal, Ayse; Sagiroglu, Gonul; Dogukan, Mevlut; Ozkaynak, Ismail
    Objective: To determine the possible risk factors associated with hepatic dysfunction during open-heart surgeries. Methods: After excluding 71 patients, 307 patients with possible low and moderate cardiac risk who underwent either coronary artery bypass graft surgery (CABG) (n=176) or valve repair surgery (mitral valve, mitral and aortic valves and/or tricuspid valve) (n=131) were investigated prospectively during a 6-month period. Hyperbilirubinemia is defined as an occurrence of a plasma total bilirubin concentration >34 mu mol/L (2 mg/dL) in any measurement during the postoperative period; the patients were divided into groups with or without postoperative hyperbilirubinemia. The collected parameters were: alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin (TBil), gamma-glutamyl transpeptidase (GGT) and albumin. The parameters were collected preoperatively and postoperatively on days 1, 3 and 7. Preoperative, intraoperative, and postoperative risk factors were investigated. Logistic regression analysis was performed to identify the risk factors for postoperative hyperbilirubinemia. Results: Postoperative hyperbilirubinemia was observed in 7 of 176 patients (4%) who underwent CABG, and in 11 of 131 patients (8.4%) who underwent valve replacement surgeries. Independent risk factors for early postoperative hyperbilirubinemia were found as: ejection fraction (EF), aortic cross-clamp (ACC) time, intensive care unit stay and extubation time (P<0.001). In comparison to CABG procedures, postoperative hyperbilirubinemia was observed more frequently in patients undergoing valve surgeries (P=0.027). Conclusion: Low EF and prolonged ACC time are significant independentrisk factors for early postoperative hyperbilirubinemia during open-heart surgeries with cardiopulmonary bypass. Valve surgeries show a higher incidence of hyperbilirubinemia in comparison to CABG.