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3-Year Follow-Up After Uniportal Thoracoscopic Sympathicotomy for Hyperhidrosis: Undesirable Side Effects
(Mary Ann Liebert, Inc, 2014) Karamustafaoglu, Yekta Altemur; Kuzucuoglu, Mustafa; Yanik, Fazli; Sagiroglu, Gonul; Yoruk, Yener
Objective: Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients. Subjects and Methods: This study included 80 patients treated by uniportal (5-mm) thoracoscopic sympathicotomy (electrocautery) for primary hyperhidrosis over a 6-year period (2007-2013). Sympathicotomy was performed bilaterally at T2 for blushing (n=2), T2-T3 for palmar-only hyperhidrosis (n=34), T2-T4 for palmar and axillary hyperhidrosis (n=39), and T3-T4 for axillary-only hyperhidrosis (n=5). Outcome was assessed 2 weeks postsurgery at the clinic and annually thereafter by telephone questionnaire. Mean follow-up time was 35.2 +/- 23.3 months. Questionnaires assessed patients' degree of sweating, postoperative CS, overall satisfaction, and complications. Results: Seventy-one patients (88.7%) were very satisfied, whereas only 9 (11.3%) were dissatisfied with the procedure. Complication incidence was 7.5%, and CS occurred in 77.5% of patients. Therapeutic success rate was 97.5%; complete relief of hyperhidrosis was achieved in 72 (90%) patients, whereas 8 (10%) experienced recurrence. Conclusions: CS is a frequent side effect of thoracoscopic sympathicotomy. We recommend all patients undergoing this procedure should be warned of the potential risk of developing severe CS.
Airway management with supraglottic airway device at pierre robin sequence
(Oxford Univ Press, 2012) Copuroglu, Elif; Colak, Alkin; Sagiroglu, Gonul; Copuroglu, Cem; Gunday, Isil
[Abstract Not Available]
Anaesthesia Management of a Child with West Syndrome
(Aves, 2014) Sahin, Sevtap Hekimoglu; Copuroglu, Elif; Ugur, Huseyin; Sagiroglu, Gonul; Colak, Alkin
West syndrome (WS) is an epileptic encephalopathy usually occurring during the first year of life and is characterized by severe electroencephalography (EEG) derangement. Most of these patients may develop cerebral palsy, facial malformations, and skeletal deformities. The anaesthesiologist should make the preoperative assessment carefully due to epileptic seizures and should consider the possibility of difficult intubation because of coexisting anatomic malformations during the anaesthesia management of patients with WS. This report presents a case of general anaesthesia management in a left femoral fixation operation in an 11-year-old, 18 kg male patient.
Can Awake Thoracoscopy Procedure be Performed with the Help of Thoracic Paravertebral Anesthesia?
(IBN SINA TRUST, 2018) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Copuruoglu, Elif; Sagiroglu, Gonul
Aim: The aim of this study was to present our experience with 11 patients who were spontaneously breathing with Awake Video Thoracoscopy (AVATS) procedure with the help of TPB because of rareness in the literature. Materials and Methods: Between December 2015 and December 2017, a total of 125 VATS cases were performed; 11 cases underwent VATS operation with the help of TPB; age, gender, operation performed, duration of operation, time of onset of mobilization-oral intake, duration of hospital stay, Visual Analogue Scale (VAS) scores were evaluated retrospectively. Results: All cases were treated with uniportal AVATS procedure with the help of TPB. The mean age was 40,3 +/- 17,4 years (range 18-64 years), nine (82%) of the pateints were male and two (18%) were female. Operation procedures included wedge resection in eight (73 %) patients (six of them for pneumothorax, two of them for diagnosis), in three (27%) patients pleural biopsy (one of them used talc pleurodesis). There were no perioperative events. The mean operation time was 27,7 +/- 6,4 minutes (range, 20-40 min) and the mean anesthesia time was 25 +/- 3,8 minutes (range 20-30 min). The mean time of mobilizitation, oral intake opening time and length of hospital stay was 1,1 +/- 0,4 hours (1-2 hours), 3,5 +/- 0,5 hours (3-4 hours), 2,6 +/- 0,5 days (2-3 days), respectively. Conclusion: Awake Video Asssited Thoracoscopic Surgery with the help of TPB has less side effects and less complication risks than other awake procedures with the help of other regional anesthesia techniques. We conclude that; although AVATS with the help of TPB has some minor complications, it has advantages such as early discharge, early mobilization and early oral intake, low pain levels in well-selected patient groups.
Comparison of continuous use of thoracic epidural analgesia and intercostal block for pain management after thoracotomy
(Termedia Publishing House Ltd, 2013) Sagiroglu, Gonul; Baysal, Ayse; Kiraz, Osman Gazi; Meydan, Burhan; Tasci, Ahmet Erdal; Iskender, Ilker
Aim of the study: We aimed to compare the efficacy of the continuous use of thoracic epidural and intercostal analgesia for post-thoracotomy pain. Material and methods: Sixty patients completed a prospective, randomized, double-blinded study. The patients were randomized to receive thoracic epidural (group 1, n = 30) or intercostal block (group 2, n = 30) for 24 hours. In both groups, 0.25% bupivacaine was infused at a rate of 5 ml/h through an inserted catheter. Visual analog scale at rest (VAS-R) and after coughing (VAS-C) scores were recorded at baseline and at 1, 6 and 24 hours after surgery to evaluate pain. Morphine consumption, complications and side effects were recorded as well. Results: VAS-R and VAS-C scores were similar at baseline; however, 1st, 6th and 24th hour scores of group 1 were significantly lower than the scores of group 2 (for VAS-R; p = 0.017, p = 0.001, p = 0.023, for VAS-C; p = 0.006, p = 0.002, p = 0.032, respectively). 24-hour morphine consumption was lower in group 1 in comparison to group 2 (p = 0.032). In group 1, 5 out of 30 patients (17%) experienced hypotension, compared with none in group 2 (p = 0.02). Conclusions: For post-thoracotomy pain, better control of analgesia is observed with the thoracic epidural technique; however, intercostal block constitutes an alternative method as it is characterized by lower incidence of hypotension.
Comparison of ON-Q elastomeric pump system and thoracic epidural analgesia methods for pain management after thoracotomy
(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2017) Sagiroglu, Gonul; Baysal, Ayse; Meydan, Burhan; Kiraz, Osman Gazi; Tasci, Ahmet Erdal
Background: This study aims to compare the results of continuous infusion of local anesthetics through either ON-Q elastomeric pump or thoracic epidural analgesia for management of pain after thoracotomy. Methods: Ninety-seven patients (86 males, 11 females; mean age 56.37 years; range 34 to 86 years) were included in this prospective and randomized study. Patients were randomized into two groups to undergo either ON-Q elastomeric pump system (group 1, n=50) or thoracic epidural analgesia (group 2, n=47) for 24 hours. In both groups, continuous 0.125% bupivacaine infusion was performed from a catheter at a rate of 0.1 mL/kg/hour. Intravenous morphine was provided to all patients through patient controlled analgesia method. Postoperative pain was evaluated with visual analog scale during rest and coughing at baseline and postoperative first, sixth, 12th, and 24th hours. Results: Although visual analog scale rest and coughing scores of group 1 at first, sixth, 12th, and 24th hours were significantly higher than group 2, its baseline values were similar to group 2. Total local anesthetic consumption of group 2 was higher than group 1. Although hypotension was not observed in any patient in group 1, significant hypotension was observed in seven patients (14.9%) in group 2. The incidences of nausea and vomiting were 4% (n=2) in group 1 and 17% (n=8) in group 2. Conclusion: Thoracic epidural analgesia provides superior analgesia compared to ON-Q elastomeric pump system in pain treatment after thoracotomy. Still, having lesser incidence of hypotension and easier technical application, ON-Q elastomeric pump system may be considered as an alternative method to thoracic epidural analgesia.
Comparison of Postoperative Analgesic Effects of Thoracic Epidural Morphine and Fentanyl in Thoracic Surgery
(Galenos Publ House, 2011) Sagiroglu, Gonul
Objective: In our study, we aimed to compare epidural morphine and fentanyl analgesia and the side effects in post-thoracotomy pain management. Material and Methods: Forty patients, planned for elective thoracotomy were included. Bupivacain- morphine was administered through an epidural catheter to the patients in Group-M while bupivacain-fentanyl was given in Group-F. Pain assessment was carried out with the Visual Analogue Scale (VAS) and VAS-I and VAS-II were assessed in 0, 4, 16 and 24(th) hour in the postoperative unit. Adverse effects were recorded after the 24(th) hour. Statistical analyses were performed by using Two-sample independent-t test, Mann Whitney-U test, Wilcoxon-signed ranks test and Pearson chi-squared tests. Results: Although, the VAS-I and VAS-II scores were lower in Group-M than Group-F, the difference was not significant statistically (p>0.05). When other hours were compared with initial states, beginning from the 4(th) hour, in both groups there was a statistically significant drop in VAS-I and VAS-II scores at all times (p<0.001). Comparing the complications between the groups, in Group-M nausea-vomiting (p<0.015) and bradycardia (p<0.012) were found significantly more frequently than in Group-F. Conclusion: We concluded that, in pain management after thoracic surgery, either morphine or fentanyl may be chosen in thoracal epidural analgesia but, especially in the early postoperative hours, close follow-up is necessary due to the risk of bradycardia development.
A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery
(Bmc, 2014) Sagiroglu, Gonul; Meydan, Burhan; Copuroglu, Elif; Baysal, Ayse; Yoruk, Yener; Karamustafaoglu, Yekta Altemur; Huseyin, Serhat
Background: We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. Methods: One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. Results: The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24 hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. Conclusions: TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.
The Comparison of Two Different Techniques of Remifentanil Administration During Implantable Vascular Access Device Procedures
(Elsevier Science Inc, 2021) Sagiroglu, Gonul; Baysal, Ayse; Yanik, Fazli
Purpose: The aim was to compare analgesic efficacy and adverse effects of two different techniques of intravenous remifentanil administration in patients undergoing vascular; access device procedures with monitored anesthesia care. Design: A randomized, single-blinded controlled study. Methods: The patients (N = 92) were 30-80 years old and of American Society of Anesthesiologists Physical Status I-III. The first group was the continuous infusion group (group CI). Intravenous continuous remifentanil was infused after starting at a dosage of 0.1 mcg/kg/min, and the dose was raised incre-mentally up to 1 mcg/kg/min if required. The second group was intravenous bolus patient-controlled sedation analgesia (PCSA) with remifentanil infusion at a dose of 0.05 mcg/kg per minute and bolus of 0.1 mcg/kg with lock-out time of 3 minutes. In both groups, a bolus dose of 0.1 mcg/kg remifentanil was administered. The data evaluated include level of pain and sedation, total amount of remifentanil con-sumption, bolus doses of remifentanil, patient and surgeon satisfaction, hemodynamic data, and adverse events. Findings: In comparison between techniques, pain and sedation scores during procedure, duration of procedure, patient and surgeon satisfaction, additional rescue medication, and bolus doses were not statistically different (P > .05). The total amount of remifentanil administered was significantly lower in the infusion group than that in the bolus group (P = .031). Conclusions: For central venous access device procedures under monitored anesthesia care, remifentanil use in both infusion and bolus techniques could provide sufficient sedation and analgesia without serious adverse effects. Total remifentanil consumption amount in infusion group is lower than that in the bolus group. (c) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
Continuous intravenous versus intermittent bolus midazolam with remifentanil during arteriovenous fistula placement with monitored anesthesia care in chronic renal failure patients: a randomized controlled trial
(K Faisal Spec Hosp Res Centre, 2020) Sagiroglu, Gonul; Baysal, Ayse
BACKGROUND: There is limited data on the use of intravenous continuous infusion (CI) versus intravenous intermittent bolus (IB) doses of midazolam for conscious sedation in patients with chronic renal failure. Unexpected adverse events can occur in chronic renal failure patients undergoing short procedures. OBJECTIVE: Investigate and compare the sedoanalgesic and adverse effects of intravenous continuous infusion (CI) use of midazolam with intravenous intermittent bolus (IB) doses of midazolam while using intravenous remifentanil as a rescue medication, and assess patient and surgeon satisfaction. DESIGN: Prospective, randomized, single-blind controlled study. SETTINGS: Two tertiary care hospitals. PATIENTS AND METHODS: Study included patients aged 43-81 years with a diagnosis of chronic renal failure who were referred for an arteriovenous fistula procedure with modified anesthesia care between August 2012 and April 2016. The patients were randomized to intravenous CI or IB doses of midazolam. IB doses of remifentanil were used as a rescue medication. MAIN OUTCOME MEASURES: Primary outcomes were amounts of midazolam and remifentanil medications during the operation, the amount of remifentanil as a rescue medication, and the satisfaction of patient and surgeon. SAMPLE SIZE: 116 assessed for eligibility; 99 randomized to CI (n=50) or IB doses (n=49 of midazolam). RESULTS: The total dose of midazolam by CI was greater than with midazolam by IB (P=.002). The total dose of remifentanil was higher with IB doses of midazolam in comparison to CI of midazolam (P=.001). The groups were similar in sedation and pain control, duration of procedure, recovery time, patient satisfaction and adverse events; surgeon satisfaction was greater with CI versus IB (P=.035). CONCLUSIONS: Intravenous CI midazolam during MAC provides better surgeon satisfaction then IB midazolam and can be used safely for arteriovenous fistula procedures. LIMITATIONS: Two different surgeon groups.
The Effect of Cerebral Oxygen Saturation Changes on Early Postoperative Neuropsychological Function in Patients Undergoing Cranial Surgery
(Turkish Neurosurgical Soc, 2023) Hekimoglu Sahin, Sevtap; Copuroglu, Elif; Delen, Emre; Tutunculer, Banu; Sut, Necdet; Colak, Alkin; Sagiroglu, Gonul
AIM: To compare the incidence of postoperative neuropsychological dysfunction in patients managed with cerebral saturation monitoring versus traditional approaches.MATERIAL and METHODS: A hundred patients undergoing elective intracranial surgery were divided into two groups to receive intraoperative management via cerebral saturation monitoring (Group O) or the conventional approach (Group C). The postoperative neuropsychological function was evaluated by the antisaccadic eye movement test (ASEM) and the Mini-Mental State Examination (MMSE). These tests were performed preoperatively and postoperatively on the first, second, and fifth days. The time for the modified Aldrete score to reach 9 (MAS 9), adverse effects, and pain using a Visual Analog Scale (VAS) scores were recorded.RESULTS: Patient characteristics and surgery data were not statistically different. The MAS 9 of group O was significantly lower than that of group C (p<0.001). The MMSE at the postoperative 1, 2, and 5 days were significantly higher in Group O compared to Group C (p<0.001). ASEM was similar between groups. Group O was subdivided according to the type of surgery applied with diagnosis, and there were no statistically significant between-group differences in terms of areas under the curve for the cerebral regional oxygen saturation. There was no between-group difference regarding the mean arterial pressure at any time perioperatively. The heart rate at 80, 90, 100, and 110 min intraoperatively was significantly higher in group C than in Group O.CONCLUSION: Intraoperative cerebral oxygenation monitoring can reduce patient mortality and morbidity by allowing early postoperative neurological evaluation to detect potential neurocognitive deficits.
Effect of Leptin and Apelin Preconditioning on Hepatic Ischemia Reperfusion Injury in Rats
(Springer India, 2014) Sagiroglu, Tamer; Aksoy, Mustafa Burak; Sagiroglu, Gonul; Tozkir, Hilmi; Oguz, Serhat; Yalta, Tulin; Yagci, Mehmet A.
Leptin and apelin are important adipocytokines involved in a variety of endocrine and paracrine functions. The aim of this study was to evaluate the effect of exogenous leptin and apelin preconditioning on hepatic ischemia reperfusion (I/R) injury in rats. Forty mice were assigned to four groups (n = 10): sham-operated control (sham), I/R injury, I/R + leptin (I/R + L), and I/R + apelin (I/R + A). Leptin 100 mu g/kg/day and apelin 2 mu g/kg/day were delivered intraperitoneally starting 3 days prior to surgical procedure in I/R + L and I/R + A groups, respectively. All I/R groups underwent 45 min of warm ischemia, followed by 30 min of reperfusion. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), liver malondialdehyde (MDA) and glutathione (GSH), and liver histopathology were compared between groups. MDA was elevated in I/R, but stayed similar in I/R + L and I/R + A compared to sham. I/R + A had significantly lower MDA compared to I/R. GSH levels did not differ significantly between the groups. ALT and AST were elevated in all I/R groups, but significant reduction was observed in I/R + L and I/R + A compared to I/R. Liver histopathology was mostly mild in I/R + L and I/R + A, in contrast to severe injury observed in the I/R group. Leptin and apelin preconditioning significantly reduced hepatic I/R injury in rats.
Effects of apelin and leptin on renal functions following renal ischemia/reperfusion: An experimental study
(Spandidos Publ Ltd, 2012) Sagiroglu, Tamer; Torun, Nese; Yagci, Mehmet; Yalta, Tulin; Sagiroglu, Gonul; Oguz, Serhat
The present study aimed to investigate the effects of apelin and leptin on renal functions following renal ischemia/reperfusion (I/R). A total of 32 rats were divided into four groups. The control group was not induced with ischemia, but was administered normal saline intraperitoneally. Normal saline, apelin and leptin were administered intraperitoneally to the I/R, ischemia/reperfusion and apelin (I/R+A) and ischemia/reperfusion and leptin (I/R+L) groups, in turn for three days prior to the surgical procedure. Blood and urine samples were obtained after 24 h of reperfusion, and scintigraphic examination was performed. Renal damage was evaluated histopathologically. Urea levels of the I/R+L and I/R+A groups were comparable, but were higher compared to that of the control group. The I/R group had the highest urea levels (control, 27 +/- 2; I/R, 120 +/- 15; I/R+A, 75 +/- 10; I/R+L, 80 +/- 11; p<0.001). Creatinine levels were higher in all three ischemic groups compared to the control group. Glomerular filtration rate values of the I/R+A and I/R+L groups were not significantly, but numerically higher compared to that of the I/R group. No pathological damage was observed in any of the animals in the control group. In the I/R group, two animals had moderate and six had severe renal damage, while three had moderate and one had severe renal damage in the I/R+L group. In the I/R+A group, moderate renal damage was found in one animal, while none had severe renal damage. This study demonstrates the functional and histopathological protective effects of leptin and apelin against renal I/R injury.
The Effects of Apelin on Mesenteric Ischemia and Reperfusion Damage in an Experimental Rat Model
(Galenos Publ House, 2012) Sagiroglu, Tamer; Oguz, Serhat; Sagiroglu, Gonul; Copuroglu, Elif; Yalta, Tulin; Sayhan, Mustafa Burak; Yagci, Mehmet Ali
Objective: Intestinal ischemia-reperfusion (I/R) injury is associated with high morbidity and mortality rates. There is ongoing research to find an effective preventive or treatment agent. We aimed to evaluate the effects of apelin 13 (AP) on intestinal I/R injury in a rat model. Material and Methods: Twenty-four male Sprague-Dawley rats aged 6-8 weeks and weighing 280 +/- 20 g were equally divided into three groups (control, I/R and I/R+AP). The control group underwent superior mesenteric artery (SMA) mobilization alone without any clamping. In the I/R and I/R+AP groups, an atraumatic microvascular bulldog clamp was placed across the SMA at its point of origin from the aorta. In the I/R+AP group, 2 mu g/kg/d apelin was administered intraperitoneally. After 60 minutes of ischemia, relaparotomy was performed to remove the microvascular clamp on the SMA for 3 hours of reperfusion. After 3 hours, tissue samples were obtained for biochemical [malondialdehyde (MDA) and glutathione (GSH) levels] and histopathological analyses. Results: MDA levels were significantly higher in the I/R group compared to the control group. Although MDA levels were lower in the I/R+AP group compared to the I/R group, the difference was not statistically significant. There was also no significant difference between the I/R+AP and I/R groups regarding GSH levels. The median histopathological grade was significantly lower in the I/R+AP group compared to the I/R group (p=0.001). Conclusion: Apelin appeared to have a positive effect on oxidative injury; this did not reach statistical significance. Thus, the role of apelin and associated findings in the initial treatment of intestinal ischemia needs further large-scale animal studies before human use.
Effects of Preoperative Anxiety on Intraoperative Hemodynamics and Postoperative Pain
(Coll Physicians & Surgeons Pakistan, 2019) Bayrak, Aysegul; Sagiroglu, Gonul; Copuroglu, Elif
Objective: To determine the effects of the level of the anxiety of the patients on the intraoperative hemodynamic parameters and postoperative pain, patient satisfaction and the stay period at the hospital. Study Design: A descriptive study. Place and Duration of Study: General Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey, from December 2015 to February 2016. Methodology: Seventy-two patients were operated for elective cholecystectomy. They were asked to answer state-trait anxiety inventory (STAI) questionnaire. The patients were classified into two groups as high and low anxiety levels. The targeted variables were compared. Results: There has not been found any significant relationship between the level of anxiety and age, gender, marial status, level of education, profession, general anesthesia, comobidity and postoperative shivering. However, patients with high preoperative anxiety scores had unstable hemodynamic parameters (arterial pressure, heart rate, peripheral oxygen saturation) intraoperatively, increased postoperative pain and analgesic consumption with dissatisfaction. Conclusion: Preoperative anxiety might cause hemodynamic problems in the intraoperative period, increased analgesic need and lower postoperative satisfaction of the patients in the postoperative period. It would be better to dispel the preoperative anxiety by conselling patient regar anesthesia, surgeon, and the institute.
The effects of sildenafil and n-acetylcysteine on ischemia and reperfusion injury in gastrocnemius muscle and femoral artery endothelium
(Sage Publications Ltd, 2015) Aksu, Volkan; Yuksel, Volkan; Chousein, Serchat; Tastekin, Ebru; Iscan, Sahin; Sagiroglu, Gonul; Canbaz, Suat
Purpose We aimed to examine the effects of sildenafil and n-acetylcystein on ischemia/reperfusion injury in femoral artery endothelium and gastrocnemius muscle. Basic methods 32 rats of Sprague-Dawley breed were randomly divided into four groups (n=8). Median laparotomy was performed, then a 120-minute ischemia was created by microvascular clamping of infrarenal aorta, followed by the release of clamping. In sildenafil group, 1mg/kg of sildenafil infusion and in the n-acetylcystein group, 100mg/kg of n-acetylcystein infusion was administered after release of clamps. Blood samples and tissue samples of femoral artery and gastrocnemius muscle were extracted for a histopathological evaluation. Principal findings Serum levels of malondialdehyde in ischemia/reperfusion group (6.160.79) were higher compared to the control group (4.69 +/- 0.33), whereas a significant decrease was detected in sildenafil (5.17 +/- 0.50) and n-acetylcystein (4.96 +/- 0.49) groups. Femoral artery tissue sections of the control group, mean tumor necrosis factor alpha and hypoxy-induced factor-1 alpha immunoreactivity were found to be negative. In the ischemia/reperfusion group, mean tumor necrosis factor immunoreactivity was intense and mean hypoxy-induced factor-1 alpha immunoreactivity was 51-75%. In the ischemia/reperfusion+Sildenafil and ischemia/reperfusion+NAS groups, mean tumor necrosis factor immunoreactivity was slight and mean hypoxy-induced factor-1 alpha immunoreactivity was 26-50%. Conclusions In conclusion, sildenafil and n-acetylcystein may reduce femoral artery endothelium and gastrocnemius muscle injury following lower extremity ischemia/reperfusion.
The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management
(Termedia Publishing House Ltd, 2013) Sagiroglu, Gonul; Baysal, Ayse; Copuroglu, Elif; Karamustafaoglu, Yekta Altemur; Sagiroglu, Tamer; Yuksel, Volkan; Huseyin, Serhat
Introduction: The definition of pain focuses mainly on tissue damage and provides information regarding pathophysiological changes in the human being [1]. Patients experience pain as a response to this tissue damage after surgery and the pain intensity after thoracotomies is known to be severe [2]. Aim of the study: Our goal was to investigate the efficacy and adverse effects of thoracic epidural and paravertebral blocks for post-thoracotomy pain management. Material and methods: In a prospective, randomized double blinded study, patients were divided into thoracic epidural (EPI group, n = 30) and paravertebral (PVB group, n = 30) groups. A bolus dose of 10 ml of 0.25% bupivacaine was followed by a continuous infusion of 0.1 ml kg(-1) h(-1) for a total of 24 hours. A visual analog scale (VAS) was used to evaluate pain at rest (VAS-R) and after coughing (VAS-C) at baseline (after extubation), 2, 4, 12 and 24 hours after surgery. The duration of catheter insertion, morphine consumption, complications and side effects were collected. Results: In comparison of EPI and PVB groups, VAS-R and VAS-C scores were similar at baseline and at 2, 4, 12 and 24 hours after surgery (p > 0.05). The incidence of hypotension was higher and the duration of catheter insertion was longer in the EPI group in comparison to the PVB group (p = 0.038, p < 0.0001, respectively). Conclusions: For post-thoracotomy pain, both thoracic epidural analgesia and paravertebral block techniques provide sufficient pain relief. As paravertebral block is an easier and quicker technique with lower incidence of hypotension, it should be considered as a good alternative to thoracic epidural technique to establish postoperative analgesia.
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.
'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.
Inadvertent Perioperative Hypothermia and Important Risk Factors during Major Abdominal Surgeries
(Coll Physicians & Surgeons Pakistan, 2020) Sagiroglu, Gonul; Ozturk, Gozde Argunsah; Baysal, Ayse; Turan, Fatma Nesrin
Objective: A relation between inadvertent perioperative hypothermia and possible important risk factors during major abdominal surgeries was investigated. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Trakya University Hospital, Edirne, Turkey during 2016-2018. Methodology: Five hundred and twenty-nine patients undergoing major abdominal surgey were divided into two groups depending on postoperative body core temperature (CTM) by the use of tympanic membrane measurement. Patients with a temperature of less than 36 degrees C indicated hypothermia group; whereas, patients with a temperature between 36 and 37.5 degrees C indicated normothermia group. The parameters that were considered as risk factors for hypothermia include; baseline characteristics, American Society of Anesthesiologists (ASA) status, comorbidities, operative type, duration of surgery, patient and operative room temperatures, intraoperative hemodynamic parameters, transfusion of fluids and packed red blood cells (PRBCs), labaratory data, and adverse events. Correlation between these parameters and inadvertent hypothermia was sought. A p-value of less than 0.05 was considered statistically significant. Results: The risk factors that showed a correlation with hypothermia include: male gender, advanced age, high ASA scores, smoking, prolonged duration of operation, transfusion of fluids and PRBCs (p<0.05). In hypothermia group, duration of operation time was longer, need for transfusion was greater, hematocrit and hemoglobin values were lower than Normothermia Group of patients (p<0.05). Hypothermia was detected in 335 (63.3%) of patients. Conclusion: In this study, important risk factors for inadvertent hypothermia were found as; male gender, advanced age, high ASA scores, smoking, prolonged duration of operation, transfusion of fluids and/or PRBCs.

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