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Öğe Adding dexmedetomidine to lidocaine for intravenous regional anesthesia(Lippincott Williams & Wilkins, 2004) Memis, D; Turan, A; Karamanlioglu, B; Pamukçu, Z; Kurt, IDexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It decreases anesthetic requirements by up to 90% and induces analgesia in patients. We designed this study to evaluate the effect of dexmedetomidine when added to lidocaine in IV regional anesthesia (IVRA). We investigated onset and duration of sensory and motor blocks, the quality of the anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative-postoperative pain and sedation. Thirty patients undergoing hand surgery were randomly assigned to 2 groups to receive IVRA. They received 40 mL of 0.5% lidocaine and either 1 mL of isotonic saline (group L, n = 15) or 0.5 mug/kg dexmedetomidine (group LD, n = 15). Sensory and motor block onset and recovery times and anesthesia quality were noted. Before and after the tourniquet application at 5, 10, 15, 20, and 40 min, hemodynamic variables, tourniquet pain and sedation, and analgesic use were recorded. After the tourniquet deflation, at 30 min, and 2, 4, 6, 12, and 24 h, hemodynamic variables, pain and sedation values, time to first analgesic requirement, analgesic use, and side effects were noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, prolonged tolerance for the tourniquet, and improved quality of anesthesia were found in group LD. Visual analog scale scores were significantly less in group LD in the intraoperative period and 30 min, and 2, 4, and 6 h after tourniquet release. Intra-postoperative analgesic requirements were significantly less in group LD. Time to first analgesic requirements was significantly longer in group LD in the postoperative period. We conclude that the addition of 0.5 mug/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects.Öğe Alternative application site of transdermal nitroglycerin and the reduction of pain on propofol injection(Greenwich Medical Media Ltd, 2003) Turan, A; Karamanlioglu, B; Memis, D; Pamukçu, Z[Abstract Not Available]Öğe Analgesic effects of gabapentin after spinal surgery(Lippincott Williams & Wilkins, 2004) Turan, A; Karamanlioglu, B; Memis, D; Hamamcioglu, MK; Tükenmez, B; Pamukçu, Z; Kurt, IBackground: A combination of opioid and nonopioid analgesic drugs may improve the quality of postoperative analgesia as well as reduce opioid requirements and their associated side effects. Studies have shown synergism between gabapentin and morphine in animal and human experiments and in the treatment of incisional pain. Therefore, the authors investigated, in a randomized, placebo-controlled, double-blind study, the effects of gabapentin on acute postoperative pain and morphine consumption in patients undergoing spinal surgery. Methods: After standard premedication, 25 patients in the control group received oral placebo, and 25 patients in the gabapentin group received 1,200 mg of gabapentin, 1 h before surgery in a randomized fashion. Anesthesia was induced with propofol and cisatracurium. and was maintained with sevoflurane and remifentanil. The total intraoperative remifentanil consumption by each patient was noted. All patients postoperatively received patient-controlled analgesia with morphine (1 mg/ml) with an incremental dose of 2 mg, a lockout interval of 10 min, and a 4-h limit of 40 mg. The incremental dose was increased to 3 mg, and the 4-h limit to 50 mg, if analgesia was inadequate after I h. Patients were questioned for the first 1 h in the PACU and were later evaluated in the ward at 1, 2, 4, 6, 12, and 24 h. Pain scores, heart rate, oxygen saturation measured by pulse oximetry, mean blood pressure, respiratory rate, sedation, morphine use, and total dose of morphine were recorded. Results: Overall, pain scores at 1, 2, and 4 It were significantly lower in the gabapentin group when compared with the placebo group. Total morphine consumption in the gabapentin group was 16.3 +/- 8.9 mg (mean +/- SD) versus 42.8 +/- 10.9 mg in the placebo patients. The incidence of vomiting and urinary retention was significantly (P < 0.05) higher in the placebo group, but there was no difference in incidence of other adverse effects between the groups. Conclusions: Preoperative oral gabapentin decreased pain scores in the early postoperative period and postoperative morphine consumption in spinal surgery patients while decreasing some morphine-associated side effects.Öğe The analgesic effects of gabapentin after total abdominal hysterectomy(Lippincott Williams & Wilkins, 2004) Turan, A; Karamanlioglu, B; Memis, D; Usar, P; Pamukçu, Z; Türe, MWe investigated, in a randomized, placebo-controlled, double-blind study, the efficacy and safety of gabapentin on pain after abdominal hysterectomy and on tramadol consumption in patients. The 50 patients were randomized to receive either oral placebo or gabapentin 1200 mg 1 h before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50% N2O/O-2 with a fresh gas flow of 2 L/min (50% N2O in O-2) and fentanyl (2 mug/kg). All patients received patient-controlled analgesia with tramadol with a 50 mg initial loading dose, 20 mg incremental dose, 10-min lockout interval, and 4-h limit of 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after 1 h. Patients were studied at 4,8,12,16, 20, and 24 h for visual analog (VAS) pain scores, heart rate, peripheral oxygen saturation, mean arterial blood pressure, respiratory rate, sedation, and tramadol consumption. The VAS scores in the sitting and supine position at 1, 4, 8, 12,16, and 20 h were significantly lower in the gabapentin group when compared with the placebo group up to 20 h after surgery. The tramadol consumption at 12, 16, 20, and 24 h and total tramadol consumption were significantly less in the gabapentin group when compared with placebo group. Sedation scores were similar at all the measured times. There were no differences between groups in adverse effects. Preoperative oral gabapentin decreased pain scores and postoperative tramadol consumption in patients after abdominal hysterectomy.Öğe The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery(Lippincott Williams & Wilkins, 2004) Turan, A; Memis, D; Karamanlioglu, B; Yagiz, R; Pamukçu, Z; Yavuz, EWe investigated the efficacy and safety of gabapentin in rhinoplasty or endoscopic sinus surgery patients. Patients received either oral placebo or gabapentin 1200 mg 1 h before surgery. After standard premedication, 25 patients in each group received propofol, fentanyl, and local anesthesia at the operative site. Sedation was maintained by a continuous infusion of propofol adjusted according to the Ramsay scale. Sedation and pain scores were obtained at 5, 15, 30, 45, and 60 min during surgery and 30 min and 2,4,6,8, 12, 16, 20, and 24 h after the procedure. Diclofenac 75 mg IM was administered as a rescue analgesic. Postoperative pain scores and intraoperative pain scores at 45 and 60 min were significantly lower in the gabapentin group. Fentanyl (122 +/- 40 mug versus 148 +/- 42 mug; P < 0.05) and diclofenac (33 +/- 53 mg versus 111 +/- 92 mg; P < 0.001) consumption was smaller and the time to first analgesic request (18 +/- 9 h versus 9 +/- 7 h; P < 0.001) was longer in the gabapentin group. A more frequent incidence of dizziness was found in the gabapentin (versus placebo) group (24% versus 4%, respectively). We conclude that gabapentin provided a significant analgesic benefit for intraoperative and postoperative pain relief in patients undergoing ambulatory rhinoplasty or endoscopic sinus surgery; however, dizziness may be a handicap for ambulatory use.Öğe Analgesic effects of rofecoxib in ear-nose-throat surgery(Lippincott Williams & Wilkins, 2002) Turan, A; Emet, S; Karamanlioglu, B; Memis, D; Turan, N; Pamukcu, ZIn this study we evaluated the analgesic efficacy and the opioid-sparing effect of rofecoxib in ear-nose-throat surgery patients. Patients undergoing nasal septal or sinus surgery were randomized to receive either oral placebo or rofecoxib 50 mg 1 h before surgery. All patients received propofol 0.8 mg/kg, fentanyl 1 mug/kg, and local anesthesia at the operative site. Sedation was maintained by a continuous infusion of propofol adjusted to maintain sedation at a 2-3 level on the Ramsey scale. Additional fentanyl 0.5-1 mug/kg was administered at the patient's request or if the verbal rating scale score was >4. Patient sedation and pain scores were obtained at 5, 15, 30 45, and 60 min during surgery and 30 min and 2, 4, 6, 12, and 24 h after completion of the procedure. During the postoperative period, diclofenac 75 mg IM was administered for analgesia at the patient's request or if the visual analog scale (VAS) rating for pain was more than 4. VAS pain scores, intraoperative fentanyl, and postoperative diclofenac requirements were significantly smaller in the rofecoxib group compared with the placebo group (P < 0.001). The times to first analgesic request were also significantly less in the rofecoxib group. We conclude that the preoperative administration of oral rofecoxib provided a significant analgesic benefit and decreased the need for opioids in patients undergoing nasal septal and nasal sinus surgery.Öğe Caudal neostigmine for postoperative analgesia in paediatric surgery(Blackwell Publishing Ltd, 2003) Memis, D; Turan, A; Karamanlioglu, B; Kaya, G; Süt, N; Pamukçu, ZBackground: This study was conducted to evaluate analgesia and side-effects of caudal neostigmine coadministered with bupivacaine in paediatric surgery. Methods: We studied children, aged 1-5 years, undergoing elective surgery (inguinal hernia and hypospadias). After standard induction of anaesthesia, caudal anaesthesia was performed. Group 1 received 0.25% bupivacaine 0.5 ml.kg(-1) and Group 2 received 0.25% bupivacaine 0.5 ml.kg(-1) with 1 mug.kg(-1) neostigmine via the caudal route. Heart rate, mean arterial pressure, peripheral oxygen saturation were recorded before induction, after induction but before caudal anaesthesia, and then every 5 min after caudal anaesthesia. Haemodynamic, Toddler, Preschooler, Postoperative Pain Scale (TPPPS) pain score and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12 and 24. A pain score >3/10 resulted in administration of rectal paracetamol. The duration of postoperative analgesia was defined as the time between caudal drug injection and the first rectal paracetamol administration. Results: There were no differences between the groups in demographic and haemodynamic date, duration of surgery and anaesthesia, time to extubation or sedation scores. The duration of postoperative pain relief did not differ between the two groups; 15.40 +/- 10.97 h for group 1 vs. 15.45 +/- 10.99 h for group 2 (P > 0.05). The incidence of nausea (three patients in group 2 and one patient in group 1) was not statistically significant. No other side-effects were seen. Conclusions: We found that a single caudal injection of 1 mug.kg(-1) neostigmine mixed with bupivacaine offers no significant advantage over bupivacaine alone for postoperative pain relief in children undergoing genitourinary surgery.Öğe Caudal ropivacaine and neostiginine in pediatric surgery(Lippincott Williams & Wilkins, 2003) Turan, A; Memis, D; Basaran, ÜN; Karamanlioglu, B; Süt, NBackground: Neostigmine has been added to local anesthetics for different nerve blocks. This study was conducted to evaluate effects of neostigmine when added to ropivacaine for caudal anesthesia. Methods: We studied children, aged 1-5 yr, undergoing inguinal hernia and hypospadias surgery. After standard induction of anesthesia, Group I received 0.2% ropivacaine 0.5 ml/kg and Group II received 0.2% ropivacaine 0.5 ml/kg with 2 ml/kg neostigmine via the caudal route. Heart rate, mean arterial pressure, and pulse oximetry were recorded before induction, after induction, and then every 10 min after caudal anesthesia. Hemodynamic, Toddler-Preschooler Postoperative Pain Scale pain score, and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12, and 24. A pain score greater than 3/10 resulted in administration of rectal paracetamol. Results: There were no differences between the groups in demographic and hemodynamic data, duration of surgery and anesthesia, time to extubation, or sedation scores. The pain scores were significantly lower in Group II at 6 and 12 h (P < 0.05). Time to first analgesic requirement was statistically prolonged in Group II (19.2 +/- 5.5h) when compared with Group 1 (7.1 +/- 5.7 h) (P < 0.05). Total analgesic consumption was statistically larger in Group I (174 +/- 96 mg) when compared with Group II (80 +/- 85.5 mg) (P < 0.05). The incidence of vomiting (3 patients in Group II and 1 patient in Group I) was not statistically significantly different. Conclusions: The authors found that a single caudal injection of neostigmine when added to ropivacaine offers an advantage over ropivacaine alone for postoperative pain relief in children undergoing genitourinary surgery.Öğe Comparison of oral dolasetron and ondansetron in the prophylaxis of postoperative nausea and vomiting in children(Lippincott Williams & Wilkins, 2003) Karamanlioglu, B; Turan, A; Memis, D; Süt, NBackground and objective: In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of oral dolasetron and ondansetron in preventing postoperative nausea and vomiting in children after various surgical operations. Methods: Children were assigned randomly to one of three groups (each contained 50 children) to receive dolasetron 1.8 mg kg(-1) or ondansetron 0.15 mg kg(-1) orally, or a placebo. All children received methylene blue capsules (10 mg) orally as an indicator before the induction of anaesthesia. Postoperatively, contamination of the mouth and the endotracheal tube by methylene blue was recorded, and postoperative nausea and vomiting was recorded for 0-1, 1-24 and 0-24 h. Metoclopramide (0.1 mg kg(-1)) intravenously was used as the rescue antiemetic. Results: In the 0-1 h period after operation, there were no differences between the groups. In the 1-24 h period, dolasetron was significantly better than placebo (nausea 8 versus 24%; vomiting 4 versus 2096; total nausea and vomiting scores 16 versus 48176). Over the 0-24 h period, both dolasetron and ondansetron were significantly better than placebo (nausea 16 versus 26 versus 4096), vomiting (8 versus 16 versus 30%), and total nausea and vomiting scores (32 versus 48 versus 78%). There were no significant differences between dolasetron and ondansetron. There was no important methylene blue contamination, and little use of rescue metoclopramide. There were no important adverse events. Conclusions: Prophylactic oral dolasetron and ondansetron were effective in reducing postoperative nausea and vomiting in children.Öğe Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index(Bmc, 2003) Memis, D; Turan, A; Karamanlioglu, B; Oguzhan, N; Pamukçu, ZIntroduction In intensive care unit patients we assessed, using bispectral index (BIS) monitoring, whether the addition of magnesium sulphate infusion could decrease the sufentanil infusion required to maintain sedation. Patients and methods A total of 30 adult patients who were expected to require mechanical ventilation for 6 hours in the intensive care unit were randomly assigned to receive either sufentanil infusion or sufentanil plus magnesium infusion. We monitored BIS levels continously. BIS levels in the range 61-88 are required to maintain a state of sedation, and in both groups BIS levels were kept within this range by increasing or decreasing the sufentanil infusion. Hourly consumption of sufentanil was monitored. Cardiovascular, respiratory and biochemical data were recorded. Results There was no significant difference between the groups with respect to cardiovascular, respiratory and biochemical parameters. Magnesium infusion, when added to sufentanil infusion, decreased the consumption of sufentanil at all times accept during the first hour (P < 0.001). There was no significant difference in BIS values between the groups (P > 0.05). Conclusion This is the first clinical study to demonstrate that magnesium sulphate infusion decreases sufentanil requirements. Because of the limited number of patients included and the short period of observation, our findings must be confirmed by larger clinical trials of magnesium infusion titrated to achieve prespecified levels of sedation. Furthermore, randomized clinical studies are needed to determine the effects of magnesium infusion on opioids.Öğe Comparison of the laryngeal mask (LMA™) and laryngeal tube (LT®) with the new perilaryngeal airway (CobraPLA®) in short surgical procedures(Lippincott Williams & Wilkins, 2006) Turan, A; Kaya, G; Koyuncu, O; Karamanlioglu, B; Pamukçu, Unewly introduced perilaryngeal airway (CobraPLA (R), PLA) with regard to haemodynamic responses induced by airway insertion, clinical performance and occurrence of postoperative sore throat after short surgical procedures. Methods: After premedication, 90 ASA I-II patients awaiting short surgical procedures were randomized to receive, LMA, LT or PLA. Anaesthesia was induced with intravenous propofol (2.5 mg kg(-1)) and mivacurium (0.2 mg kg(-1)). Number of attempts, time of insertion of the device, any other unwanted effect, mean aterial pressure, heart rate, oxygen saturation and end-tidal carbon dioxide were recorded. At the end of surgery, the cuff of the device was immediately deflated and the airway device was removed. The device was examined and noted for the presence of visible blood. Patients were asked to rate their throat soreness, dysphonia and dysphagla 1 and 24 h postoperatively. Results: There were no differences in haemodynamic variables. Insertion times for the devices were similar (LMA: 20 +/- 11 s, IT: 19 +/- 14 s and PLA: 21 +/- 12 s.) The success rates at first insertion were lower in the (LMA group (57%) when compared with the PLA (97%, P < 0.05). The number and type of airway interventions for achieving an effective airway were similar. When the airways were removed 50% of the PLA devices had positive blood traces, while only 17% of the LMA and IT devices had positive blood traces (P < 0.01). Fifty percent of the patients suffered from a sore throat in the PLA group, which was significantly higher than in the LMA and IT groups (P < 0.05). Conclusion: We conclude that haemodynamic, ventilation and oxygenation variables throughout the surgery were similar with, LMA, IT and PLA, but IT and PLA were easier to insert; LMA and IT caused less mucosal trauma.Öğe Effect of aminophylline on bispectral index(Wiley, 2004) Turan, A; Memis, D; Karamanlioglu, B; Pamukçu, Z; Süt, NBackground: The aim of the present study was to investigate the effects of aminophylline on BIS as well as clinical recovery in patients anesthetized with sevoflurane. Methods: Sixty patients with status of ASA I-II scheduled for elective surgery were enrolled in this study. Anesthesia was induced by 2 mg kg(-1) of propofol and 0.5 mg kg(-1) of atracurium, maintained with 1:1 ratio of oxygen and nitrous oxide and 2-2.5% sevoflurane, keeping BIS values at 50 +/- 5. During the last 30 min of the operation no muscle relaxant was given and anesthesia was continued without decreasing anesthetic concentration. After sevoflurane discontinuation, saline was given to Group P, and 5 mg kg(-1) of aminophylline was given to Group A. Bispectral index values, heart rate, blood pressure and oxygen saturation were determined in all the patients before and every min after injection of the test drug for 15 min. The following variables were measured in both groups: eye opening, extubation time, response to command, Aldrete scores, and performing three simple arithmetic calculations. Results: Between groups there was no statistically significant difference in mean arterial blood pressure, SPO2 and anesthesia time. Heart rate was found to be statistically higher (P < 0.001) at 2 to 6 min in Group A when compared with group P. Eye opening, verbal response, extubation and arithmetic calculation times were significantly shorter (P < 0.001) in Group A. Bispectral index scores were significantly higher in Group A at 1 to 12 min after aminophylline injection when compared with placebo (P < 0.001). Conclusion: Recovery from sevoflurane anesthesia and BIS scores are improved in early period when aminophylline is given at emerging from anesthesia.Öğe Effect of aminophylline on recovery from sevoflurane anaesthesia(Lippincott Williams & Wilkins, 2002) Turan, A; Memis, D; Karamanlioglu, B; Çolak, A; Pamukçu, Z; Turan, NBackground and objective: In this randomized, double-blind study, we aimed to investigate the effect of aminophylline on recovery from sevoflurane. Methods: One-hundred ASA I-II patients scheduled for elective surgery were randomly divided into two groups receiving either NaCl 0.9% (Group 1, n = 50) or aminophylline 5 mg kg(-1) (Group 2, n = 50). All patients were premedicated with atropine 0.01 mg kg(-1) and midazolam 0.06 mg kg(-1) intramuscularly. Anaesthesia was induced with propofol 2 mg kg(-1) for muscle relaxation, and atracurium 0.5 mg kg(-1) was maintained with sevoflurane 2% in 50% oxygen and nitrous oxide. Further atracurium (0.1 mg kg(-1)) was given when needed. Aminophylline or saline was given after sevoflurane was discontinued. Heart rate, mean arterial pressure, peripheral oxygen saturation, the duration of anaesthesia and recovery times (eye opening, verbal response, extubation and successful performance of arithmetical calculations) were recorded. Results: There were no statistically significant differences in mean arterial pressure, peripheral oxygen saturation and anaesthesia time between the two groups. Heart rate increased significantly (P < 0.05) after aminophylline and was also higher than in the placebo group. Recovery times were significantly shorter (P < 0.001) in the patients receiving aminophylline. Conclusions: Aminophylline speeded recovery after sevoflurane anaesthesia and it may have some advantage in anaesthesia practice for patients.Öğe The effect of intravenous pantoprazole and ranitidine for improving preoperative gastric fluid properties in adults undergoing elective surgery(Lippincott Williams & Wilkins, 2003) Memis, D; Turan, A; Karamanlioglu, B; Saral, P; Türe, M; Pamukçu, ZWe studied pantoprazole, a new potent and fast-acting proton pump inhibitor. Its effects on preoperative gastric fluid volume and pH have not yet been determined. In this randomized, controlled trial, we examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. Ninety patients (ASA status I and II, scheduled for elective surgery) were studied. One hour before surgery, patients in Group I (n = 30) were given IV saline 5 mL, those in Group II (n = 30) were given 40 mg of pantoprazole IV, and those in Group III (n = 30) were given 50 mg of ranitidine IV. A nasogastric tube was inserted immediately after anesthesia induction. Gastric contents were aspirated, and volume and pH were recorded. The pH values determined in Group I were 3.73 +/- 0.82; in Group II, they were 5.30 +/- 1.84; and in Group III, they were 4.80 +/- 1.40. There was no statistical difference between Groups 2 and 3, but there was a significant difference between Group I and Groups 2 and 3 (P < 0.0005). The volume of the gastric contents was 28.67 +/- 10.98 mL in Group I, 15.20 +/- 15.52 mL in Group II, and 7.77 +/- 11.17 mL in Group III. There was no statistical difference between Groups 2 and 3, but there was a statistically significant difference between Group I and Groups 2 and 3 (P < 0.0005). The proportion of patients considered at risk of significant lung injury should aspiration occur was 20% of Group I, 10% of Group II, and 3.3% of Group III. When statistically evaluated, there was no difference among groups. We concluded that the administration of IV pantoprazole and ranitidine 1 h before surgery is effective in reducing gastric pH and volume.Öğe Effect of oral gabapentin on postoperative epidural analgesia(Elsevier Sci Ltd, 2006) Turan, A; Kaya, G; Karamanlioglu, B; Pamukçu, Z; Apfel, CCBackground. Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that gabapentin might be a useful adjuvant for postoperative analgesia provided with patient-controlled epidural analgesia (PCEA). Methods. Forty patients undergoing lower extremity surgery procedures were randomly assigned to receive (i) placebo capsules (control) or (ii) gabapentin (1.2 g day(-1)) before and for 2 days after surgery. Anaesthetic technique was standardized. Postoperative assessments included verbal rating scale scoring for pain and sedation, PCEA usage, quality of recovery assessment, times of GI function recovery, and patient satisfaction scoring for pain management. Results. Pain scores at 1, 4, 8, 12, and 16 h (P < 0.001), PCEA bolus requirements (n) at 24 [21 (3), 14 (2)], 48 [15 (4), 10 (3)] and 72 [8 (5), 2 (3)] (P < 0.05) and paracetamol (mg) consumption [700 (523), 350 (400)]; P < 0.05), were significantly lower in the gabapentin-treated patients than in the control group. Patient satisfaction with postoperative pain management at 24 h was better in gabapentin-treated patients [85.5 (7.5), 66.5 (15)]; P < 0.001). Gabapentin-treated patients had less motor block when compared with control group. Times of return of bowel function, hospitalization, and resumption of dietary intake were similar in the groups. However, the incidence of dizziness was higher in the gabapentin group (35% vs 5%; P < 0.05). Conclusions. Oral gabapentin (1.2 g day(-1)) as an adjunct to epidural analgesia decreased pain and analgesic consumption. Despite an increased incidence of dizziness it also increased patient satisfaction.Öğe Effect of preoperative oral use of erythromycin and nizatidine on gastric pH and volume(Sage Publications Ltd, 2002) Memis, D; Turan, A; Karamanlioglu, B; Guler, T; Yurdakoc, A; Pamukcu, Z; Turan, NThis randomized controlled trial examined the effects of preoperative oral erythromycin or nizatidine on gastric pH and volume. Sixty patients, ASA I and 2 status scheduled for elective surgery were studied. All subjects received oral study medication with 10 ml of water 60 minutes prior to surgery. Patients in Group I (it = 20) were given erythromycin 200 mg, in Group 2 (n = 20) nizatidine 300 mg, and in Group 3 (n = 20) placebo capsule. A nasogastric tube was inserted immediately after anaesthesia induction. Gastric content was aspirated, and volume and pH recorded. pH values determined in Group I were 5.6+/-1.87, in Group 2, 5.65+/-1.92 and in Group 3, 3.5+/-1.93. There was no statistical difference between Groups I and 2, but there was a statistically significant difference between Group 3 and Groups I and 2 (P<0.001). The volume of gastric content was 10.25+/-6.65 ml in Group 1, 10.3+/-6.29 ml in Group 2, and 20.25+/-16.72 ml in Group 3. Again, there was no statistical difference between Groups I and 2, but there was a statistically significant difference between Group 3 and Groups I and 2 (P<0.05). The proportion of patients considered at risk of significant lung injury should aspiration occur was 10% of Group 1, 5% of Group 2 and 20% of Group 3 (not statistically different). We conclude that oral erythromycin and nizatidine given one hour prior to surgery are effective in reducing gastric pH and volume.Öğe Effects of lornoxicam on the physiology of severe sepsis(Bmc, 2004) Memis, D; Karamanlioglu, B; Turan, A; Koyuncu, O; Pamukçu, ZIntroduction The purpose of the present study was to evaluate the effects of intravenous lornoxicam on haemodynamic and biochemical parameters, serum cytokine levels and patient outcomes in severe sepsis. Methods A total of 40 patients with severe sepsis were included, and were randomly assigned ( 20 per group) to receive either lornoxicam ( 8 mg administered intravenously every 12 hours for six doses) or placebo. For both groups the following were recorded: haemodynamic parameters ( heart rate, mean arterial pressure), nasopharyngeal body temperature, arterial blood gas changes ( pH, partial oxygen tension, partial carbon dioxide tension), plasma cytokine levels (IL-1beta, IL-2 receptor, IL-6, IL-8, tumour necrosis factor-alpha), biochemical parameters ( lactate, leucocytes, trombocytes, creatinine, total bilirubin, serum glutamate oxalate transaminase), length of stay in the intensive care unit, duration of mechanical ventilation and mortality. All measurements were obtained at baseline ( before the start of the study) and at 24, 48 and 72 hours from the start of lornoxicam/placebo administration. Results No significant differences were found between the intravenous lornoxicam and placebo groups in major cytokines, duration of ventilation and length of intensive care unit stay, and inspired fractional oxygen/arterial oxygen tension ratio ( P > 0.05). Conclusion In these patients with severe sepsis, we found intravenous lornoxicam to exert no effect on haemodynamic and biochemical parameters, cytokine levels, or patient outcomes. Because of the small number of patients included in the study and the short period of observation, these findings require confirmation by larger clinical trials of intravenous lornoxicam, administered in a dose titrated manner.Öğe A factorial trial of six interventions for the prevention of postoperative nausea and vomiting(Massachusetts Medical Soc, 2004) Apfel, CC; Korttila, K; Abdalla, M; Kerger, H; Turan, A; Vedder, I; Zernak, CBACKGROUND Untreated, one third of patients who undergo surgery will have postoperative nausea and vomiting. Although many trials have been conducted, the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown. METHODS We enrolled 5199 patients at high risk for postoperative nausea and vomiting in a randomized, controlled trial of factorial design that was powered to evaluate interactions among as many as three antiemetic interventions. Of these patients, 4123 were randomly assigned to 1 of 64 possible combinations of six prophylactic interventions: 4 mg of ondansetron or no ondansetron; 4 mg of dexamethasone or no dexamethasone; 1.25 mg of droperidol or no droperidol; propofol or a volatile anesthetic; nitrogen or nitrous oxide; and remifentanil or fentanyl. The remaining patients were randomly assigned with respect to the first four interventions. The primary outcome was nausea and vomiting within 24 hours after surgery, which was evaluated blindly. Results Ondansetron, dexamethasone, and droperidol each reduced the risk of postoperative nausea and vomiting by about 26 percent. Propofol reduced the risk by 19 percent, and nitrogen by 12 percent; the risk reduction with both of these agents ( i.e., total intravenous anesthesia) was thus similar to that observed with each of the antiemetics. All the interventions acted independently of one another and independently of the patients' baseline risk. Consequently, the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention. Absolute risk reduction, though, was a critical function of patients' baseline risk. CONCLUSIONS Because antiemetic interventions are similarly effective and act independently, the safest or least expensive should be used first. Prophylaxis is rarely warranted in low-risk patients, moderate-risk patients may benefit from a single intervention, and multiple interventions should be reserved for high-risk patients.Öğe Gabapentin(Lippincott Williams & Wilkins, 2006) Turan, A; White, PF; Karamanlioglu, B; Memis, D; Tasdogan, M; Pamukçu, Z; Yavuz, EThe cyclooxygenase-2 inhibitor, rofecoxib, was a popular analgesic adjuvant for improving perioperative pain management. We designed this placebo-controlled study to test the hypothesis that gabapentin could produce similar reductions in postoperative pain and opioid analgesic usage, thereby improving the recovery process. One hundred patients undergoing abdominal hysterectomy procedures were randomly assigned to one of four treatment groups: 1) control group received placebo capsules and pills before and for 2 days after surgery, 2) rofecoxib group received 50 mg/d PO and placebo capsules before and after surgery and, 3) gabapentin group received 1.2 g/d PO and placebo pills before and after surgery, and 4) combination group received rofecoxib 50 mg/d and gabapentin 1.2 g/d PO before and after surgery. The anesthetic technique was standardized and the postoperative assessments included verbal rating scales for pain and sedation, IV morphine usage, quality of recovery assessment, recovery of bowel function, resumption of normal activities, and patient satisfaction with their pain management. Postoperative pain scores were significantly reduced in all three analgesic treatment groups (versus control group). Compared with the control group, patient-controlled analgesia morphine usage was also significantly reduced in the 3 analgesic treatment groups at 1, 8,24, and 30 h after surgery. Total PCA morphine usage was decreased by 43%, 24%, and 50% in groups 2,3, and 4, respectively, compared with group 1. Oral analgesic consumption was also smaller in groups 2 and 4 when compared with the control group. The opioid-sparing effects of rofecoxib and gabapentin lead to a faster recovery of bowel function. Discharge eligibility scores in groups 2 and 4 were improved at 24 h when compared with group 1, and patient satisfaction with postoperative pain management was significantly higher at 24 h in all 3 analgesic treatment groups. At the 72 h followup, all of the patients in group 4 were completely satisfied with their pain management compared with only 32%, 64%, and 72% in groups 1, 2, and 3, respectively. Gabapentin (1.2 g/d PO) appears to be an acceptable alternative to rofecoxib (50 mg/d PO) for short-term use as an adjuvant to opioid analgesics in patients undergoing lower abdominal surgery.Öğe Glutamine and chronic obstructive pulmonary disease(Cambridge Univ Press, 2006) Memis, D; Turan, A; Karamanlioglu, B; Koyuncu, O; Pamukçu, Z[Abstract Not Available]
