Publications by authors named "Ülkü Aypar"

65 Publications

Effect of magnesium sulfate on anesthesia depth, awareness incidence, and postoperative pain scores in obstetric patients. A double-blind randomized controlled trial.

Saudi Med J 2018 Jun;39(6):579-585

Department of Anesthesiology and Reanimation, Training and Research Hospital, Muğla Sıtkı Koçman University, Muğla, Turkey. E-mail.

Objectives: To assess the effects of magnesium on the depth of anesthesia and to determine the effects of magnesium on incidence of awareness and postoperative pain after caesarean section.  Methods: The study was designed as a double-blind, controlled, randomized study and conducted in Hacettepe University Hospital, Ankara, Turkey  between January 2015 and March 2016. A total of 100 pregnant healthy women who were between 17 and 41 years old, ASA II, and scheduled for an elective cesarean section with general anesthesia were included in the study. After induction, sevoflurane was used for maintenance in Group S and desflurane in Group D (control groups). At Group S-M and Group D-M (study groups), magnesium infusion was started with sevoflurane and desflurane anesthesia respectively. Minimum alveolar concentration of sevoflurane and desflurane were kept constant. Bispectral index scores (BIS), fentanyl consumption and postoperative visual analogue scale (VAS) values were recorded. All of the patients had been followed-up for awareness until the postoperative first year. Results: Demographic variables of the patients were similar. BIS values were significantly higher in control groups throughout the operation (p less than 0.001). No significant difference was detected for intraoperative fentanyl consumption and awareness incidence. VAS values were significantly lower in study groups (p less than 0.05). Conclusion: Magnesium infusion provided significantly lower intraoperative BIS values and lower postoperative VAS scores. We believe that magnesium can be useful as an adjuvant to general anesthesia.
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http://dx.doi.org/10.15537/smj.2018.6.22376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058748PMC
June 2018

Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis.

Crit Care 2017 10 18;21(1):255. Epub 2017 Oct 18.

Departement d'Anesthesie-Reanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre Assistance Publique - Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, Paris, France.

Background: Mildly elevated lactate levels (i.e., 1-2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome.

Methods: This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed.

Results: In 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80-1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1-5.7, P = 0.027).

Conclusions: In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels.

Trial Registration: ClinicalTrials.gov, NCT01179243 . Registered on August 3, 2010.
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http://dx.doi.org/10.1186/s13054-017-1842-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646128PMC
October 2017

Increased heart rate on first day in Intensive Care Unit is associated with increased mortality.

Pak J Med Sci 2016 Nov-Dec;32(6):1402-1407

Prof. Dr. Ulku Aypar, Anesthesiology and Reanimation Unit, Hacettepe University Medical Faculty, Ankara, Turkey.

Objective: To investigate the association of maximum HR during the first day of intensive care unit (ICU) and mortality.

Methods: Data of 850 patients over 45 years of age, who were hospitalized in ICU, was retrospectively analyzed. They were divided into two groups; Group-I, patients with maximum HR<100/min Group-II, patients with maximum HR≥100/min on first day. The groups were compared regarding age, sex, use of beta-blockers, use of inotropic and vasopressor drugs, hemodynamic parameters, anemia, mechanical ventilation, length of hospitalization (ICU and total), mortality (ICU and total), and CHARLSON & APACHE-II scores.

Results: The mean age of patients was 63±12 years and 86% were after non-cardiac surgery. Maximum HR was 83±11 in Group-I and 115±14/min in Group-II (p=0.002). Group-II patients had more frequent vasopressor and inotropic drugs usage, (p<0.001), anemia, mechanical ventilation (p<0.005), higher CHARLSON & APACHE-II scores, stayed longer in ICU and hospital, and had higher ICU and hospital mortality compared to group-I (p<0.05). APACHE-II scores and maximum HR<100/min were independent variables predicting ICU mortality in multivariate logistic regression analysis whereas usage of beta-blockers was not.

Conclusions: Our study showed that maximum HR less than100/minute during the first day of ICU is associated with decreased mortality in Intensive Care Unit.
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http://dx.doi.org/10.12669/pjms.326.11507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216290PMC
January 2017

Comparison of risk scoring systems in congenital heart surgery.

Turk J Pediatr 2016 ;58(5):512-517

Department of Thoracic-Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Hacettepe University Faculty of Medicine Department of Cardiovascular Surgery; data of 413 patients under 18 years old who had congenital heart surgery were evaluated between 01.01.2011-30.10.2012 and risk scorings were made by "RACHS-1 (Risk Adjustment in Congenital Heart Surgery)", "Aristotle Basic Complexity Score (ABS)" and "Aristotle Comprehensive Complexity Score (ACS)" systems used in evaluation of the risk of mortality and morbidity in (ACS)" systems used in evaluation of the risk of mortality and morbidity in congenital heart surgery. Data obtained were compared by Mann-Whitney U test and how effective these systems were in evaluating mortality and morbidity and their superiorities over each other were examined. Following the research, it was observed that all three systems were effective in evaluating mortality and morbidity; the most successful of them in foreseeing the event was the ACS system, ACS system was followed by RACHS-1 system and ABS system was the most incapable of these in foreseeing the event. It was seen that in detecting time related mortality, rating of these tests changed, RACHS-1 system detected the time related mortality best. It was also seen that with RACHS-1 system, a previously evaluated concept, it was possible to determine morbidity.
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http://dx.doi.org/10.24953/turkjped.2016.05.008DOI Listing
September 2017

Comparison of intraarticular bupivacaine and levobupivacaine injection in rat synovial inflammation.

Turk J Med Sci 2014 ;44(4):540-5

Department of Anesthesia and Reanimation, Atatürk Education and Research Hospital, Ankara, Turkey.

Background/aim: Both bupivacaine and levobupivacaine are local anesthetics with strong analgesic efficacy that can be used intraarticularly. The aim of this study was to compare the effects of intraarticular bupivacaine and levobupivacaine injection on inflammation in articular cartilage and the synovium of the rat knee joint.

Materials And Methods: Twenty Sprague-Dawley rats were injected in the right knee joint with 0.2 mL of bupivacaine, while 0.2 mL of levobupivacaine was injected into the left knee joint. Groups of 5 were sacrificed on days 1, 7, 14, and 21 after bupivacaine and levobupivacaine administration and knee joints were examined for subintimal fibrosis, synovial hyperplasia, chronic inflammation, neutrophil infiltration, edema, and synovial and periarticular congestion by microscopy. Alterations in the articular cartilage structure were evaluated using Mankin scoring.

Results: We found that both drugs have similar effects on synovial and articular cartilage resulting in mild to moderate congestion, edema, neutrophil infiltration, chronic inflammation, and synovial hyperplasia, which diminished gradually. However, increases in fibrosis were also seen to varying degrees. Thus, the use of these drugs intraarticularly can be recommended.

Conclusion: Careful usage of bupivacaine and levobupivacaine is recommended in intraarticular applications since they cause inflammation shortly after injection and fibrosis at later time points.
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http://dx.doi.org/10.3906/sag-1302-32DOI Listing
January 2015

The effect of intravenous paracetamol for the prevention of rocuronium injection pain.

Kaohsiung J Med Sci 2014 Nov 22;30(11):566-9. Epub 2014 Sep 22.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.

Rocuronium is a nondepolarizing neuromuscular blocking agent used in anesthesia induction and is associated with considerable discomfort and burning pain during injection, which is reported to occur in 50-80% of patients. This study was carried out to investigate the effectiveness of intravenous paracetamol pretreatment compared with lidocaine and normal saline to prevent rocuronium injection pain. The study included 150 ASA I-II patients undergoing elective orthopedic, gastrointestinal, and gynecological procedures under general anesthesia. They were allocated into three groups according to pretreatment drugs: lidocaine (40 mg) (n = 50), paracetamol (n = 50), and normal saline group (n = 50). Before anesthesia induction with propofol, all patients were pretreated with rocuronium. The pain caused by the injection was evaluated. Local signs were assessed on the arm at the end of the injection, as well as 24 hours after recovery from anesthesia. There were no patients with blurred speech or vision and there was no respiratory depression in any group after pretreatment with the study drug. The level of pain on injection was statistically lower in those who had received paracetamol compared to normal saline (p = 0.009). There were more patients in the saline group with severe pain (p < 0.001). Paracetamol relieved the rocuronium injection pain better than normal saline but lidocaine was the best of the three drugs (p < 0.001).
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http://dx.doi.org/10.1016/j.kjms.2014.08.002DOI Listing
November 2014

International study on microcirculatory shock occurrence in acutely ill patients.

Crit Care Med 2015 Jan;43(1):48-56

1Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 2Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands. 3Department of Biomedical Science and Public Health, Università Politecnica delle Marche, Ancona, Italy. 4Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina. 5Department of Emergency Medicine and Center for Vascular Biology Research, Beth Isreal Deaconess Medical Center, Boston, MA. 6Barts and The London School of Medicine and Dentistry, London, United Kingdom. 7Dor e Terapia Intensiva, Universidade Federal de São Paolo, São Paolo, Brasil. 8Klinik für Anesthesiologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany. 9K. Ko[Latin Small Letter s with comma below]uyolu High Specialty Education and Research Hospital, Kartal Ko[Latin Small Letter s with comma below]uyolu, Ko[Latin Small Letter s with comma below]uyolu University, Istanbul, Turkey. 10Department of Intensive Care, Lithuanian University of Health Sciences, Kaunas, Lithuania. 11Section of Cardiology, Cooper University Hospital, Camden, NJ. 12Medical Intensive Care Unit, University Hospital of Basel, Basel, Switzerland. 13Department of Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Nieuwegein, The Netherlands. 14Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. 15Critical Care Medicine/Neurocritical Care, Mercy Hospital St. Louis, St. Louis University Hospital, St. Louis, MO. 16Derriford Hospital, Plymouth University Peninsula School of Medicine, Plymouth, United Kingdom. 17Intensive Care Unit, Hacettepe University, Ankara, Turkey. 18Intensive Care Unit, Hospital Español-ASSE, School of Medicine, UDELAR, Montevideo, Uruguay. 19Intensive Care Unit, New Cross Hospital, Wolverhampton, United Kingdom. 20Department of Anesthesiology, Critical Care et SMUR, Hôpital Lariboisière AP-HP/Université Paris 7 Diderot, Paris,

Objectives: Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables.

Design: Multicenter observational point prevalence study.

Setting: The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide.

Patients: A heterogeneous ICU population consisting of 501 patients.

Interventions: None.

Measurements And Main Results: Demographic, hemodynamic, and laboratory data were collected in all ICU patients who were 18 years old or older. Sublingual Sidestream Dark Field imaging was performed to determine the prevalence of an abnormal capillary microvascular flow index (< 2.6) and its additional value in predicting hospital mortality. In 501 patients with a median Acute Physiology and Chronic Health Evaluation II score of 15 (10-21), a Sequential Organ Failure Assessment score of 5 (2-8), and a hospital mortality of 28.4%, 17% exhibited an abnormal capillary microvascular flow index. Tachycardia (heart rate > 90 beats/min) (odds ratio, 2.71; 95% CI, 1.67-4.39; p < 0.001), mean arterial pressure (odds ratio, 0.979; 95% CI, 0.963-0.996; p = 0.013), vasopressor use (odds ratio, 1.84; 95% CI, 1.11-3.07; p = 0.019), and lactate level more than 1.5 mEq/L (odds ratio, 2.15; 95% CI, 1.28-3.62; p = 0.004) were independent risk factors for hospital mortality, but not abnormal microvascular flow index. In reference to microvascular flow index, a significant interaction was observed with tachycardia. In patients with tachycardia, the presence of an abnormal microvascular flow index was an independent, additive predictor for in-hospital mortality (odds ratio, 3.24; 95% CI, 1.30-8.06; p = 0.011). This was not true for nontachycardic patients nor for the total group of patients.

Conclusions: In a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death.
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http://dx.doi.org/10.1097/CCM.0000000000000553DOI Listing
January 2015

The growth of bacteria in infusion drugs: propofol 2% supports growth when remifentanil and pantoprazole do not.

Braz J Anesthesiol 2013 Nov-Dec;63(6):466-72. Epub 2013 Dec 5.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background And Objectives: Contamination risks of propofol 2%, remifentanil, and pantoprazole; and in vitro effects of these drugs on the growth of common infective agents in intensive care units were evaluated.

Methods: For detection of contamination risk, drugs were prepared ready to use under intensive care unit conditions, were tested. Effects of these three drugs on bacterial growth were also investigated. Drugs were prepared at the concentrations used in the intensive care unit and inoculated with common pathogens after which they were incubated at 4°C, 22°C and 36°C. Subcultures were made at 0, 2, 4 and 8h and colony counts were evaluated. Minimum inhibitory concentration values were determined for all drugs at 4°C, 22°C and 36°C.

Results: No growth was observed in the drugs prepared in the intensive care unit. Propofol tended to support while remifentanil inhibited bacterial growth. Effect of pantoprozole differed according to the bacteria tested. None of the drugs showed antibacterial activity at the maximum concentrations which may be achieved in blood of the patients.

Conclusion: Propofol strongly supports the growth of the microorganisms tested, although remifentanil and pantoprazole do not. Therefore, it is important to follow the strict aseptic techniques for the preparation of propofol.
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http://dx.doi.org/10.1016/j.bjane.2012.10.003DOI Listing
April 2015

The Effect of Different End-tidal Desflurane Concentrations on Bispectral Index Values in Normal Children and Children with Cerebral Palsy.

Turk J Anaesthesiol Reanim 2013 Dec 23;41(6):200-5. Epub 2013 May 23.

Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objective: In this study, we aimed to compare the effects of different intraoperative end-tidal desflurane concentrations on bispectral index (BIS) values in normal children and children with cerebral palsy.

Methods: Twenty normal children (Group N) and 20 children with non-communicative/nonverbal cerebral palsy (Group CP), between 2 and 15 years of age, undergoing elective orthopaedic surgery were included in the study. Following premedication with midazolam, anaesthesia was induced by infusing 1% propofol at a rate of 200 mL hr(-1) until BIS reached 50. Heart rate, blood pressure and BIS values were recorded before and after the induction of anaesthesia, at steady-state end-tidal concentrations of 4% and 6% desflurane, and after emergence from anaesthesia. A p value <0.05 was considered significant in the statistical analyses, including Kolmogorov-Smirnov, t-test, paired samples t-test and chi-square test.

Results: The time to extubation and eye opening after discontinuation of anaesthesia was longer in Group CP. BIS values before the induction of anaesthesia, at a steady-state end-tidal desflurane concentration of 4% and after emergence from the anaesthetic were significantly lower in Group CP. At a steady-state end-tidal desflurane concentration of 6%, BIS values were slightly lower in Group CP but this difference was not statistically significant.

Conclusion: Based on the data obtained, we concluded that BIS monitoring in children with cerebral palsy can be useful in terms of decreasing adverse effects and drug interactions due to multiple drug usage by reducing the use of anaesthetic agents and improving emergence from the anaesthetic.
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http://dx.doi.org/10.5152/TJAR.2013.33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894209PMC
December 2013

Asymptomatic vallecular cyst: case report.

Braz J Anesthesiol 2013 Sep-Oct;63(5):419-21

Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Hacettepe University, Ancara, Turquia. Electronic address:

A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 μg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.
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http://dx.doi.org/10.1016/j.bjan.2013.03.018DOI Listing
April 2015

The analgesic efficacy of intra-articular acetaminophen in an experimental model of carrageenan-induced arthritis.

Pain Res Manag 2013 Sep-Oct;18(5):e63-7

Background: Acetaminophen is one of the most common drugs used for the treatment of pain and fever.

Objectives: To examine the effects of intra-articular (IA) acetaminophen on carrageenan-induced arthritic pain-related behaviour and spinal c-Fos expression in rats.

Methods: The present study was performed using 20 Sprague Dawley rats. Forty microlitres of IA 0.9% NaCl was injected in the control group, and 40 µL of IA carrageenan was injected in the carrageenan group. One hour after carrageenan injection, 400 µg of IA acetaminophen was injected in the IA acetaminophen group, and 400 µg of intraperitoneal (IP) acetaminophen was injected in the IP acetaminophen group. One day before injection, and 4 h and 8 h after injection, diameters of both knee joints, motility of the rat, paw loading and joint mobility were assessed. After the rats were euthanized, L3 and L4 spinal segments were excised for c-Fos assessment.

Results: IA acetaminophen decreased both the severity and distribution of c-Fos expression. IP acetaminophen decreased only the distribution of c-Fos expression. IA acetaminophen decreased knee diameter at 8 h. IA and IP acetaminophen increased rat motility and paw loading scores. Joint mobility scores of IP acetaminophen were similar to saline at 8 h.

Conclusions: Results of the present study indicate an analgesic and⁄or possible anti-inflammatory effect of IA acetaminophen and provide further evidence on the efficacy of systemic acetaminophen injection in reducing arthritic pain.
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http://dx.doi.org/10.1155/2013/148392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805351PMC
June 2014

Protective effect of coenzyme Q10 in paclitaxel-induced peripheral neuropathy in rats.

Neurosciences (Riyadh) 2013 Apr;18(2):133-7

Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Samanpazari 06100, Ankara, Turkey.

Objective: To investigate the possible protective effect of coenzyme Q10 (CQ10) on neuropathy in rats.

Methods: Experiments were conducted in the Department of Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey between January and March 2012. Forty rats were divided into 4 groups: group 1 (control), group 2 (paclitaxel), group 3 (control + CQ10), and group 4 (paclitaxel + CQ10). Group 2 and 4 rats received paclitaxel (2 mg/kg, intraperitoneally, on days 0, 2, 4, 6). Group 3 and 4 rats were treated with CQ10 (10 mg/kg, intraperitoneally, on days 0, 1, 2, 3, 4, 5, 6, 7, 8, 9). The rats that did not receive paclitaxel or CQ10 received vehicle. Mechanical allodynia tests were performed for each animal on day 0, 2, 6, 8, 10, 14, 16, 19, 39 and 41 for all groups with von Frey filaments.

Results: At day 0, mean mechanical withdrawal thresholds were similar among all groups. Starting from day 2, the threshold of the paclitaxel group decreased. Starting from day 10, paclitaxel+CQ10 treated rats had significantly higher thresholds compared with the paclitaxel group, but these values were still significantly lower than that of the controls. Control and control + CQ10 rats had similar threshold values during the protocol.

Conclusion: The CQ10 treatment decreased the degree of paclitaxel-induced peripheral neuropathy in rats.
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April 2013

The effects of non-leukoreduced red blood cell transfusions on microcirculation in mixed surgical patients.

Transfus Apher Sci 2013 Oct 9;49(2):212-22. Epub 2013 Feb 9.

Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Anesthesiology and Reanimation, Hacettepe University, Faculty of Medicine, Ankara, Turkey. Electronic address:

Background: The impact of the storage process on oxygen-carrying properties of red blood cells and the efficacy of red blood cell (RBC) transfusions concerning tissue oxygenation remain an issue of debate in transfusion medicine. Storage time and leukocyte content probably interact since longer storage duration is thought to cause greater accumulation of leukocyte-derived cytokines and red blood cell injury.

Objectives: The aim of this study was to investigate the effects of storage and the efficacy of fresh (stored for less than 1 week) versus aged (stored for more than 3 weeks) non-leukoreduced RBC transfusions on sublingual microvascular density and flow in mixed surgical patients.

Methods: Eighteen surgical patients were included in this study. Patients were randomly assigned into two groups receiving fresh (Group A) and aged (Group B) RBC transfusions. Sublingual microcirculatory functional capillary density (FCD) and microvascular flow index (MFI) were assessed using orthogonal polarization spectral (OPS) imaging. Measurements and collection of blood samples were performed after induction of general anesthesia, before RBC transfusion and 30 min after the RBC transfusion ended.

Results: In both groups RBC transfusions caused an increase in hemoglobin concentration (p<0.001). RBC transfusions increased FCD in Group A (p<0.001), while FCD remained unaffected in Group B. Changes in MFI following RBC transfusion in both groups remained unaltered.

Conclusions: Fresh non-leukoreduced RBC transfusions but not RBCs stored for more than 3weeks, were effective in improving microciruculatory perfusion by elevating the number of perfused microvessels in mixed surgical patients.
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http://dx.doi.org/10.1016/j.transci.2013.01.016DOI Listing
October 2013

The effect of HES (130/0.4) usage as the priming solution on renal function in children undergoing cardiac surgery.

Ren Fail 2013 11;35(2):210-5. Epub 2012 Dec 11.

Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Experience with hydroxyethyl starch (HES) in children is limited. This study was conducted to observe the effects of HES or Ringer's lactate (RL) usage as the priming solution on renal functions in children undergoing cardiac surgery.

Methods: After ethical committee approval and parent informed consent, 24 patients were included in this prospective, randomized study. During cardiopulmonary bypass (CPB), Group I received RL and Group II received HES (130/0.4) as priming solution. Serum creatinine, blood urea nitrogen (BUN), β2-microglobulin, cystatin C, and urinary albumin and creatinine, serum, and urine electrolytes were analyzed after the induction (T1), before CPB (T2), during CPB (T3), after CPB (T4), at the end of the operation (T5), on 24th hour (T6), and on 48th hour postoperatively (T7). Fractional sodium excretion (FENa), urinary albumin/creatinine ratio, and creatinine clearance were calculated. Drainage, urine output, inotropes, diuretics, and blood requirements were recorded.

Results: In both the groups, β2-microglobulin was decreased during CPB and cystatin C was decreased at T3,T4, and T5 periods (p < 0.05) and the levels remained within the normal range. Creatinine clearance did not differ in the HES group, but increased in the RL group (p < 0.05). Urine albumin/creatinine ratio was increased (p < 0.05) after CPB in the HES group, and it increased at T3, T4, and T5 in the RL group (p < 0.05). There were no differences in cystatin C, β2-microglobulin, FENa, urine albumin/creatinine ratio, creatinine clearance, total fluid amount, urine output, drainage, and inotropic and diuretic requirements between the groups.

Conclusion: We conclude that usage of HES (130/0.4) did not have negative effects on renal function, and it can be used as a priming solution in pediatric patients undergoing cardiac surgery.
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http://dx.doi.org/10.3109/0886022X.2012.747139DOI Listing
August 2013

Urinary lipid and protein oxidation products upon halothane, isoflurane, or sevoflurane anesthesia in humans: potential biomarkers for a subclinical nephrotoxicity.

Biomarkers 2013 Feb 9;18(1):73-81. Epub 2012 Nov 9.

Department of Toxicology, Faculty of Pharmacy, Ege University, Bornova-Izmir, Turkey.

Objective: To investigate whether lipid and protein oxidation products are elevated and correlated with routine clinical markers of hepatic and renal function in patients anesthetized with halothane, isoflurane, or sevoflurane.

Methods: Urine and blood samples were collected from patient groups. Excretion of aldehydes, acetone, and o,o'-dityrosine was measured before and after anesthesia. Blood samples were analysed for clinical markers.

Results: Urinary concentrations of aldehydes, acetone, o,o'-dityrosine and glucose were significantly increased after anesthesia in halothane and sevoflurane groups earlier than clinical markers. Significant correlations were found in sevoflurane group.

Conclusion: Lipid and protein oxidation contributes to subclinical sevoflurane nephrotoxicity. Oxidation products may serve as early biomarkers.
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http://dx.doi.org/10.3109/1354750X.2012.737026DOI Listing
February 2013

Comparison of the effects of sevoflurane, isoflurane, and desflurane on microcirculation in coronary artery bypass graft surgery.

J Cardiothorac Vasc Anesth 2012 Oct 15;26(5):791-8. Epub 2012 May 15.

Department of Anesthesia, Hacettepe University, Ankara, Turkey.

Objective: This investigation was performed to compare the effects of inhalation agents on microcirculation in coronary artery bypass grafting (CABG) using orthogonal polarization spectral imaging.

Design: This prospective and randomized study was performed in patients scheduled for CABG surgery from March through September 2010.

Setting: Tertiary care university hospital.

Participants: Thirty patients undergoing elective CABG.

Interventions: Patients were assigned to sevoflurane, desflurane, or isoflurane.

Measurements And Main Results: Orthogonal polarization spectral imaging was used to evaluate the sublingual microcirculation. Hemodynamic variables (heart rate, mean arterial pressure, central venous pressure, cardiac output, and pulmonary capillary wedge pressure), laboratory parameters (hematocrit, lactate, and potassium), and microcirculatory variables (total vascular density [TVD] [mm/mm(2)], microvascular flow index [MFI] [arbitrary units], perfused vessel density [PVD] [mm/mm(2)], and proportion of perfused vessels [PPV] [percentage] were obtained before induction, after induction, during cardiopulmonary bypass, at the end of surgery, and 24 hours after surgery. The greatest alterations in microcirculation parameters were found during cardiopulmonary bypass. In the sevoflurane group, TVD (14.7%), PVD (22%), PPV (5.97%, p < 0.05), and MFI (7.69%, p > 0.05) were decreased. In the isoflurane group, TVD (14.7%) and PVD (20.3%) were decreased, whereas PPV (1.69%) and MFI (17.99%) were increased (p < 0.05). In the desflurane group, there were no changes in TVD and PVD, but MFI (8.99%, p > 0.05) and PPV (1.48%, p < 0.05) were increased in the small vessels. These changes returned to their initial values 24 hours postoperatively.

Conclusions: Sevoflurane had a negative effect on the microcirculation. Isoflurane decreased vascular density and increased flow. Desflurane produced stable effects on the microcirculation. These inhalation agents induced transient alterations in microvascular perfusion.
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http://dx.doi.org/10.1053/j.jvca.2012.03.019DOI Listing
October 2012

The effects of sevoflurane anesthesia and cardiopulmonary bypass on renal function in cyanotic and acyanotic children undergoing cardiac surgery.

Ren Fail 2012 12;34(2):135-41. Epub 2011 Dec 12.

Department of Anesthesiology and Reanimation, Selcuklu Faculty of Medicine, Selcuk University, Konya, Turkey.

Background: There are few data on the effects of anesthesia and cardiopulmonary bypass (CPB) on perioperative renal function in children with cyanotic congenital heart disease undergoing open heart surgery. This study aims to investigate the perioperative renal function in cyanotic versus acyanotic children undergoing sevoflurane anesthesia for open heart surgery.

Methods: After receiving ethical committee approval, 12 acyanotic patients (preoperative oxygen saturation: SaO(2) > 85%) and 12 cyanotic children (SaO(2) < 85%) were included. Sevoflurane was administered at concentration levels of 2% before CPB and 1-2% during CPB after standard anesthesia induction. Inorganic fluoride, electrolytes, creatinine, urea nitrogen in serum and urine samples, and N-acetyl-β-d-glucosaminidase (NAG) in urine samples were measured before induction, before CPB, during CPB, after CPB, at the end of surgery, and at 24th h postoperatively.

Results: The levels of serum uric acid levels were higher in the cyanotic group (p < 0.05). There were no differences in the levels of serum creatinine and urine creatinine, urea nitrogen, and electrolytes between the two groups. Serum inorganic fluoride levels were always higher in the acyanotic group than in the cyanotic group, but these differences between the groups reached statistical significance at two measurement times (before CPB and end of surgery) (p < 0.05). Urinary inorganic fluoride levels increased with time in both groups. Although urinary NAG increased significantly after the CPB in the cyanotic group, the differences between the two groups did not reach statistical significance.

Conclusions: We have concluded that renal function was not affected during open heart surgery with sevoflurane anesthesia, in both cyanotic and acyanotic children.
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http://dx.doi.org/10.3109/0886022X.2011.641513DOI Listing
May 2012

Pain on injection of propofol: a comparison of methylene blue and lidocaine.

J Clin Anesth 2011 Jun;23(4):270-4

Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, TR-06100, Turkey.

Study Objective: To investigate whether methylene blue, given before injection of propofol, was effective in reducing the frequency and severity of pain associated with propofol injection.

Design: Prospective, randomized, double-blinded clinical study.

Setting: Operating room of a university hospital.

Patients: 90 adult, ASA physical status 1 and 2 patients undergoing elective surgery.

Interventions: Patients were randomly allocated to one of three groups of 30 patients each. Group I received 50 mg of methylene blue, Group II received 40 mg of lidocaine, and Group III, the control group, was given normal saline. All drugs were given as a 2.0 mL bolus 45 seconds before propofol administration.

Measurements: Injection pain using vocal responses, facial grimacing, arm withdrawal, tears, and questioning of the patient were noted. A 4-point scale was used for documenting pain.

Main Results: Pain frequency was 90% in the saline group, whereas the frequencies were significantly lower in the lidocaine and methylene blue groups (26.7% and 40%, respectively).

Conclusions: Intravenous pretreatment with methylene blue appears to be effective in reducing the pain during propofol injection.
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http://dx.doi.org/10.1016/j.jclinane.2010.09.008DOI Listing
June 2011

A clinical comparison of etomidate-lipuro, propofol and admixture at induction.

Saudi J Anaesth 2011 Jan;5(1):62-6

Department of Anesthesiology and Reanimation, Ankara, Turkey.

Objective: The purpose of this study was to compare etomidate-lipuro and propofol and 50%, (1:1) admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus.

Methods: Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro-propofol admixture. After monitorization with bispectral index (BIS) all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 (BIS 40 time) and total amounts of induction doses were measured.

Results: BIS 40 time measurements were P > E > PE (199.4 ± 40.9, 176.9 ± 31.6, 163.5 ± 20.6 s). The hemodynamic (systolic, diastolic and mean blood pressures, heart rate) changes were minimal in group PE than other two groups (P = 0.017). The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E (76.3%). Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were (83.8%) in group P and in (63.2%) group E.

Conclusion: Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction.
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http://dx.doi.org/10.4103/1658-354X.76509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101756PMC
January 2011

The addition of metamizole to morphine and paracetamol improves early postoperative analgesia and patient satisfaction after lumbar disc surgery.

Turk Neurosurg 2010 Jul;20(3):341-7

Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ankara, Turkey.

Aim: Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery.

Material And Methods: After Ethics Committee approval and informed consent, 63 patients were allocated to three treatment groups; as Group paracetamol: paracetamol (1 g), Group paracetamol-metamizole: paracetamol (1 g) and metamizole (1 g), and Group placebo: no analgesic. All the patients received intravenous (i.v.) morphine with a patient-controlled analgesia device (PCA) as the rescue analgesic. Pain was assessed by the numerical pain rating scale (NRS, 0-3). Total morphine consumption at 24 hours, patient satisfaction and side effects were investigated.

Results: NRS of Group paracetamol-metamizole was low at 15th min, 30th min and 1st hour, and the difference reached statistical significance at 30th min (p=0.033). Patient satisfaction at the same measurement times was high in this group. Total morphine consumption and side effects were not statistically different between the three groups.

Conclusion: Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction.
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http://dx.doi.org/10.5137/1019-5149.JTN.3081-10.3DOI Listing
July 2010

Spinal 5-HT7 receptors play an important role in the antinociceptive and antihyperalgesic effects of tramadol and its metabolite, O-Desmethyltramadol, via activation of descending serotonergic pathways.

Anesthesiology 2010 Mar;112(3):696-710

Department of Anesthesiology and Reanimation, Gulhane Military Academy of Medicine, Ankara, Turkey.

Background: Tramadol is an analgesic drug, and its mechanism of action is believed to be mediated by the mu-opioid receptor. A further action of tramadol has been identified as blocking the reuptake of serotonin (5-HT). One of the most recently identified subtypes of 5-HT receptor is the 5-HT7 receptor. Thus, the authors aimed to examine the potential role of serotonergic descending bulbospinal pathways and spinal 5-HT7 receptors compared with that of the 5-HT2A and 5-HT3 receptors in the antinociceptive and antihyperalgesic effects of tramadol and its major active metabolite O-desmethyltramadol (M1) on phasic and postoperative pain models.

Methods: Nociception was assessed by the radiant heat tail-flick and plantar incision test in male Balb-C mice (25-30 g). The serotonergic pathways were lesioned with an intrathecal injection of 5,7-dihydroxytryptamine. The selective 5-HT7, 5-HT2, and 5-HT3 antagonists; SB-269970 and SB-258719; ketanserin and ondansetron were given intrathecally.

Results: Systemically administered tramadol and M1 produced antinociceptive and antihyperalgesic effects. The antinociceptive effects of both tramadol and M1 were significantly diminished in 5-HT-lesioned mice. Intrathecal injection of SB-269970 (10 microg) and SB-258719 (20 microg) blocked both tramadol- and M1-induced antinociceptive and antihyperalgesic effects. Ketanserin (20 mumicrog) and ondansetron (20 microg) were unable to reverse the antinociceptive and antihyperalgesic effects of tramadol and M1.

Conclusions: These findings suggest that the descending serotonergic pathways and spinal 5-HT7 receptors play a crucial role in the antinociceptive and antihyperalgesic effects of tramadol and M1.
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http://dx.doi.org/10.1097/ALN.0b013e3181cd7920DOI Listing
March 2010

Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures.

Paediatr Anaesth 2009 May;19(5):500-6

Department of Anaesthesiology and Reanimation, Hacettepe University, Sihhiye, Ankara 06100, Turkey.

Background: With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation.

Methods And Materials: Sixty consenting American Society of Anesthesia physical status I-III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double-blinded, institutional review board approved protocol. Group 1 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + ketamine 0.5 mg.kg(-1), and group 2 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + same volume of %0.9 NaCl intravenously.

Results: While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus.

Conclusions: In conclusion, addition of low dose ketamine to propofol-fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.
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http://dx.doi.org/10.1111/j.1460-9592.2009.02971.xDOI Listing
May 2009

The effects of maternal presence during anesthesia induction on the mother's anxiety and changes in children's behavior.

Turk J Pediatr 2008 Nov-Dec;50(6):566-71

Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey.

This study aimed to evaluate whether maternal presence during induction has additional beneficial effects on a mother's anxiety or changes in the child's behavior when an information booklet was given to all mothers and premedication was given to all patients. One hundred children, aged 2-10 years, scheduled for ambulatory surgery were randomly assigned to a mother-present (Group M) or mother-absent group (Group C) after premedication with intranasal midazolam. All mothers were informed about general anesthesia with a detailed information booklet. Preoperatively (pre) and one week after the operation (post), maternal anxiety was assessed using State-Trait Anxiety Inventory (STAI), and Posthospitalization Behavior Questionnaire (PHBQ) was used to measure changes in children's behavior. Anesthesia was induced using sevoflurane-oxygen-nitrous oxide inhalation. The anesthesiologist graded the level of the children's stress at anesthesia induction with a four-point scale. There were no differences between the two groups regarding demographics, anxiety levels of the mothers and postoperative behavioral changes and stress scores of the children (p>0.05 between the groups *p<0.005 within groups). In summary, maternal presence during induction in addition to premedication for children and information booklets for mothers had no additive effects in terms of reducing the mother's or the child's anxiety or postoperative behavioral changes.
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March 2009

Dexmedetomidine as a substitute for remifentanil in ambulatory gynecologic laparoscopic surgery.

Saudi Med J 2009 Jan;30(1):77-81

Anaesthesiology and Reanimation Department, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Objective: To compare dexmedetomidine with remifentanil in desflurane based ambulatory gynecologic laparoscopic surgery, in respect to its effects on orientation, discharge time, nausea-vomiting, and postoperative analgesic need.

Methods: Sixty 20-40 year old ASA I-II patients undergoing gynecologic laparoscopic surgery were randomized into 2 groups. This study was performed in the operating theaters of the Hacettepe University Faculty of Medicine, Hacettepe, Turkey in 2004 as a prospective, randomized, and double blinded study. The remifentanil group (group R), and dexmedetomidine group (group D) received a bolus of 1 microg/kg over 10 minutes, followed by 0.2 microg/kg/minute peroperative infusion of remifentanil, and 0.4 microg/kg/hour of dexmedetomidine. Hemodynamic parameters, time to extubation, and to orientation to person, place, and date, postoperative nausea, vomiting, pain, analgesic requirement at home, and satisfaction with anesthesia were recorded.

Results: Demographic, hemodynamic data, postoperative pain scores, and discharge time were similar in both groups. Time to extubation, to orientation to person, to place and date were shorter in group R. Postoperative nausea, vomiting, and analgesic requirements at home were less in group D.

Conclusion: This study demonstrated that dexmedetomidine infusion causes a relatively slow recovery with reduced postoperative nausea, vomiting, and analgesic requirements, and similar hemodynamics compared to remifentanil in ambulatory laparoscopic surgeries. It may be an alternative to remifentanil in ambulatory anesthesia.
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January 2009

Doctors' opinions, knowledge and attitudes towards cancer pain management in a university hospital.

Agri 2008 Apr;20(2):20-30

Hacettepe University Faculty Of Medicine Department Of Anesthesiology, 06100 Ankara, Turkey.

Cancer pain management is still reported to be inadequate despite of recent developments in medicine, resulting in serious outcomes. This study is to evaluate opinions, knowledge and attitudes of doctors working and/or being trainedg in surgical and medical departments in our university hospital, towards cancer pain management via a questionnaire. Of all doctors approached, eighty percent could be reached and 83% of them completed the questionnaire. In this group of doctors, reportedly 60% evaluating cancer patients with pain at least once in a week, most had not have any formal education about cancer pain management during their medical school or residency training and the ones reporting "any" education, described this as "limited in quality and as hours of lessons" and were not satisfied. The results of this survey suggest specific targets for the strategic and educational projects to overcome some of the barriers against the optimal cancer pain management. Most of the doctors believe that barriers originating from health professionals and systems are more important than the ones resulting from patients and give high priority to treatment of cancer pain relative to the treatment of cancer; but still half of them report that legal regulations have some influence on opioid prescription; and almost three quarters of them believe that opioid use may cause high rates of psychological addiction or abuse. Two thirds of the doctors feel themselves "insufficient" in cancer pain management, being more prominent in tasks requiring knowledge, skill, education and experience about opioid use.
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April 2008

Effect of intraarticular injection of lornoxicam on the articular cartilage & synovium in rat.

Indian J Med Res 2008 Apr;127(4):362-5

Hacettepe University, Departments of Anesthesiology & Reanimation, Ankara, Turkey.

Background & Objective: Intraarticular (i.a) drug application is consider to be a new therapeutic approach for the treatment of postoperative pain after arthroscopic knee surgery without any systemic adverse effects. Lornoxicam, a nonsteroid anti-inflammatory drug is a short acting agent, and its anti-inflammatory and analgesic activity may be effective in the postoperative pain management in minor surgery. In this study, the effects of intraarticular administration of lornoxicam on the synovium and articular cartilage in the rat knee joint were investigated.

Methods: Lornoxicam (0.25 ml) was given as an injection into the right knee joint and 0.25 ml of 0.9 per cent saline solution by injection into the left knee joint as a control in 25 rats. Groups of five rats were sacrificed by a lethal injection of ketamine 1st, 2nd, 7th, 14th and 21st days after lornoxicam administration. Knee joints were detached, fixed in 10 per cent buffered formalin and decalcified. Serial sections of 5 microm were stained with haematoxylin-eosin and evaluated for the presence of inflammation in the articular, periarticular regions and synovium. Inflammatory changes in the joints were graded according to a five-point scale, histologically.

Results: There were no significant differences in inflammation and cartilage degeneration, between control and lornoxicam applied knees. Grade 3 inflammatory changes occurred only in one knee in lornoxicam group, at 24 h after injection. No pathological changes were observed in both groups at any time point.

Interpretation & Conclusion: Lornoxicam did not show significant effect on inflammation on rat synovia in knee joint. Further studies including in human need to be done before any recommendations are made for i.a. administration of lornoxicam.
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April 2008

Influence of sevoflurane and desflurane on neurological and adaptive capacity scores in newborns.

Saudi Med J 2008 Jun;29(6):841-6

Department of Anesthesiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objectives: To evaluate maternal and neonatal effects of desflurane compared with the sevoflurane for general anesthesia for cesarean section.

Methods: The study was conducted as a prospective randomized blind study between January 2003 to January 2004 at the Hacettepe University, Ankara, Turkey. One hundred and two American Society of Anesthesiologists (ASA) I patients aged between 20-35 at 37-42 weeks of pregnancy were randomly allocated into 2 groups. All patients received thiopental and succinylcholine for induction. Patients assigned to the first group received desflurane 2.5%, and the second group sevoflurane 1.5% combined with 50% nitrous oxide and oxygen. Maternal blood loss, umbilical arterial blood gas values, delivery intervals, Apgar scores, and neurologic and adaptive capacity score (NACS) on the fifteenth minute, second hour, and twenty-fourth hour of age were evaluated to assess the neonatal status.

Results: One hundred and two (52 sevoflurane group, 50 desflurane group) parturients were included in the study. In the desflurane group, NACS were significantly better on the fifteenth minute and second hour evaluations. There were no statistically significant differences in twenty-fourth hour NACS evaluations, Apgar scores, umbilical arterial blood gas values, delivery times, and maternal blood loss between the groups.

Conclusion: Desflurane anesthesia offers more favorable results compared to sevoflurane in newborns delivered by elective cesarean section under general anesthesia in the early hours after delivery.
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June 2008

Mercury intoxication and neuropathic pain.

Paediatr Anaesth 2008 May 28;18(5):440-2. Epub 2008 Feb 28.

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http://dx.doi.org/10.1111/j.1460-9592.2008.02452.xDOI Listing
May 2008

The efficacy of ketamine for the treatment of postoperative shivering.

Anesth Analg 2008 Jan;106(1):120-2, table of contents

Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey.

Background: There are few reports on the utility of ketamine for the prevention of postoperative shivering. We thus established the efficacy of two doses of ketamine compared with meperidine for the treatment of postoperative shivering.

Methods: This is a prospective, randomized double-blind study involving 90 ASA I-II patients after general anesthesia. Patients with shivering grade 3-4 were allocated to receive either meperidine 25 mg, ketamine 0.5 mg/kg, or ketamine 0.75 mg/kg IV. Shivering and side effects were monitored at set time intervals.

Results: Shivering grades for the first 4 min after treatment were lower in the ketamine groups; however, nystagmus and feeling like "walking in space" was experienced with both doses of ketamine.

Conclusion: Ketamine 0.5-0.75 mg/kg is more rapid than meperidine (25 mg) for the reduction of postoperative shivering, but the side effect profile may limit its usefulness.
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http://dx.doi.org/10.1213/01.ane.0000296458.16313.7cDOI Listing
January 2008
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