Publications by authors named "Esra Sultan Karabulut"

3 Publications

  • Page 1 of 1

Effective and safe mannitol administration in patients undergoing supratentorial tumor surgery: A prospective, randomized and double blind study.

Clin Neurol Neurosurg 2017 Aug 15;159:55-61. Epub 2017 May 15.

University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Istanbul, Turkey. Electronic address:

Objectives: Although osmotic diuresis with mannitol is commonly used to provide brain relaxation, there is no consensus regarding its optimal dose and combination with loop diuretics. The aim of the present study is to evaluate the effects of mannitol and combination of furosemide with different doses of mannitol on brain relaxation and on blood electrolytes, lactate level, urine output, fluid balance and blood osmolarity in patients undergoing supratentorial tumor surgery.

Patients And Methods: This prospective, randomized, double blind, placebo-controlled study included 51 patients (ASA I-III) scheduled for elective supratentorial craniotomy. Different doses and combinations of diuretics were administered after the bone flap removal. The Group 1 received mannitol at 0.5gkg and furosemide at 0.5mgkg, the Group 2 received mannitol at 1gkg and furosemide at 0.5mgkg, and the Group 3 received mannitol at 0.5gkg and placebo. The primary end-point of the present study is to evaluate the effects of mannitol and combination of furosemide with different doses of mannitol on brain relaxation and the secondary end-points are to evaluate their effects on blood electrolytes, lactate level, urine output, fluid balance and blood osmolarity.

Results: This study shows that mannitol alone (0.5gkg), and the combinations of furosemide (0.5mgkg) with different doses of mannitol (0.5gkg-1gkg) provides adequate brain relaxation. However, administration of furosemide with low or high doses of mannitol may cause reduction in the sodium and chloride levels as well as rise in the lactate level. Moreover it may cause high urine output and negative intra-operative fluid balance.

Conclusion: Administration of 0.5gkg mannitol provides adequate brain relaxation without causing systemic side effects in patients undergoing supratentorial tumor surgery. This study is registered to clinical trials (Clinical Trials.gov identifier NCT02712476).
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http://dx.doi.org/10.1016/j.clineuro.2017.05.018DOI Listing
August 2017

Postoperative analgesia for supratentorial craniotomy.

Clin Neurol Neurosurg 2016 Jul 4;146:90-5. Epub 2016 May 4.

Istanbul Bilim University, Department of Anesthesiology and Intensive Care, Turkey. Electronic address:

Objectives: The prevalence of moderate to severe pain is high in patients following craniotomy. Although optimal analgesic therapy is mandatory, there is no consensus regarding analgesic regimen for post-craniotomy pain exists. This study aimed to investigate the effects of morphine and non-opioid analgesics on postcraniotomy pain.

Patients And Methods: This prospective, randomized, double blind, placebo controlled study included eighty three patients (ASA 1, II, and III) scheduled for elective supratentorial craniotomy. Intravenous dexketoprofen, paracetamol and metamizol were investigated for their effects on pain intensity, morphine consumption and morphine related side effects during the first 24h following supratentorial craniotomy. Patients were treated with morphine based patient controlled analgesia (PCA) for 24h following surgery and randomized to receive supplemental IV dexketoprofen 50mg, paracetamol 1g, metamizol 1g or placebo. The primary endpoint was pain intensity, secondary endpoint was the effects on morphine consumption and related side effects.

Results: When the whole study period was analyzed with repeated measures of ANOVA, the pain intensity, cumulative morphine consumption and related side effects were not different among the groups (p>0.05).

Conclusion: This study showed that the use of morphine based PCA prevented moderate to severe postoperative pain without causing any life threatening side effects in patients undergoing supratentorial craniotomy with a vigilant follow up during postoperative 24h. Although we could not demonstrate statistically significant effect of supplemental analgesics on morphine consumption, it was lower in dexketoprofen and metamizol groups than control group.
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http://dx.doi.org/10.1016/j.clineuro.2016.04.026DOI Listing
July 2016

Perioperative Temperature Monitoring and Patient Warming: A Survey Study.

Turk J Anaesthesiol Reanim 2013 Oct 1;41(5):149-55. Epub 2013 Oct 1.

Department of Anaesthesiology and Reanimation, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey.

Objective: Hypothermia is defined as the decrease of core body temperature under 36°C. Hypothermia is observed at a rate of 50-90% in the perioperative period. In our study, we aimed to measure the perception of hypothermia in our country, to evaluate the measures taken by physicians to intercept hypothermia, to determine the frequency and the methods used to monitor body temperature and the techniques used in warming the patients. Another aim was to develop a guideline for preventing perioperative hypothermia.

Methods: The questionnaire consisted of 26 multiple-choice questions. The time needed to answer the questions was 8-10 minutes.

Results: Of the 1380 individuals, 312 (22.6%) answered the questions in the questionnaire. Of these, 148 (47.4%) declared they were working in university hospitals, 80 (25.6%) in training and research hospitals, 51 (16.4%) in government hospitals and 33 (10.6%) in various private hospitals. Of the 312 individuals, 134 (42.9%) were specialists, 107 (34.3%) were resident physicians, 71 (22.8%) were academics. In addition, 212 (67.9%) reported working in operating rooms, 49 (15.7%) in intensive care units and 42 (13.5%) both in operating rooms and intensive care units. In the answers, there was variation among the hospital types in applications of body temperature monitoring and warming the patient. Another finding was that the individuals had different approaches to the concepts on perioperative hypothermia and its consequences.

Conclusion: The perceptions of physicians and the allied health personnel in government and private hospitals should be enhanced by informing them about the passive and active heating systems to prevent hypothermia. Although the situation in university and training and research hospitals seems to be better, defects are still observed in practice. Preparation of a national guideline for prevention of perioperative hypothermia is needed.
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http://dx.doi.org/10.5152/TJAR.2013.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894089PMC
October 2013
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