Publications by authors named "Ozlem Korkmaz Dilmen"

26 Publications

  • Page 1 of 1

Effects of propofol, desflurane, and sevoflurane on respiratory functions following endoscopic endonasal transsphenoidal pituitary surgery: a prospective randomized study.

Korean J Anesthesiol 2019 12 11;72(6):583-591. Epub 2019 Oct 11.

Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine, University of Istanbul-Cerrahpasa, Istanbul, Turkey.

Background: General anesthesia with intravenous or inhalation anesthetics reduces respiratory functions. We investigated the effects of propofol, desflurane, and sevoflurane on postoperative respiratory function tests.

Methods: This single-center randomized controlled study was performed in a university hospital from October 2015 to February 2017. Ninety patients scheduled for endoscopic endonasal transsphenoidal pituitary surgery were randomly categorized into either of these three groups: propofol (n = 30, the Group TIVA), desflurane (n = 30, the Group D) or sevoflurane (n = 30, the Group S). We analyzed the patients before, after, and 24 h following surgery, to identify the following parameters: forced expiratory volume in 1 second (FEV1) %, forced vital capacity (FVC) %, FEV1/FVC, and arterial blood gases (ABG). Furthermore, we also recorded the intraoperative dynamic lung compliance and airway resistance values.

Results: We did not find any significant differences in FEV1 values (primary outcome) among the groups (P = 0.336). There was a remarkable reduction in the FEV1 and FVC values in all groups postoperatively relative to the baseline (P < 0.001). The FVC, FEV1/FVC, ABG analysis, compliance, and airway resistance were similar among the groups. Intraoperative dynamic compliance values were lower at the 1st and 2nd hours than those immediately after intubation (P < 0.001).

Conclusions: We demonstrated that propofol, desflurane, and sevoflurane reduced FEV1 and FVC values postoperatively, without any significant differences among the drugs.
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http://dx.doi.org/10.4097/kja.19336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900426PMC
December 2019

The Effects of Locally Administered Morphine Over the Dura on Postoperative Morphine Consumption and Pain After Lumbar Disc Surgery: A Prospective, Randomised, Double-Blind and Placebo-Controlled Study.

Turk J Anaesthesiol Reanim 2019 Aug 21;47(4):301-306. Epub 2019 Feb 21.

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

Objective: Effective pain management by avoiding side effects in the perioperative period is essential for patient outcome. Lumbar disc surgery is associated with moderate to severe postoperative pain, and opioids are widely used. The primary aim of the present study was to compare the effects of 1 mg and 2 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura on morphine consumption, and the secondary aims were to compare pain scores and opioid-related side effects during postoperative 24 h.

Methods: The study included 44 patients (American Society of Anesthesiologists I and II). After the discectomy procedure and before the closure, in Group A (n=15), 1 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura was used. In Group B (n=14), 2 mg morphine was used for the same technique, and in Group C (n=15) (control), normal saline was used. All patients used intravenous morphine patient-controlled analgesia pumps for 24 h following lumbar disc surgery. Morphine consumption, pain scores and opioid-related side effects were recorded at 10 min, 1, 2, 6, 12 and 24 h postoperatively.

Results: Morphine consumption, pain scores and opioid-related side effects were similar among the groups.

Conclusion: Morphine-impregnated absorbable cellulose haemostat material placement over the dura after single level lumbar discectomy did not reduce postoperative morphine consumption, pain scores and incidence of opioid-related side effects.
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http://dx.doi.org/10.5152/TJAR.2019.77854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645841PMC
August 2019

The Role of Neuroprotection in Subarachnoid Haemorrhage.

Turk J Anaesthesiol Reanim 2018 Dec 1;46(6):479. Epub 2018 Dec 1.

Department of Anesthesiology and Intensive Care, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey.

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http://dx.doi.org/10.5152/TJAR.2018.30633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223876PMC
December 2018

The role of "Integrated Pulmonary Index" monitoring during morphine-based intravenous patient-controlled analgesia administration following supratentorial craniotomies: a prospective, randomized, double-blind controlled study.

Curr Med Res Opin 2018 11 5;34(11):2009-2014. Epub 2018 Aug 5.

a Department of Anesthesiology and Intensive Care, Cerrahpasa School of Medicine , University of Istanbul , Turkey.

Objective: Morphine is commonly used in post-operative analgesia, but opioid-related respiratory depression causes a general reluctance for its use. The "Integrated Pulmonary Index" is a tool calculated from non-invasively obtained respiratory and hemodynamic parameters. The aim of this prospective, randomized, double blind, and placebo-controlled study is to determine a more safe and effective dose for morphine in patient-controlled analgesia following supratentorial craniotomy using the "Integrated Pulmonary Index".

Methods: This study included 60 patients (ASA I, II, and III). All patients used iv PCA for 24 h following supratentorial craniotomy. The PCA was set to administer a bolus dose of 1 mg morphine in Group 1 and 0.5 mg morphine in Group 2. The PCA contained placebo in Group 3 and patients received dexketoprofen 50 mg iv after awakening, repeated every 8 h. The IPI and NRS scores, total morphine consumption, and morphine related side-effects were recorded at 10 min, 1, 2, 6, 12, and 24 h post-operatively. The lowest IPI score, count of apnea, and desaturation events were recorded during the study period.

Results: The IPI scores were similar among the groups. Although a statistically significant difference was not observed among the groups the lowest IPI scores were observed in Group 1; apnea and desaturation counts were also higher in Group 1. Statistically significant differences were not observed among the groups in terms of pain scores, but were lower in Groups 1 and 2 compared to Group 3.

Conclusion: Patient controlled analgesia with 0.5 mg morphine may be safe and effective for pain management following supratentorial craniotomies. Integrated pulmonary index can be used for detecting opioid-induced respiratory depression. Clinical Trials registration number: NCT02929147.
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http://dx.doi.org/10.1080/03007995.2018.1501352DOI Listing
November 2018

Can Amantadine Ameliorate Neurocognitive Functions After Subarachnoid Haemorrhage? A Preliminary Study.

Turk J Anaesthesiol Reanim 2018 Apr 1;46(2):100-107. Epub 2018 Apr 1.

Department of Anesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.

Objective: Aneurysmal subarachnoid haemorrhage (SAH) may have devastating effects on patients. Motor and neurocognitive impairments may arise depending on the location and grade of the SAH. Although the effects of amantadine on neurocognitive function after traumatic brain injury have been widely studied to the best of our knowledge, their effects on recovery from SAH in humans have not been studied. The present study aimed to evaluate how amantadine influences improvement in neurocognitive function in patients with aneurysmal SAH over a period of six months.

Methods: This preliminary study included 12 patients with aneurysmal SAH who were admitted to the neurointensive care unit of Cerrahpasa Faculty of Medicine. Patients in Group A (n=5) received the standard treatment for SAH and amantadine for 30 days after admission, and those in Group C (n=7) received only the standard treatment. Neurocognitive function was evaluated using the Coma Recovery Scale-Revised and Disability Rating Scale on the first and fifth days and at the third and sixth months after admission. The primary endpoint of the present study was to compare the effects of amantadine in combination with the standard treatment to those of the standard treatment alone on the neurocognitive function of patients with SAH for over 6 months.

Results: Compared to the standard treatment alone, amantadine administration with the standard treatment during the early period of SAH may improve recovery.

Conclusion: Amantadine along with the standard treatment can ameliorate neurocognitive function after SAH.
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http://dx.doi.org/10.5152/TJAR.2018.20280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937455PMC
April 2018

Is CPAP treatment not effective after supratentorial craniotomy? Author's reply.

J Clin Anesth 2018 03 22;45:52. Epub 2017 Dec 22.

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

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http://dx.doi.org/10.1016/j.jclinane.2017.12.015DOI Listing
March 2018

Pain management in spine surgery.

J Clin Anesth 2018 03 19;45:29. Epub 2017 Dec 19.

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

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http://dx.doi.org/10.1016/j.jclinane.2017.12.013DOI Listing
March 2018

Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: A prospective randomized controlled study.

J Clin Anesth 2017 Nov 7;42:31-35. Epub 2017 Aug 7.

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

Study Objective: Volume controlled ventilation with low PEEP is used in neuro-anesthesia to provide constant PaCO levels and prevent raised intracranial pressure. Therefore, neurosurgery patients prone to atelectasis formation, however, we could not find any study that evaluates prevention of postoperative pulmonary complications in neurosurgery.

Design: A prospective, randomized controlled study.

Setting: Intensive care unit in a university hospital in Istanbul.

Patients: Seventy-nine ASAI-II patients aged between 18 and 70years scheduled for elective supratentorial craniotomy were included in the study.

Interventions: Patients randomized into 3 groups after surgery. The Group IS (n=20) was treated with incentive spirometry 5 times in 1min and 5min per hour, the Group CPAP (n=20) with continuous positive airway pressure 10 cmHO pressure and 0.4 FO via an oronasal mask 5min per hour, and the Group Control (n=20) 4L·minO via mask; all during the first 6h postoperatively. Respiratory functions tests and arterial blood gases analysis were performed before the induction of anesthesia (Baseline), 30min, 6h, 24h postoperatively.

Main Results: The IS and CPAP applications have similar effects with respect to FVC values. The postoperative 30min FEV values were statistically significantly reduced compared to the Baseline in all groups (p<0.0001). FEV values were statistically significantly increased at the postoperative 24h compared to the postoperative 30min in the Groups IS and CPAP (p<0.0001). This increase, however, was not observed in the Group Control, and the postoperative 24h FEV values were statistically significantly lower in the Group Control compared to the Group IS (p=0.015).

Conclusion: Although this study is underpowered to detect differences in FEV values, the postoperative 24h FEV values were significantly higher in the IS group than the Control group and this difference was not observed between the CPAP and Control groups. It might be evaluate a favorable effect of IS in neurosurgery patients. But larger studies are needed to make a certain conclusion.
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http://dx.doi.org/10.1016/j.jclinane.2017.08.010DOI Listing
November 2017

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

Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration.

Clin Neurol Neurosurg 2017 Mar 30;154:98-103. Epub 2017 Jan 30.

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

Objectives: The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h.

Methods: This prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared.

Results: The scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period.

Conclusion: The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.
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http://dx.doi.org/10.1016/j.clineuro.2017.01.018DOI Listing
March 2017

Does preoperative oral carbohydrate treatment reduce the postoperative surgical stress response in lumbar disc surgery?

Clin Neurol Neurosurg 2017 Feb 29;153:82-86. Epub 2016 Dec 29.

VKF, American Hospital, Department of General Intensive Care Unit, Turkey. Electronic address:

Objectives: Surgical trauma produces metabolic and hormonal responses, which are characterized by insulin resistance. Due to extension of the preoperative fasting period, which increases the magnitude of postoperative insulin resistance, preoperative oral carbohydrates (POC) have been developed.

Patients And Methods: This prospective, randomized, controlled study was performed on 43 ASA I-II patients undergoing elective microsurgical lumbar discectomy. The intervention group received oral carbohydrate solution 800mL the night before and 400mL 2h prior to operation. The other group fasted for 8h prior to operation. Blood samples were obtained the day before the operation, before induction of anesthesia, after skin incision, 1h, 2h, 6h and 24h following skin incision. Blood glucose, plasma insulin, cortisol and interleukin-6 (IL-6) levels were determined. The primary endpoint was to assess the effect of POC treatment on insulin resistance and surgical stress response following lumbar disc surgery. The secondary endpoint was to assess POC's effects on postoperative nausea and vomiting.

Results: The serum insulin levels were higher before induction of anesthesia in the study group and returned to fasted group levels by 2h after skin incision. The plasma IL-6 levels were higher in the intervention group at 6h after the skin incision. There were no differences between the two groups with respect to blood glucose, plasma cortisol levels and the incidence of nausea and vomiting.

Conclusion: This study suggests that use of POC treatment does not attenuate development of insulin resistance in patients undergoing lumbar disc surgery.
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http://dx.doi.org/10.1016/j.clineuro.2016.12.016DOI Listing
February 2017

Lithium Intoxication Accompanied by Hyponatremia.

Turk J Anaesthesiol Reanim 2016 Aug 1;44(4):219-221. Epub 2016 Aug 1.

General Intensive Care Unit VKF American Hospital, İstanbul, Turkey.

Lithium is frequently used in the management of bipolar affective disorders. It has a narrow therapeutic index and can cause acute or chronic intoxication. Toxic symptoms may be present even when concentrations are within the recommended therapeutic range. We believe that lithium intoxication is a very important issue for a physician. In this report, we aimed to evaluate the pathophysiological view of two chronic lithium intoxication cases accompanied by hyponatremia.
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http://dx.doi.org/10.5152/TJAR.2016.74317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019874PMC
August 2016

Comparison of Conscious Sedation and Asleep-Awake-Asleep Techniques for Awake Craniotomy.

J Clin Neurosci 2017 Jan 19;35:30-34. Epub 2016 Oct 19.

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

Since awake craniotomy (AC) has become a standard of care for supratentorial tumour resection, especially in the motor and language cortex, determining the most appropriate anaesthetic protocol is very important. The aim of this retrospective study is to compare the effectiveness of conscious sedation (CS) to "awake-asleep-awake" (AAA) techniques for supratentorial tumour resection. Forty-two patients undergoing CS and 22 patients undergoing AAA were included in the study. The primary endpoint was to compare the CS and AAA techniques with respect to intraoperative pain and agitation in patients undergoing supratentorial tumour resection. The secondary endpoint was comparison of the other intraoperative complications. This study results show that the incidence of intraoperative agitation and seizure were lower in the AAA group than in the CS group. Intraoperative blood pressures were significantly higher in the CS group than in the AAA group during the pinning and incision, but the level of blood pressures did not need antihypertensive treatment. Otherwise, blood pressures were significantly higher in the AAA group than in the CS group during the neurological examination and the severity of hypertension needed statistically significant more antihypertensive treatment in the AAA group. As a result of hypertension, the amount of intraoperative bleeding was higher in the AAA group than in the CS group. In conclusion, the AAA technique may provide better results with respect to agitation and seizure, but intraoperative hypertension needed a vigilant follow-up especially in the wake-up period.
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http://dx.doi.org/10.1016/j.jocn.2016.10.007DOI Listing
January 2017

Letter to the Editor: Intraoperative neurophysiological monitoring: an anesthesiologist's point of view.

Neurosurg Focus 2016 Sep;41(3):E17

University of Istanbul, Cerrahpasa School of Medicine, Istanbul, Turkey.

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http://dx.doi.org/10.3171/2016.3.FOCUS16103DOI Listing
September 2016

Anaesthetic Management in Costello Syndrome.

Turk J Anaesthesiol Reanim 2015 Dec 1;43(6):427-30. Epub 2015 Dec 1.

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

Costello syndrome is a rare genetic disorder characterised by growth and mental retardation, macrocephaly, short neck and macroglossia. Cardiac involvement can also occur in Costello syndrome and is presented in the form of hypertrophic cardiomyopathy, tachyarrythmias and valvular dysfunction. Nervous system involvement including ventriculomegaly, hydrocephaly and Chiari type 1 malformation are also common. Predisposition of papillomata and malignant tumours are high. General anaesthesia practice in patients with Costello syndrome may be complicated by difficult airway because of macrocephaly, short neck, macroglossia and oral or laryngeal papillomas. The airway management and cardiac abnormalities are the major concerns of an anaesthesiologist in Costello syndrome. We report the anaesthetic management of ventriculo-peritoneal shunt replacement for hydrocephaly in an 18-month-old child with Costello syndrome.
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http://dx.doi.org/10.5152/TJAR.2015.93546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894188PMC
December 2015

Management of Severe Paroxysmal Sympathetic Hyperactivity Following Hypoxic Brain Injury.

Turk J Anaesthesiol Reanim 2015 Aug 3;43(4):297-8. Epub 2015 Mar 3.

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

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http://dx.doi.org/10.5152/TJAR.2015.82957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917148PMC
August 2015

Methods used to measure postoperative insulin resistance.

Int Urol Nephrol 2017 04 1;49(4):647. Epub 2016 Jul 1.

Department of Anaesthesia and Intensive Care, Cerrahpasa Medical Faculty, University of Istanbul, Cerrahpasa, 34098, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s11255-016-1322-zDOI Listing
April 2017

Fever treatment with a catheter-based heat exchange system in the neurointensive care unit.

Anaesthesiol Intensive Ther 2016 7;48(3):208-10. Epub 2016 Jun 7.

University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology& Intensive Care.

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http://dx.doi.org/10.5603/AIT.a2016.0032DOI Listing
March 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

Intensive Care Treatment in Traumatic Brain Injury.

Turk J Anaesthesiol Reanim 2015 Feb 9;43(1):1-6. Epub 2014 Dec 9.

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

Head injury remains a serious public problem, especially in the young population. The understanding of the mechanism of secondary injury and the development of appropriate monitoring and critical care treatment strategies reduced the mortality of head injury. The pathophysiology, monitoring and treatment principles of head injury are summarised in this article.
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http://dx.doi.org/10.5152/TJAR.2014.26680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917118PMC
February 2015

The Effect of BIS Usage on Anaesthetic Agent Consumption, Haemodynamics and Recovery Time in Supratentorial Mass Surgery.

Turk J Anaesthesiol Reanim 2014 Jun 11;42(3):117-22. Epub 2014 Mar 11.

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

Objective: In this study, we aimed to compare Bispectral Index (BIS) monitoring with the conventional anaesthesia approach based on haemodynamic changes in terms of anaesthetic agent consumption, haemodynamic recordings, recovery time and cost.

Methods: This study was performed in 82 patients, aged 20 to 60 years, who were operated for supratentorial mass and were graded ASA I or II. Cases were randomly divided into two equal groups. In the standard control group haemodynamic parameters were used to determine depth of anaesthesia and in the BIS group, BIS monitoring was applied. In the BIS group the BIS values were kept between 40 and 60; in the control group haemodynamic changes within the range of +/-20% of initial values were controlled using appropriate anaesthetic practice. Haemodynamic parameters, awakening conditions and drug usage were recorded.

Results: The difference between the two groups in terms of timing of eye opening and initial spontaneous breath was not statistically significant. The 'Aldrete' score at the 20(th) postoperative minute for the BIS group was significantly higher than the score calculated for the control group (p<0.05). Rocuronium consumption (mg kg(-1) hr(-1)) was significantly lower in the BIS group than the control group (p<0.05). Although a statistically significant difference (p<0.05) was found between the two groups in terms of initial heart rate and SpO2 values, there was no clinically significant difference in other haemodynamic parameters.

Conclusion: Although using BIS monitoring to evaluate depth of anaesthesia does not bring much benefit versus the use of haemodynamic parameters, it may be beneficial for selected surgeries such as awake craniotomy, for patients with a history of awareness and in haemodynamically unstable patients.
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http://dx.doi.org/10.5152/TJAR.2014.24892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894218PMC
June 2014

Efficacy of intravenous paracetamol and dexketoprofen on postoperative pain and morphine consumption after a lumbar disk surgery.

J Neurosurg Anesthesiol 2013 Apr;25(2):143-7

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, 34098 Istanbul, Turkey.

Background: We compared the analgesic effects of intravenous (IV) paracetamol with that of dexketoprofen on postoperative pain and morphine consumption during the first 24 hour after a lumbar disk surgery.

Methods: This prospective, placebo-controlled, double blind study investigated the analgesic effects of IV paracetamol and dexketoprofen on postoperative pain, morphine consumption, and morphine-related side effects after a lumbar disk surgery. Sixty American Society of Anesthesiologists 1 or 2 status patients scheduled for elective lumbar disk surgery under general anesthesia were included in the study. Patients were treated using patient-controlled analgesia with morphine for 24 hours after a lumbar disk surgery and randomized to receive IV paracetamol 1 g, dexketoprofen 50 mg, or isotonic saline (placebo). The primary endpoint was pain intensity measured by the visual analogue scale, and secondary endpoints were morphine consumption and related side effects.

Results: Pain intensity was lower in the dexketoprofen group (P=0.01) but not in the paracetamol group (P=0.21) when compared with the control group. Cumulative morphine consumption and morphine-related side effects did not reveal significant differences between the groups.

Conclusions: The study showed that pain intensity during 24 hours after the lumbar disk surgery was significantly lowered by dexketoprofen, but not with paracetamol, as a supplemental analgesic to morphine patient-controlled analgesia when compared with controls.
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http://dx.doi.org/10.1097/ANA.0b013e31827464afDOI Listing
April 2013

Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases.

Turk Neurosurg 2011 ;21(4):634-40

Istanbul University, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Intensive Care, 34098 Istanbul, Turkey.

Aim: The sitting position is routinely used in many centers, although its use remains controversial and appears to be diminishing because of the risk of venous air embolism (VAE).

Material And Methods: This is a retrospective analysis of 601 adult and 91 pediatric cases underwent neurosurgery from January 1995 through December 2010 in the sitting position. The incidence of VAE and other complications related to the sitting position has been determined. VAE was defined as a sudden and sustained decrease of end-tidal carbon dioxide (ETCO2) ≥0.7 kPa.

Results: The incidence of VAE in children and adults were found to be 26.3% (n=24) and 20.4% (n=123) consecutively but the difference was not significant. The incidence of positioning induced hypotension was more in adults (37.6%) compared to children (18.6%, p=0.00001). The presence of COPD (p=0.04) and ASA status (p=0.03) showed a correlation with 'hypotension with positioning'. There was no peroperative mortality.

Conclusion: The study provides a significant body of data on neuroanesthesia for the sitting position and our results suggest that if the sitting position is a neurosurgical necessity it can be used with vigilant follow up throughout the procedure to detect any occurrence of VAE by ETCO2 monitoring if you do not have the chance to use more sensitive tools.
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http://dx.doi.org/10.5137/1019-5149.JTN .4974-11.0DOI Listing
April 2012

A comparison of the TruView EVO2 and macintosh laryngoscope blades.

Clinics (Sao Paulo) 2011 ;66(4):709-11

Department of Anesthesiology, Cerrahpasa Medical Faculty, Istanbul University, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093804PMC
http://dx.doi.org/10.1590/s1807-59322011000400029DOI Listing
December 2011

Effect of arterial blood pressure on the arterial to end-tidal carbon dioxide difference during anesthesia induction in patients scheduled for craniotomy.

J Neurosurg Anesthesiol 2010 Oct;22(4):303-8

Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.

Background: Before obtaining results of arterial blood gas analysis in mechanically ventilated patients undergoing neurosurgery, the volume of ventilation is primarily adjusted according to endtidal CO2 (EtCO2). We characterized the impact of various arterial blood pressure changes on arterial PCO2 (PaCO2) to EtCO2 differences (PaCO2-EtCO2) in patients anesthetized for craniotomy.

Methods: Seventy-two elective craniotomy patients were enrolled in this prospective study. Noninvasive blood pressure was measured before anesthesia induction. Anesthesia was induced with thiopental, rocuronium or suxamethonium, and fentanyl and was maintained with inhaled anesthetics or propofol and remifentanil. Volume-controlled ventilation was adjusted after intubation according to the clinical judgment. The first arterial blood gas analysis was taken just before the head pinning. Systolic, diastolic, and mean arterial blood pressures (MAP) and heart rate were registered after intubation every 5 minutes until the head pinning.

Results: PaCO2-EtCO2 correlated positively with percentage difference between MAP awake at arrival in operating room and during arterial CO2 determination (P=0.0008, r=0.388). In analysis according to a MAP decrease of less than 20% (n=17), 20% to 29% (n=24), 30% to 35% (n=16), and more than 35% (n=15), the mean (SD) PaCO2-EtCO2 was greater in patients with MAP decrease of over 35% or 30% to 35% than in patients with MAP decrease of less than 20%. The mean (SD) absolute values of the PaCO2-EtCO2 were 0.96 (0.43) kPa or 0.85 (0.31) kPa versus 0.55 (0.24) kPa, respectively (P<0.05 between categories). Mean EtCO2 was not different in the various MAP difference categories, but PaCO2 was greatest when MAP decreased more than 35% (P<0.05).

Conclusions: There was a positive correlation between PaCO2-EtCO2 and MAP decrease shortly after induction of anesthesia. PaCO2-EtCO2 is recommended to be interpreted together with change in MAP during early phase of neuroanesthesia to guarantee optimal mechanical ventilation.
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http://dx.doi.org/10.1097/ANA.0b013e3181e33791DOI Listing
October 2010

Efficacy of intravenous paracetamol, metamizol and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery.

Eur J Anaesthesiol 2010 May;27(5):428-32

Department of Anesthesia and Intensive Care, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.

Background And Objective: The combination of opioids with supplemental analgesics is commonly used for additive or synergistic analgesic effects. We aimed to determine the most advantageous supplemental analgesic for postoperative pain relief after lumbar disc surgery.

Methods: This prospective, placebo-controlled, randomized, double-blind study compared the effects of intravenous metamizol, paracetamol and lornoxicam on postoperative pain control, morphine consumption and side effects after lumbar disc surgery. Eighty patients with American Society of Anesthesiologists classification 1 or 2 scheduled for elective lumbar disc surgery under general anaesthesia were treated using patient-controlled analgesia with morphine until 24 h postoperatively and randomized to receive additional intravenous injections of metamizol 1 g, paracetamol 1 g, lornoxicam 8 mg or isotonic saline 0.9% (placebo). The primary endpoint was pain over 24 h after surgery measured by visual analogue scale. Secondary endpoints were morphine consumption and side effects.

Results: During the 24 h study period, pain was reduced in the metamizol (P = 0.001) and paracetamol (P = 0.04) groups, but not in the lornoxicam (P = 0.20) group compared with the control group. Further analysis revealed that pain scores in the metamizol group were significantly lower than in the lornoxicam group (P = 0.031). Although the rate of morphine consumption in the paracetamol group was decreased over time (P < 0.001), the total amounts of morphine consumed in 24 h were not different between groups. No significant differences with respect to morphine-related side effects were observed between groups.

Conclusion: Metamizol or paracetamol, but not lornoxicam, provides effective analgesia following lumbar disc surgery.
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http://dx.doi.org/10.1097/EJA.0b013e32833731a4DOI Listing
May 2010