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    A Needle-Free Injection System (INJEX™) with lidocaine for epidural needle insertion: A randomized controlled trial
    (Professional Medical Publications, 2016) Gozdemir, Muhammet; Demircioglu, Ruveyda Irem; Karabayirli, Safinaz; Sert, Huseyin; Muslu, Bunyamin; Usta, Burhanettin; Yazici, Ummugulsum
    Objectives: Local anesthetic infiltration is also a process of a painful process itself. INJEX (TM) technology, known as Needle-free drug delivery system, was designed for reducing the pain associated with cutaneous procedures. We conducted a prospective, randomized trial to evaluate the application of lidocaine with INJEX (TM) system and 27-gauge needle. Methods: A total of 60 consecutive patients were allocated to receive either INJEX group or 27-gauge needle group. Local anesthetic infiltration was applied two minutes before epidural needle insertion. Results: Mean VAS, at the time of local anesthetic injection was 0 for group I and 2 for group II. When the effect of epidural needle insertion was compared, the mean VAS score was one versus two for Group-I versus Group-II, respectively. Lidocaine applied with the INJEX (TM) system before epidural needle insertion significantly reduced the intensity of pain during that procedure and was least effective the lidocaine applied with the 27-gauge needle and patients felt less pain during at the time of local anesthetic injection in Group-I. Conclusion: Needle-free delivery of lidocaine is an effective, easy to-use and noninvasive method of providing local anesthesia for the epidural needle insertion.
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    Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections
    (Medknow Publications & Media Pvt Ltd, 2015) Karabayirli, Safinaz; Keskin, Esra Aktepe; Kaya, Ahmet; Koca, Cemile; Erel, Ozcan; Demircioglu, Ruveyda Irem; Muslu, Bunyamin
    Background: We aimed to investigate the effects of general, spinal and epidural anesthesia on fetal total antioxidant status (TAS) and total oxidant status (TOS), and oxidative stress index (OSI) during elective cesarean section in this study. Materials and Methods: Forty-seven parturients scheduled for elective cesarean section were randomly allocated into three groups: Group spinal (n = 15), group epidural (n = 17), and group general (n = 15), This prospective randomized study was performed in Faculty of Medicine, Turgut Ozal University, Turkey. After the baby was delivered; TAS, TOS levels, and arterial blood gases parameters were analyzed in an umbilical arterial blood sample. OSI values are calculated by a ratio of TOS to the TAS. Results: The levels of TAS and TOS in umbilical arterial blood sample were not statistically different among three. However, OSI values were significantly different among the three groups (P = 0.042). Median OSI values is 24 (interquartile range [IQR], 2-37) in group spinal, 19 (IQR, 4-44) in group epidural, and 8 (IQR, 4-36) in group general. There was no significant difference in OSI values in the comparison of group spinal with group general and group epidural, but it was significantly lower in group general when compared with group epidural with Bonferroni correction (P = 0.017). Umbilical cord arterial blood gas values (pH, PaCO2 , PaO2 , SaO(2) , HCO3 , and CtO(2) ), glucose, lactate, and hemoglobin levels were similar in three groups. Conclusion: General anesthesia may be more favorable than epidural in those undergoing cesarean section when fetal oxidative status gains importance.
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    Evaluation of the effects of esmolol and remifentanil for controlled hypotension application on hemodynamics and oxidative stress parameters
    (Anaesthesia Pain & Intensive Care, 2020) Kasikara, Hulya; Demircioglu, Ruveyda Irem; Gozdemir, Muhammet; Karabayirli, Safinaz; Erdamar, Husamettin; Namuslu, Mehmet; Yazici, Ummugulsum
    Introduction: Anesthesia induced during a surgical intervention, the duration of the surgical intervention, and the surgical intervention itself tend to affect immune functions, resulting in the formation of free radicals in the metabolism. Free radicals can cause postoperative disorders by targeting biomolecules in the cell, such as lipids, carbohydrates, proteins, and DNA. In the present study, we used remifentanil or esmolol to induce a controlled hypotension in patients who were undergoing septorhinoplasty under general anesthesia, and we planned to compare the effect of these agents on hemodynamics and oxidative stress relative to the control group. Methodology: A total of 75 patients aged between 18 and 65 y, ASA I-II, planned to undergo elective septorhinoplasty, were included in this study. Patients were randomly divided into the following three groups: Group R (remifentanil group, n = 25); Group E (esmolol group, n = 25); and Group C (control, n = 25). Anesthesia was induced with 2 mg/kg propofol 2 mg/kg, fentanyl 1 mu g/kg, and rocuronium 0.6 mg/kg. Immediately after induction, Group R was started loading dose of remifentanil 1 mu g/kg/min, followed by infusion at 0.25-0.50 mu g/kg/min. In Group E, a loading dose of esmolol 500 mu g/kg was given for 1 min, then infusion was continued @ 150-300 mu g/kg. A targeted mean arterial pressure (MAP) of 55-65 mmHg was aimed. In Group C, remifentanil was infused at 0.1-0.2 mu g/kg/min until a MAP of 70-100 mmHg was reached. During operation; systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO(2)), EtCO2 (end tidal CO2) were recorded before induction, after induction, after intubation, at 5-min intervals during the first 30 min, and then at 10-min intervals during the intervention. The amounts of remifentanil and esmolol consumed by the patients during the operation were calculated and recorded. Blood samples that were taken twice, preoperatively and postoperatively, for malondialdehyde (MDA), superoxide dismutase (SOD), total oxidant level (TOL), total antioxidant level (TAL), and oxidative stress index (OSI). Results: MAP showed a greater decrease starting from the 25th min and 40th min after intubation in remifentanil group and esmolol group respectively, compared to the control group. In the remifentanil and control groups, there was a statistically significant decrease in the postoperative OSI levels compared to the preoperative levels. One the other hand, in the esmolol group, there was no statistically significant difference between the preoperative and postoperative median OSI levels. There was a significant increase in the postoperative TAL of the remifentanil group compared to the preoperative level. Conclusion: It was observed that during a hypotensive anesthesia induced by remifentanil or esmolol, remifentanil ensured more stable operating conditions in terms of hemodynamics compared with esmolol, and that remifentanil was also superior to esmolol in reducing oxidative stress.
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    Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil
    (Springer, 2017) Karabayirli, Safinaz; Ugur, Kadriye Serife; Demircioglu, Ruveyda Irem; Muslu, Bunyamin; Usta, Burhanettin; Sert, Huseyin; Ark, Nebil
    To compare dexmedetomidine with remifentanil in functional endoscopic sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic consumption and post-operative recovery. Randomized, double blind study. Tertiary care medical center. Fifty patients with nasal polyposis who had been scheduled for FESS were randomly divided into two groups. In group D (n = 25), dexmedetomidine 1 A mu g/kg infused intravenous (IV) over 10 min before anesthesia induction, followed by a continuous of 0.7 A mu g/kg/h infusion during operation. In group R (n = 25), 1 A mu g/kg remifentanil IV bolus, was administered with induction of anesthesia and continued 0.25-0.50 A mu g/kg/min during operation. Heart rates, mean arterial pressure, end tidal CO2, end tidal sevoflurane were recorded. The amount of bleeding, surgical field condition for bleeding and the time to reach Aldrete recovery score 9-10 were recorded. Postoperative nausea, vomiting, pain, shivering, sedation were followed up over 24 h. There was no significant difference between groups according to the amount of bleeding during surgery, assessment of surgical field condition, consumption of sevoflurane, scores of postoperative VAS, rates of nausea and vomiting, shivering, demands of additional analgesic medication (P > 0.05). The time to reach Aldrete recovery score 9-10, sedation scores at the postoperative first hour were significantly higher in group D (P = 0.001). We concluded that in comparison to remifentanil, dexmedetomidine during FESS for controlled hypotension is of limited value as it has no additional benefits in terms of control of hypotension and amount of bleeding in the surgical field and it is associated with higher recovery time and first-hour postoperative sedation scores.
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    The comparison of preincisional peritonsillar infiltration of ketamine and tramadol for postoperative pain relief on children following adenotonsillectomy
    (Elsevier Ireland Ltd, 2013) Ugur, Kadriye Serife; Karabayirli, Safinaz; Demircioglu, Ruveyda Irem; Ark, Nebil; Kurtaran, Hanifi; Muslu, Bunyamin; Sert, Huseyin
    Objective: To investigate and compare the effectiveness of preincisional peritonsillar infiltration of ketamine and tramadol for post-operative pain on children following adenotonsillectomy. Study design: Prospective randomized double blind controlled study. Methods: Seventy-five children aged 3-10 years undergoing adenotonsillectomy were included in study. Patients received injections in peritonsillar fossa of tramadol (2 mg/kg-2 ml), ketamine (0.5 mg/kg-2 ml) or 2 ml serum physiologic. During operation heart rate, oxygen saturation, average mean blood pressures were recorded in every 5 min. Operation, anesthesia and the time that Alderete scores 9-10, patient satisfaction, analgesic requirements were recorded. Postoperatively nausea, vomiting, sedation, dysphagia, bleeding scores were recorded at 0, 10, 30, 60 min and 2, 4, 8, 12, 18, 24 h postoperatively. Pain was evaluated using modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at fixed intervals after the procedure (15 min and 1, 4, 12, 16, and 24 h postoperatively). Results: The recordings of heart rate, mean arterial pressure, nausea, vomiting, sedation and bleeding scores were similar in all groups (p > 0.05). The mCHEOPS scores at 10 min, 30 min, 1 h, 8 h were significantly lower in both tramadol and ketamine group when compared with control (p < 0.05). Use of additional analgesia at 10 min and 18 h were higher in control group than ketamine, tramadol group (p < 0.05). Dysphagia scores were significantly lower for both ketamine and tramadol group when compared with control group (p < 0.05). mCHEOPS, additional analgesia, dysphagia, patient satisfaction scores were similar in tramadol, ketamine groups (p > 0.05). Conclusions: Preincisional injection of ketamine and tramadol prior to tonsillectomy is safe, effective method and equivalent for post-tonsillectomy pain, patient satisfaction, postoperative nausea, vomiting, dysphagia. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
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    The effects of adding ischemic preconditioning during desflurane inhalation anesthesia or propofol total intravenous anesthesia on pneumoperitoneum-induced oxidative stress
    (Acta Medical Belgica, 2017) Karabayirli, Safinaz; Surgit, Onder; Kasikara, Hulya; Bicer, Cemile Koca; Ergin, Merve; Demircioglu, Ruveyda Irem; Muslu, Bunyamin
    Background: The aim of the study was to explore the differences in oxidative stress during anesthesia with desflurane/N2O or propofol/remifentanil in patients undergoing laparoscopic cholecystectomy and additionally to evaluate the differential effects of desflurane and propofol on ischemic preconditioning (IP). Materials and methods: One hundred patients were randomly allocated to four groups. For anesthesia maintenance, the inhalation group (Group I) and the inhalation plus IP group (Group IIP) received desflurane at an end-tidal concentration of 4-6 vol% in oxygen/N2O, and the TIVA group (Group T) and TIVA plus IP group (Group TIP) received infusions of propofol and remifentanil. In Groups IIP and TIP, IP was carried out by 10 min of pneumoperitoneum followed by 10 min of deflation. Preoperative and postoperative plasma total antioxidant status (TAS), total oxidant status (TOS), paraoxonase, stimulated paraoxonase, arylesterase, ceruloplasmin, and myeloperoxidase levels were analyzed; oxidative stress index (OSI) was calculated. Results: When oxidative stress parameters were compared between groups, myeloperoxidase values in Group I were statistically significantly lower compared to Group TIP (p = .004 with Bonferroni's correction). There were no differences between preoperative and postoperative TAS, paraoxonase, stimulated paraoxonase, arylesterase, or ceruloplasmin levels (p>.05). In intragroup evaluations, postoperative paraoxonase and stimulated paraoxonase levels were found to be lower than preoperative values in Group TIP (p = .021 and .012, respectively). Conclusion: In laparoscopic cholecystectomy lasting less than 60 min, there were no differences in the measured oxidative stress parameters between maintenance of anesthesia by desflurane/ N2O and propofol/remifentanil/N2O. The addition of 10 min IP administration during both anesthesia techniques did not result in additional changes in the analyzed oxidative stress.
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    Transient neurological symptoms after spinal anesthesia
    (Canadian Soc Clinical Investigation, 2016) Gozdemir, Muhammet; Muslu, Bunyamin; Sert, Huseyin; Usta, Burhanettin; Demircioglu, Ruveyda Irem; Kasikara, Hulya
    Purpose: The aim of this study was to investigate the incidence of transient neurological symptoms (TNS) after spinal anesthesia with levobupivacaine, bupivacaine, articaine or lidocaine. Methods: The patients (n=400)were randomly assigned to receive spinal anesthesia with levobupivacaine, bupivacaine, articaine or isobaric lidocaine. Onsets of sensory and motor block were recorded. On postoperative days 1, 2 and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic agent used. The patients were classified as having TNS if there was pain in the hips, thighs and/or lower limbs following recovery from anesthesia. Results: Time to maximum sensory block was significantly longer in the articaine group than the lidocaine group. The incidence of TNS was much less after spinal anesthesia with levobupivacaine, bupivacaine and articaine than after lidocaine.