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Öğe 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, UmmugulsumObjectives: 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.Öğe Comparison of intrathecal plain articaine and levobupivacaine with fentanyl for Caesarean section(Canadian Soc Clinical Investigation, 2016) Demircioglu, Ruveyda I.; Gozdemir, Muhammet; Usta, Burhanettin; Sert, Huseyin; Karabayirli, Safinaz; Muslu, Bunyamin; Keskin, Esra A.Purpose: Articaine is used as a local anesthetic for outpatient surgery because it offers rapid onset of anesthesia and short duration motor block. Levobupivacaine is often preferred for Caesarean section. We evaluated the anesthetic characteristics of fentanyl-supplemented plain articaine and levobupivacaine for Caesarean section under combine spinal epidural anesthesia. Methods: Patients undergoing Caesarean section received in random order plain articaine 40 mg (Group A, n=50) or plain levobupivacaine 10 mg (Group L, n=50) mixed with fentanyl 20 mu g intrathecally. The onset and duration of sensory and motor block, first analgesic request, and hemodynamic parameters were recorded. Results: Onset times of maximum motor block were longer in Group L than Group A (P=0,001). Time to two-segment regression of sensory block were 70 min for Group A and 90 min group L (P=0.001). Times to complete regression of motor blockade were significantly longer in group L than group A (P =0,001). Conclusion: To have a faster onset and shorter duration of spinal anesthesia, we recommend the use of plain articaine for Caesarean section.Öğe Comparison of neck ultrasonography with a pH meter to confirm correct position of nasogastric tube(Canadian Soc Clinical Investigation, 2016) Muslu, Bunyamin; Sert, Huseyin; Demircioglu, Ruveyda I.; Gozdemir, Muhammet; Usta, BurhanettinPurpose: The aim of this study was to compare pH meter and neck ultrasonograph for evaluation of nasogastric tube (NGT) position. Methods: A total of 35 adult patients who required NGT insertion were included. The NGT was inserted by an anesthetist after endotracheal intubation, and the transducer was placed transversely on the neck, just superior to the suprasternal notch. The passage of the NGT in the esophagus was evaluated by a sonographer, and the stomach was emptied by nasogastric suction. Secretion from inside the NGT was analyzed using a pH meter. The tip of the NGT was accepted as being in the stomach if the pH measured between 1 and 5. Neck ultrasonography was compared with the pH meter analysis for confirmation of NGT position. Results: Ultrasonography was highly sensitive (100% (95% CI 89.6-100%) and specific (97.2% (95% CI 85.4-99.5%) for evaluation of NGT position. The specificity for the pH meter was 100% (95% CI 16.6-100%), while the sensitivity was 76.5% (95% CI 58.8-89.2%). Conclusions: This study showed that neck ultrasonography is more sensitive than the pH meter for confirmation of NGT position.Öğe Effect of positive end-expiratory pressure administration on intraocular pressure in laparoscopic cholecystectomy Randomised controlled trial(Lippincott Williams & Wilkins, 2016) Karabayirli, Safinaz; Cimen, Nuran Kavun; Muslu, Bunyamin; Tenlik, Aylin; Gozdemir, Muhammet; Sert, Huseyin; Hepsen, Ibrahim Feyzi[Abstract Not Available]Öğe Effects of remifentanil, nitroglycerin, and sevoflurane on the corrected QT and Tp-e intervals during controlled hypotensive anesthesia(Elsevier Science Inc, 2016) Cimen, Nuran Kavun; Kosem, Bahadir; Cimen, Tolga; Kartal, Seyfi; Muslu, Bunyamin; Karabayirli, Safinaz; Gozdemir, MuhammetStudy objective: Controlled hypotension is a preferred method in various surgical operations, but limited data are available for the effects of drug combinations that are used to ensure the desired level of hypotension on cardiac repolarization. Design: Randomized, prospective, double-blinded study. Patients: The study comprised 65 patients undergoing septorhinoplasty surgery under general anesthesia. Interventions: Group S received sevoflurane inhalation alone, group R received sevoflurane and remifentant and group N received sevoflurane and nitroglycerine in a way that a mean arterial pressure of 60 +/- 5 mm Hg was achieved. Measurements: Electrocardiogram was performed before induction (T1), 30 minutes after induction (T2), and 5 minutes after extubation (T3). Corrected QT (QTc), QT dispersion (QTd), and corrected Tp-e (Tp-ec) intervals and Tp-e/corrected QT (Tp-e/QTc) ratio were calculated. Main results: QTc prolongation was observed at T2 and T3 in all groups, but only QTc prolongation at T2 was statistically significant in group S (P> .05). Significant prolongation of QTd interval at T2 and T3 was observed in group S (P< .05). In all groups, Tp-ec decreased at T2. However Tp-ec decrease was not statistically significant in group S (P= .103) and group R (P= .058). Tp-e/QTc was significantly decreased on T2 in all 3 groups, and it was returned to baseline at T3 (P< .05). Conclusion: The present study demonstrated that none of the 3 hypotensive anesthesia methods has an overall negative effect on Tp-e and Tp-e/QTc. Therefore, we conclude that all 3 methods can be used safely in terms of proarrhythmic risk, but increased sevoflurane consumption may require more attention due to significant prolongation of QTc and QTd. (C) 2016 Elsevier Inc. All rights reserved.Öğe 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, UmmugulsumIntroduction: 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.Öğe Transient neurological symptoms after spinal anesthesia(Canadian Soc Clinical Investigation, 2016) Gozdemir, Muhammet; Muslu, Bunyamin; Sert, Huseyin; Usta, Burhanettin; Demircioglu, Ruveyda Irem; Kasikara, HulyaPurpose: 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.
