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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 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, BunyaminBackground: 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.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 Intrathecal Plain Articaine And Levobupivacaine With Fentanyl For Caesarean Section(The Canadian Society for Clinical Investigation, 2016) Demircioğlu, Rüveyda İrem; Goz?demir, Muhammet; Usta, Burhanettin; Sert, Hüseyin; Karabayirli, Safinaz; Muslu, Bünyamin; Keskin, Esra AktepePurpose: 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 ?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 © 2021 Elsevier B.V., All rights reserved.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 Hearing loss after spinal anesthesia: A comparative prospective randomized cohort study(ARSMB-KVBMG aob.edit@skynet.be Avenue W. Churchill-laan 11/30 Brussels B-1180, 2016) Karabayirli, Safinaz; Uğur, Kadriye Şerife; Ayrim, Aylin; Demircioğlu, Rüveyda İrem; Ark, Nebil; Usta, Burhanettin; Kurtaran, HanifiObjective: In this comparative randomized cohort study, we aimed at evaluating the occurrence of sensorineural hearing loss after general and spinal anesthesia using both subjective and objective tests. Material and Methods: Fifty patients scheduled for elective cesarean section were approached, of which 21 patients received spinal anesthesia (group S), and 16 patients received general anesthesia (group G). In group S, a 27 G pencil point spinal needle was used. Pure tone audiometry and Distortion Product Otoacoustic Emissions (DPOAE) were performed before and 48 hours after surgery. Results: No between-group significant difference in pre and postoperative audiometric hearing threshold and pure tone average value were noticed, as well as in pre and postoperative DPOAE amplitude and signal-to-noise ratio (SNR). Conclusion: In this study, we did not observe any hearing loss after cesarean section under general or spinal anesthesia. Using the non-traumatic 27 gauge pencil point needle for performing spinal anesthesia does not seem to be associated with a risk of hearing loss, similarly to general anesthesia. © 2018 Elsevier B.V., All rights reserved.Öğe 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, NebilTo 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.Öğe 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, HuseyinObjective: 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.Öğe The effect of hypotermia on potassium concentration in blood cardioplegia during cardiopulmonary bypass surgery(Turkish Anaesthesiology and Intensive Care Society tsisa@logos.com.tr, 2014) Peker, Murat; Karabayirli, Safinaz; Özanbarci, Azra; Çolak, Necmettin; Demircioğlu, Rüveyda İrem; Muslu, BünyaminObjective: Cardioplegia is quite important for myocardial protection during cardiopulmonary by-pass In order to benefit from cardioprotective effect of hypotermia cold- blood cardioplegia is commonly used. Hypotermia can alter potassium concentration. In this study we have investigated the effect of hypotermia on potassium concentration in blood cardioplegia. Material and Methods: We studied 70 patients who will undergo coronary artery bypass grafting with the aid of cardiopulmonary bypass. Potassium levels were measured from arterial blood samples of the patients before the cardiopulmonary bypass (CBP) operation. During CBP surgery, in order to achieve 16 mEq/L potassium levels, potassium was added to a 400 ml blood sample taken from cardiopulmonary pump to prepare blood cardioplegia. After addition of potassium, blood samples were deri altiwn to measure blood gases, potassium, sodium, calcium and lactate levels Blood cardioplegic solution was cooled at 4°C in an ice water container and measurements were repeated. Results: Potassium levels were detected as 16.8±0.7 mEq/L at 32°C and 16.3±0.7 mEq/L at 4°C in samples of blood cardioplegic solution (p=0.001). There was no difference bet ween analytical results of blood gases and other electrolytes. Conclusion: A decrease in potassium levels is observed after cooling blood cardioplegic solution at 4°C. However this decrease which occurs at 0.5 mEq/L concentrations may not be so important clinically. Whereas, during preparation of cardioplegic solution, estimated potassium levels were near the lower limits,m then cooling process might drop potassium levels below this lower limit. Therefore it may be helpful to keep the potassium level slightly above the target level. © 2014 Elsevier B.V., All rights reserved.Öğe The effect of positive end-expiratory pressure on inflammatory cytokines during laparoscopic cholecystectomy(Saudi Med J, 2015) Yilmazlar, Firdevs; Karabayirli, Safinaz; Gzdemir, Muhammet; Usta, Burhanettin; Peker, Murat; Namuslu, Mehmet; Erdamar, HuesamettinObjectives: To investigate effects of the positive end-expiratory pressure (PEEP) application of 10 cm H2O on the plasma levels of cytokines during laparoscopic cholecystectomy. Methods: A prospective study was conducted on 40 patients who presented to the Department of General Surgery, Medical Faculty, Turgut Ozal University, Ankara, Turkey scheduled for laparoscopic cholecystectomy operation during a 10 month period from September 2012 to June 2013. Forty patients scheduled for laparoscopic cholecystectomy operation were randomly divided into 2 groups; ventilation through zero end-expiratory pressure (ZEEP) (0 cm H2O PEEP) (n = 20), and PEEP (10 cm H2O PEEP) (n = 20). All patients were ventilated with 8 ml/kg TV. Levels of interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, IL 10, and transforming growth factor (TGF)-beta 1 were measured in the pre- and post-operatively collected samples. Results: Blood samples of 30 patients' were analyzed for plasma cytokine levels, and 10 were excluded from the study due to hemolysis. Post-operative plasma IL-6 levels were observed to be significantly higher than the pre-operative patients (p = 0.035). Post-operative plasma TGF-beta 1 levels in the PEEP group was found significantly higher compared with the pre-operative group levels (p = 0.033). However, there were no significant differences in the pre- and post-operative plasma cytokine levels between the 2 groups. Conclusion: The application of PEEP of 10 cm H2O, which has known beneficial effect on respiratory mechanics, does not have any effect on systemic inflammatory response undergoing pneumoperitoneum during laparoscopic cholecystectomy surgery.Öğe 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, BunyaminBackground: 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.
