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- ArticleAçık Erişim2025Impact of low-pressure pneumoperitoneum and deep neuromuscular blockade on surgeon satisfaction and patient outcomes in laparoscopic cholecystectomy patients: A prospective randomised controlled study
Koç, Alparslan; Memiş, Ufuk; Onk, Didem; Karataş, Talha; Gazi, Mustafa; Sayar, Ali Caner; Ari, Muhammet Ali
Introduction: The impact of laparoscopic surgery on homeostatic systems necessitates careful consideration of intra-abdominal pressure (IAP) management. This study investigated the effects of low-pressure pneumoperitoneum with deep neuromuscular blockade (NMB) on surgeon satisfaction, haemodynamics and post-operative outcomes in laparoscopic cholecystectomy patients. Patients and Methods: The study design involves prospective randomised control. Ninety patients were assigned to low (7-10 mmHg, n = 45) or normal (12-16 mmHg, n = 45) IAP groups. Deep NMB, guided by train-of-four monitoring, was administered. This study evaluated surgical rating scale scores, haemodynamics and post-operative outcomes through a literature review. A computer programme (IBM, SPSS) was used for statistical analysis. Chi-square and Mann-Whitney U tests were used to analyse patients' IAP levels, additional NMB requirements, surgical rating scale scores and numerical rating scales. Patient demographics and other intraoperative and post-operative variables were analysed with Student's t-test and the Mann-Whitney U test. Values of P < 0.05 were considered to indicate statistical significance. Results: No significant demographic differences were observed. The low-pressure group exhibited lower post-operative pain (P < 0.01) and reduced analgesia requirements (P = 0.00). On analysis of the surgeon rating scale, no disparities were evident between the groups. NMB usage correlated with height and weight (P < 0.01). Heart rate showed no intergroup differences. The MAP measured after 15 min was lower in Group L, and the difference was significant (P = 0.023). The SAP measured after 30 min was lower in Group L, and the difference was significant (P = 0.017). Blood gas values and surgical field visibility were unaffected by the IAP. The positive correlations between NMB, height and weight aligned with previous research. Conclusion: This study highlights successful laparoscopic cholecystectomy under low IAP, deep NMB and favourable post-operative outcomes. Despite these limitations, the findings contribute to optimising laparoscopic surgical approaches.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2024The Effect of Intra-abdominal Pressure on Heart Rate Variability and Hemodynamics During Laparoscopic Cholecystectomy: A Prospective Observational Study
Eren, Nurhan; Onk, Didem; Koç, Alparslan; Kuyrukluyildiz, Ufuk; Nalbant, Remziye Aysenur
Introduction This study aimed to evaluate hemodynamic changes using heart rate variability (HRV) measurements in diabetic and nondiabetic patients who will undergo laparoscopic cholecystectomy and to provide our preoperative measurements to guide us for better perioperative anesthesia management. Materials and methods The study included 143 patients aged 40 years and older who would undergo elective laparoscopic surgery, did not have any comorbidities other than diabetes mellitus (DM) type II, and were in the American Society of Anesthesiologists (ASA) class I -III risk group. Patients were divided into two groups: the control group (n = 77) and the DM group (n = 66). The preoperative glycated hemoglobin (HbA1C) level was measured. Peripheral oxygen saturation (SpO2) and hemodynamic parameters such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and HRV parameters were measured preoperatively, perioperatively, and postoperatively. Intra-abdominal pressure (IAP) was administered at 10-12 mmHg. Results Even though SAP, DAP, MAP, and HR decreased with induction, they increased with insufflation, and an overall decrease was seen at the postoperative 24th hour for all parameters. When the groups were evaluated, no difference was observed except that the DAP was significantly lower in the DM group (p = 0.029) at insufflation and the HR was higher in the DM group at induction, and the difference was significant (p = 0.001). Preoperative HRV parameters were significantly lower in the DM group. According to the HRV parameters, although a decrease was observed after induction and insufflation, conversely, an increase was observed postoperatively. When the postoperative and preoperative values were compared, the standard deviation of the NN (R -R) intervals (SDNN), SDNN index, high frequency (HF), low frequency (LF), and LF/HF parameters were found to be significantly lower in the DM group than in the control group. Conclusion Diabetic patients are more sensitive to increased intra-abdominal pressure (IAP) in laparoscopic surgery, and the effects on cardiac autonomic functions can be determined by HRV measurements without clinically reflecting on hemodynamic data. Additionally, in diabetic patients with preoperative LF and/or HF values less than 100, we believe that careful follow-up in terms of autonomic neuropathy complications and anesthesia management should be done more meticulously in these patients.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Comparison of Post-Intensive Care Syndrome between Patients with and without COVID-19 who had Non-Invasive Mechanical Ventilation Support in the Intensive Care Unit
Onk, Didem; Tas, Hakan Gokalp; Subasi, Faruk; Karatas, Talha; Kuyrukluyildiz, Ufuk
Introduction: Post-intensive care syndrome (PICS) is defined as new or deteriorating physical, cognitive, or mental health state after intensive care. This study compared patients with and without a diagnosis of coronavirus disease-2019 (COVID-19) who received noninvasive mechanical ventilation support in the intensive care unit and were monitored for the onset of PICS. Methods: Retrospective imaging was performed on 50 COVID-positive and 50 non-COVID patients who were over 18 years of age and receiving non-invasive mechanical ventilation. The Mini Mental State test, Beck Depression test, Beck Anxiety test, and Post-Traumatic Stress Disorder test were administered to the patients to evaluate cognitive and psychiatric functioning after contacting them via the hospital system and obtaining the required consents. Results: Patients with COVID had longer stays in the ICU (p<0.001). Patients with COVID were observed to have a more severe depression than patients without COVID (p=0.019). Patients with COVID had a higher percentage of moderate and severe anxiety than those without COVID (p=0.003). Patients with COVID had a greater incidence of PTSD (p=0.025). Although COVID patients were more likely to have severe cognitive dysfunction than non-COVID patients, the difference was not statistically significant (p=0.184). Physical dysfunction was significantly higher in the COVID group than in the non-COVID group (p=0.019). Longer stays in the ICU were found in patients who had PICS (p=0.008). Conclusion: When we examined the patient groups with and without a diagnosis of COVID, we concluded that PICS is more prevalent among COVID patients receiving non-invasive mechanical ventilator support.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2023Molecular mechanism of the protective effect of adenosine triphosphate against paracetamol-induced liver toxicity in rats
Koç, Alparslan; Gazi, Mustafa; Caner Sayar, Ali; Onk, Didem; Ali Arı, Muhammet; Süleyman, Bahadır; Gökhan Ağgül, Ahmet; Altındağ, Fikret; Altuner, Durdu; Süleyman, Halis
Toxic doses of paracetamol are also known to be close to therapeutic doses. This study aimed to biochemically investigate the protective effect of ATP against paracetamol-induced oxida-tive liver injury in rats and to examine the tissues histopathologically. We divided the animals into the paracetamol alone (PCT), ATP + paracetamol (PATP), and healthy control (HG) groups. Liver tissues were examined biochemically and histopathologically. Malondialdehyde level, AST and ALT activity in the PCT group were significantly higher than those in the HG and PATP groups (p < 0.001). The glutathione (tGSH) level, superoxide dismutase (SOD) and catalase (CAT) activity in the PCT group was significantly lower than that in the HG and PATP groups (p < 0.001), while animal SOD activity was significantly different between the PATP and HG groups (p < 0.001). The activity of CAT was almost the same. In the group treated with paracetamol alone, lipid deposition, necrosis, fibrosis, and grade 3 hydropic degeneration were observed. No histopathological damage was observed of the ATP-treated group, except for grade 2 edema. We discovered that ATP reduces the oxidative stress caused by paracetamol ingestion and protects against paracetamol-induced liver injury at the macroscopic and histological levels.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Effects of ketamine, thiopental and their combination on the rat liver: A biochemical evaluation
Bedir, Zehra; Ozkaloglu Erdem, Kezban Tuna; Ates, Irem; Olmezturk Karakurt, Tulay Ceren; Gursul, Cebrail; Onk, Didem; Kurt, Nezahat; Suleyman, Zeynep; Suleyman, Halis
Background. In the literature, it has been suggested that ketamine-related oxidative organ damage results from increased blood adrenaline level, and thiopental-related oxidative damage is caused by decreased adrenaline level, suggesting that ketamine-thiopental combination (KT) may be beneficial in reducing the hepatotoxic effect of ketamine. Objectives. To biochemically investigate the effects of ketamine, thiopental and KT on the liver in rats. Materials and methods. Male albino Wistar type rats received intraperitoneally (ip.) 30 mg/kg ketamine in the ketamine alone (KG) group (n = 6), 15 mg/kg thiopental in the thiopental alone (TG) group (n = 6), and 30 mg/kg ketamine + 15 mg/kg thiopental in the ketamine+thiopental (KTG) group (n = 6). The same volume of distilled water as solvent was given to the healthy (HG) animal group. This procedure was repeated once daily for 30 days. At the end of this period, the animals were killed by decapitation and their livers were removed. In liver tissue, malondialdehyde (MDA), total glutathione (tGSH), total oxidant status (TOS), total antioxidant status (TAS), tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin-6 (IL-6) levels were measured. The IL-1β, IL-6, TNF-α, adrenalin (ADR), noradrenalin (NDR), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined in blood samples taken from the tail veins. Results. In the group treated with ketamine and thiopental alone, MDA, TOS, IL-1β, IL-6, TNF-α, ADR, NDR, ALT, and AST levels were found to be high, and those of tGSH and TAS to be low. However, there was no significant change in the levels of these parameters in the KTG. Conclusions. These results indicate that oxidative stress and inflammation developed in the liver tissue of the group that used ketamine and thiopental alone, suggesting that the KT form may be safer in terms of toxicity in the clinical usage.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2022The Effect of Thiamine Pyrophosphate and Tocilizumab Alone and in Combination upon Ethanol-Induced Peripheral Neuropathy and Neuropathic Pain in Rats
Ekinci, Bilge; Suleyman, Bahadir; Mammadov, Renad; Cankaya, Murat; Yazici, Gulce Naz; Suleyman, Zeynep; Dal, Cagatay Nusret; Ergul, Emine Esra; Onk, Didem; Suleyman, Halis
The aim of the study to determine the effects of thiamine pyrophosphate (TPP) and tocilizumab (TCZ) either alone or in combination on ethanol-induced neuropathic pain and peripheral neuropathy in rat nerve tissues, biochemically and histopathologically. Albino Wistar male rats were divided into five groups as the healthy (HG), ethanol alone (EtOH), TPP + ethanol (TPE), TCZ + ethanol (TCE), and TPP + TCZ + ethanol (TPTE) groups. TPE (n = 6), TCE (n = 6) and TPTE (n = 6) groups were injected with 20 mg/kg TPP, 8 mg/kg TCZ, and 20 mg/kg TPP+8 mg/kg TCZ intraperitoneally (respectively). Distilled water were given the HG (n = 6) and EtOH (n = 6) groups. One hour after the drugs and distilled water were administered, 35% ethanol was administered orally by lavage at a 5 g/kg dose to the TPE, TCE, TPTE, and EtOH groups. Paw pain thresholds of animals were measured using Basile Algesimeter. TPTE, which suppressed the decrease of the pain threshold with ethanol more significantly than TPP and TCZ. The best inhibitor of MDA increase and inhibit the reduction of tGSH by etanol was listed as TPTE > TPE > TCZ. The potency of suppressing the increase in cytokine production with ethanol was listed as TPTE > TCE > TPE. In conclusion, the results indicate that TPP+TCZ may be more beneficial than TPP and TCZ alone in treating ethanol-related neuro-pathic pain.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2022Negative-pressure pulmonary edema after mammoplasty: a case report
Onk, Didem; Işık, Onur; Subaşı, Faruk; Karaali, Soner; Kuyrukluyıldız, Ufuk
Negative-pressure pulmonary edema (NPPE) is a rare but life-threatening postoperative complication that occurs due to the acute obstruction of the upper airway. In our case report, we present a 25-year-old female patient who underwent elective mammoplasty under general anesthesia and developed NPPE 4 hours after extubation. The patient had a preoperative mallampati score of 3. After routine anesthesia induction, the patient was intubated with an endotracheal tube with a guide wire. Aspiration wasn't observed during extubation. The patient was followed in the post-anesthesia care unit (PACU) for 30 minutes with a saturation of 95% and was subsequently transferred to the service. Four hours after the operation, the patient was re-examined due to dyspnea and shortness of breath. Due to oxygen saturation of 88% and pO2 of 56mmHg despite mask ventilation, the patient was admitted to the intensive care unit (ICU). A computed tomography (CT) scan revealed extensive diffuse ground-glass opacities and consolidations in both lungs. She did not respond to mask ventilation and was given non-invasive ventilation with continuous positive airway pressure (CPAP). Forced diuresis was induced with furosemide. Tachypnea resolved within 2 hours after CPAP was initiated, the patient did not require oxygen support and COVID-19 polymerase chain reaction (PCR) testing was negative. Subsequently, the patient was discharged to the clinical ward on postoperative day 1. When considering NPPE, early diagnosis and respiratory support are associated with reduced mortality and rapid recovery. Patients who develop laryngospasm during extubation must be closely monitored, and in the case of pulmonary edema, NPPE should be considered in the differential diagnosis.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2022Effect of Fluid Therapy on Coagulation in COVID-19 Patients in the Intensive Care Unit
Onk, Didem; Işik, Onur; Akyol, Fethi; Karaca, Nurcan Kutluer; Arslan, Yusuf Kemal; Kuyrukluyildiz, Ufuk
Study Objectives: Several studies have evaluated CT pulmonary angiography of COVID-19 patients and reported a 7%–30% increase in the incidence of pulmonary embolism. In this study, it was aimed to investigate the effect of fluid therapy on coagulation in COVID-19 patients in the intensive care unit. Methods: This retrospective study included 120 patients hospitalized in the COVID-19 Intensive Care Unit for more than one week, between August 2020 and February 2021. Blood prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, troponin, D-dimer levels, platelet count measured at the time of admission (T1, baseline) and one week after admission (T2), and the fluid treatments administered during this period were recorded. Patients were divided into the saline solution (SS) group (n=75), 0.45% saline solution group (0.45%, n=30), and combined fluid therapy group (SS+0.45%, n=15). Results: The change in PT was statistically significant for the SS group (p = 0.005), but not for the 0.45% and SS+0.45% groups (p = 0.625, p = 0.262, respectively). In the SS group, the aPTT levels increased posttreatment (p = 0.005). INR levels were significantly different between SS and SS+0.45% groups (p = 0.008). In the SS group, the INR levels increased between T1 and T2 (p = 0.014). In the SS group, the D-dimer levels significantly increased posttreatment. Conclusion: The D-dimer levels were prominent in the follow-up of the COVID-19 patients. Accordingly, using SS for fluid therapy may increase hypercoagulation and the risk of an embolism when compared to the SS, 0.45%, and combined (SS+0.45%) treatment.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2022Evaluation of the effects of total intravenous anesthesia and inhalation anesthesia on postoperative cognitive recovery; [Bewertung der Auswirkungen einer totalen intravenösen Anästhesie und einer Inhalationsnarkose zur postoperative kognitive Erholung]
Ölmeztürk Karakurt, Tülay Ceren; Kuyrukluyıldız, Ufuk; Onk, Didem; Ünver, Süheyla; Arslan, Yusuf Kemal
Objective: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) used in lumbar disc herniectomy on postoperative cognitive recovery based on the mini-mental state examination (MMSE) score and neuron-specific enolase (NSE) levels. Material and methods: The study sample consisted of 80 patients aged 18–65 years who were scheduled for elective lumbar disc herniectomy. The patients were divided into two groups according to the anesthesia technique applied, such as TIVA or IA. The patients in the TIVA group were administered remifentanil and propofol and those in the IA group were administered sevoflurane for maintenance. The MMSE was applied to the patients before the operation and 1h and 24 h postoperatively. Venous blood samples were obtained for the measurement of NSE before the operation and on the 24 h postoperatively. Results: The mean preoperative MMSE scores were similar in the two groups. In the TIVA group, the preoperative and postoperative MMSE scores at 1 h were similar but were higher at 24 h postoperatively compared to the previous two scores (p = 0.001 and p < 0.001, respectively). In the IA group, the preoperative and postoperative 24 h MMSE scores were similar but lower at 1h postoperatively than the other two scores (p = 0.006 and p < 0.001, respectively). In the TIVA group, there was a significant decrease in the postoperative serum NSE levels than the preoperative values (p = 0.038). Conclusion: The use of IA may result in higher cognitive dysfunction 1h after the operation compared to TIVA. The effects of both methods on cognitive functions were similar at 24 h postoperatively.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2022Pregnancy-Associated Plasma Protein-A as an Inflammatory Biomarker in Patients Undergoing Coronary Artery Bypass Surgery
Onk, Oruç Alper; Onk, Didem; Ozcelik, Fatih; Günay, Murat
Study Objectives: Data is limited to show whether PAPA-A and/or VEGF are useful tests to predict the prognosis of coronary artery disease. We sought to investigate the potential roles of PAPP-A and VEGF in predicting the severity of coronary artery disease in patients undergoing coronary artery bypass grafting. Methods: A total of 212 male patients who were scheduled to undergo coronary angiography were included. Patients were divided into five groups. Group 0: Patients with normal coronary arteries, Group 1: Patients with <50% stenosis in only one coronary artery, Group 2: Patients with >50% stenosis in 1 or 2 coronary arteries, Group 3: Patients with >50% stenosis in 3 or 4 coronary arteries, Group 4: Patients with >50% stenosis in 5 or more coronary arteries. PAPP-A, TNF-α, IL-6, and VEGF, blood samples were centrifuged at a rate of 3500 rpm for 10 minutes. Results: In the preoperative measurements, all inflammatory biomarkers except VEGF were significantly associated with an increasing number of diseased coronary arteries where hsCRP and PAPP-A showed the highest level of association. In the 7th postoperative day measurements, only PAPP-A and IL-6 showed significant association with the dependent outcome. PAPP-A was found to be associated with an increased risk of a higher number of diseased coronary arteries. Conclusion: PAPP-A offers a useful tool in the diagnosis of the severity of coronary artery involvement in patients undergoing CABG. Its use alone or in combination with TNF- α and/or CRP may potentially distinguish patients with and without advanced disease.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2021The effect of dexmedetomidine on gastric ischemia reperfusion injury in rats. Biochemical and histopathological evaluation
Kuyrukluyildiz, Ufuk; Delen, Leman Acun; Onk, Didem; Yazici, Gulce Naz; Gulaboglu, Mine; Suleyman, Halis
Purpose: To evaluate the protective effect of dexmedetomidine on gastric injury induced by ischemia reperfusion (I/R) in rats. Methods: A total of 18 male albino Wistar rats were divided groups as: gastric ischemia reperfusion (GIR), gastric ischemia reperfusion and 50 μg/kg dexmedetomidine (DGIR) and sham operation (HG) group. After the third hour of reperfusion, the biochemical and histopathological examinations were performed on the removed stomach tissue. Results: Malondialdehyde (MDA) and myeloperoxidase (MPO) levels were found to be significantly higher in GIR compared to HG (p < 0.05). A statistically significant decrease was observed at the DGIR compared to the GIR for oxidants levels. Total glutathione (tGSH) and superoxide dismutase (SOD) levels were statistically significantly decreased at the GIR, and antioxidants levels were found to be significantly higher in the DGIR (p < 0.05) There was no significant difference between HG and DGIR in terms of SOD (p = 0.097). The DGIRs’ epitheliums, glands and vascular structures were close to normal histological formation. Conclusions: Dexmedetomidine is found to prevent oxidative damage on the stomach by increasing the antioxidant effect. These results indicate that dexmedetomidine may be useful in the treatment of ischemia-reperfusion-related gastric damage.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Effects of melatonin treatment on the spermatogenesis and serum inflammatory cytokine levels in diabetic rats
Erol, Huseyin Serkan; Terzioğlu, Merve Aydın; Onk, Didem; Gürsul, Cebrail; Gumustas, Sinem; Bozkurt, Aliseydi; Karabakan, Mehmet
Aim: Diabetes mellitus (DM) is known to have side effects on sexual and reproductive functions in males. The aim of current study was to investigate the effect of melatonin treatment on spermatogenesis and serum inflammatory cytokine levels in diabetic rats.Material and Method: Eighteen adult Wistar albino male rats were divided randomly into three groups each containing 6 rats; control group (group 1), diabetic group (group 2), diabetic treated with melatonin group (group 3). Experimental diabetes was obtained by administrating 50 mg/kg streptozotocin. Melatonin treatment was administered intraperitoneally for 7 days at a dose of 20 mg, daily. Serum levels of interleukin-1 beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were assayed. Spermatogenesis was evaluated according to Johnsen score at immunopathological examination.Results: The Johnsen scores in control, diabetic and treatment groups were 9.78, 8.91, and 9.61, respectively. Spermatogenesis was negatively affected in diabetic rats and significantly improved with melatonin therapy (p<0.05). The serum levels of TNF-α in diabetic rats were observed to be increased compared to the control group (p<0.05). The levels of serum IL-1β and TNF- α were significantly decreased with melatonin treatment. IL-6 levels were not different among the three groups (p=0.248).Conclusions: In the present study, intraperitoneal melatonin treatment was determined to have a positive effect of on spermatogenesis and caused a decrease in serum inflammatory cytokine levels in diabetic rats.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2019Effect of taxifolin on oxidative gastric injury induced by celiac artery ligation in rats
Eken, Hüseyin; Cimen, Orhan; Cimen, Ferda Keskin; Kurnaz, Eray; Yildirim, Murat; Tasova, Volkan; Kurt, Nezahat; Pehlivanoglu, Kamil; Onk, Didem; Bilgin, Asli Ozbek
Purpose: To examine the effect of taxifolin on I/R induced gastric injury in rats using biochemical and histopatholohical methods. Methods: Eighteen albino Wistar male rats equally grouped as; gastric I/R (I/R), 50 mg/kg taxifolin + gastric I/R (TAX+ I/R) and sham operation applied (SHAM). Ischemia induced for 1 hour, and reperfusion induced for 3 hours. Results: Oxidant parameters like, Malondialdehyde (MDA) and Hydroxyguanine (8-OHdG) were higher, whereas total glutathione (tGSH) was lower in the I/R group according to SHAM group, histopathological findings such as marked destruction, edema, and proliferated dilated congested blood vessels were observed severely in the I/R group, whereas there was not any pathological finding except mild dilated congested blood vessels in the TAX+ I/R group. Conclusion: The taxifolin can be clinically beneficial in the treatment of gastric injury due to I/R procedure.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2018The effect of esomeprazole on postoperative pain and lung and heart complications in rats
Onk, Didem; Coskun, Resit; Onk, Oruc A.; Cimen, Ferda K.; Kurt, Nezahat; Suleyman, Bahadir; Mammadov, Renad; Altuner, Durdu; Gul, Vahdet; Malkoc, Ismail
Postoperative pain begins with tissue incision, continues with the production of free oxygen radicals, and is intensified by the inflammatory response. We investigated the effect of esomeprazole on postoperative pain and lung and heart complications of laparotomy. Albino Wistar-type rats were grouped into the paw scalpel incision (PSI), applied control (SIC), PSI + 20 mg/kg esomeprazole (SIE), PSI + 20 mg/kg meperidine (SIM), and healthy group (HG). For the laparotomy test, the rats were grouped as follows: laparotomy applied control (LTC), laparotomy + 20 mg/kg esomeprazole (LTE), laparotomy + 20 mg/kg meperidine (LTM), and healthy group (HG). Meperidine suppressed the PSI-induced pain. Esomeprazole decreased the level of oxidant and proinflammatory cytokines in the serum and lung and heart tissues of the LTE group and in the paw tissues of the SIE group, but meperidine did not. There were no histopathological findings in the lung and heart tissues of the LTE group, but tissue damage was found in the LTC and LTM groups. Esomeprazole may help reduce major surgery complications.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018Effect of melatonin on antioxidant capacity, ınflammation and apoptotic cell death in lung tissue of diabetic rats
Onk, Didem; Onk, Oruç Alper; Erol, Hüseyin Serkan; Özkaraca, Mustafa; Çomaklı, Selim; Ayazoğlu, Tülin Akarsu; Kuyrukluyıldız, Ufuk; Ünver, Süheyla
Purpose: To investigate the effects of melatonin on antioxidant capacity, inflammation and apoptotic cell death (through expression of cleaved-caspase 3) in lung tissue samples of diabetic rats.Methods: Thirty male Sprague-Dawley rats were randomly divided into three groups.Group 1 (control group) was made up of healthy rats.Group 2 (diabetes group) received streptozotocin at a dose of 50 mg/kg/day for 5 days.Group 3 (diabetes plus melatonin group) received streptozotocin at a dose of 50 mg/kg/day for 5 days and then they received melatonin at a dose of 20 mg/kg/day between 28thand 35thdays of the study.Results: Tissue MDA and MPO levels were found to be significantly higher in diabetes group compared to control group (p<0.05) whilst administration of melatonin was found to significantly lower this increase down to normal levels (p<0.05).Bronchus associated lymphoid tissue (BALT) was more severe in diabetics whereas administration of melatonin alleviated this hyperplasia.Cleaved caspase 3 activity was severe in hyperplastic BALT in diabetic rats however in lowered down to moderate level when melatonin was administered.Conclusion: The melatonin caused an increase in antioxidant capacity and decreased the expression of cleaved-caspase 3.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018The effect of thiamine and its metabolites on peripheral neuropathic pain induced by cisplatin in rats
Onk, Didem; Mammadov, Renad; Suleyman, Bahadir; Cimen, Ferda Keskin; Cankaya, Murat; Gul, Vahdet; Altuner, Durdu; Senol, Onur; Kadioglu, Yucel; Malkoc, Ismail
Thiamine pyrophosphate (TPP) is the active metabolite of thiamine. This study aimed to investigate the effects of thiamine and TPP on cisplatin-induced peripheral neuropathic pain (PNP). Male albino Wistar type Rattus norvegicus were divided into six groups (n=6) that received 2 mg/kg cisplatin (CIS), 25 mg/kg thiamine (TM), 2 mg/kg cisplatin+25 mg/kg thiamine (CTM), 25 mg/kg TPP (TPP), 2 mg/kg cisplatin+25 mg/kg TPP (CTPP), or distilled water (healthy group; HG) for 8 days intraperitoneally. Analgesic effect was measured with a Basile Algesimeter. IL-1β, malondialdehyde (MDA), total glutathione (tGSH), thiamine, and TPP were determined in blood samples. Histopathological examinations were performed on removed sciatic nerves. The percent analgesic effects of the CTM and CTPP groups were calculated to be 21.3% and 82.9%, respectively. Increased production of IL-1β and MDA by cisplatin was inhibited by TPP, while it was not inhibited by thiamine. Conversion of thiamine to TPP significantly decreased in the CIS group. Histopathological and biochemical investigations demonstrated that hyperalgesia and sciatic nerve damage developed in the CIS and CTM groups with low TPP levels. These results indicate that cisplatin inhibits the formation of TPP from thiamine, leading to severe PNP. This finding suggests that TPP may be more beneficial than thiamine for the treatment of cisplatin-induced PNP.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2018Assessment of renal and hepatic tissue-protective effects of n-acetylcysteine via ammonia metabolism: A prospective randomized study
Onk, Didem; Özçelik, Fatih; Onk, Oruç Alper; Günay, Murat; Ayazoğlu, Tülin Akarsu; Ünver, Ethem
Background: The present study sought to assess the renal and liver protective effect of N-acetylcysteine through NH3 and urea metabolism in patients with chronic obstructive pulmonary disease who were scheduled for coronary artery bypass grafting surgery. Material/Methods: Patients with chronic obstructive pulmonary disease (COPD) who were scheduled for coronary artery bypass grafting were divided into 2 groups so as to receive (Group 1, n=35) or not receive (Group 2, n=35) 900 mg/day of n-acetylcysteine for 7 days before the operation starting from their admission to the service by a pulmon-ologist with the purpose of treating COPD until the day of surgery. Both groups were subjected to the same anesthesia protocol. Blood samples were taken preoperatively, within the first 15th minute following cessation of the cardiopulmonary bypass, at postoperative 24th hour, and at postoperative 48th hour. Blood tests included ammonia (NH3), lactate, blood urea nitrogen, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), troponin I (Tn I), and creatinine kinase-muscle brain (CKMB). Results: There was a significant difference between the groups’ NH3 and lactate levels after cardiopulmonary bypass, postoperative 24th hour, and postoperative 48th hour (respectively, NH3: 39.0±8.8 vs. 55.4±19.6 and 40.1±8.4 vs. 53.2±20.2 mcg/dl, lactate: 1.7±0.9 vs. 2.1±1.2 and 1.2±0.5 vs. 1.8±1.4 mmol/L; p<0.01). Creatinine and BUN levels in Group 2 were found to be significantly higher at the postoperative 48th hour compared to the levels of Group 1 (P<0.05). Conclusions: N-acetylcysteine pretreatment appears to improve renal and hepatic functions through regulation of ammonia and nitrogen metabolism and reduction of lactate in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass grafting surgery. We found that N-acetylcysteine improved kidney and/or liver functions.
RDL Kalıcı Kaydıİncele - ArticleYalnız künye2017Kardiyak cerrahide önkoşullamanın laboratuvar kanıtları olarak olarak inflamatuvar sitokinlerin ve kan PAPP-A düzeylerinin kullanımı
Onk, Oruç Alper; Onk, Didem; Özçelik, Fatih; Ayazoğlu, Tülin Akarsu; Çoban, Taha Abdulkadir; Günay, Murat
Kardiyoprotektif yönetim kalp cerrahisi sırasında myokard re- zervinin korunması için, giderek artan bir bakım standardı ha- line gelmiştir. Bu çalışma, uygun önkoşullama yönteminin ön- görülmesinde inflamatuvar sitokinlerin ve PAPP-A düzeylerinin yararlılığını araştırmaktadır. KABG cerrahisi için planlanan ASA III 90 hasta dahil edildi ve üç gruba ayrıldı. Grup 1’e (n=30) %5 desfluran inhalasyonu ile, propofol (2-3 mg.kg-1.h-1) ve fentanyl (3-5 mcg.kg-1.h-1) infüzyonları uygulandı. Grup 2’ye (n=30) %5 desfluran inhalasyonu ile propofol (5-6 mg.kg-1.h-1) ve fentanyl (3-5 mcg.kg-1.h-1) infüzyonları uygulandı. Grup 3’e (n=30) %5 desfluran inhalasyonu ile midazolam (0.04-0.06 mg.kg-1.h-1) ve fentanyl (3-5 mcg.kg-1.h-1) infüzyonları uygulandı. TNF-α, PAPP-A ve us-CRP düzeyleri operasyondan bir gün önce (S1), kardiyopul- moner bypasın (S2) hemen öncesinde, kardiyopulmoner bypasın tamamlanmasından sonra (S3) ve operasyondan 48 saat sonra (S4) ölçüldü. Tüm gruplarda, TNF-α, S2 ve S3’te artarken, S4’te azaldı (P<0,05), en belirgin artış ise grup 2’de gözlendi. S2 ve S3 aşamalarında PAPP-A düzeylerindeki en yüksek artış grup 2’de bulunurken, S4’teki en düşük azalma ise Grup 1 ve 3’te bulundu. us-CRP düzeyleri grup 1’de S1 ve S2 ile kıyaslandığında S3’te an- lamlı bir artış gösterdi (p<0,05) ve S1 ile S2’nin seviyelerine yak- laştı. KABG operasyonunun anestezik yönetiminde optimal ön koşullandırma yöntemini belirlemek için PAPP-A, CRP ve TNF-α ile birlikte kullanılabilir. Bu parametreleri kullanarak, midazolam- desfluran ve düşük doz propofol-desfluran’ın, CABG operasyonu sırasında anestetik önkoşullamada etkili olduğunu gözlemledik.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017Can Postoperative or Preemptive Epidural Analgesia Affect the Incidence of Postoperative Delirium After Major Abdominal Surgery?
Ayazoglu, Tulin Akarsu; Gun, Yavuz; Onk, Didem
Objectives: The study aimed to investigate the effects of postoperative and preemptive epidural analgesia combined with total intravenous anesthesia (TIVA) on the incidence of postoperative delirium (POD) in patients undergoing major abdominal surgery for >= 4 h. Methods: In this prospective randomized study, after evaluating 158 patients, 110 patients who were more than 50 years old were divided as follows: Group A, which received postoperative epidural analgesia (n=57), and Group B, which received preemptive epidural analgesia (n=54) combined with TIVA. Before and after surgery, delirium was diagnosed using the Mini-Mental State Examination, Confusion Assessment Method, and writing test. Risk factors for delirium were determined. Results: The overall incidence of delirium was 8.1% (9/110). POD was seen in five patients in Group A and four patients in Group B. The mean age of patients diagnosed with POD was 67.3 +/- 4.1 years, and this was greater than that of the remaining study patients (p=0.001). The average time until the onset of delirium was 2.2 +/- 0.8 days, and the mean duration of delirium was 6.3 +/- 4.2 days; however, there were no significant differences when comparing Group A patients with Group B patients in terms of these parameters (p>0.05). Significant risk factors for the development of delirium were old age, previous history of chronic obstructive pulmonary disease, male sex, being single, and excess smoking (p<0.001). Conclusion: Older patients showed POD within the first 3 days after undergoing major abdominal surgery. The incidence of delirium was not different between the patients who received postoperative epidural analgesia and those who received preemptive epidural analgesia combined with TIVA.
RDL Kalıcı Kaydıİncele - ArticleAçık Erişim2017The effect of desflurane and propofol protocols on preconditioning
Onk, Didem; Ozcelik, Fatih; Kuyrukluyildiz, Ufuk; Gunay, Murat; Onk, Alper; Ayazoglu, Tulin Akarsu; Coban, Abdulkadir; Alagol, Aysin
Background. Preconditioning is one of the most powerful mechanisms preventing the myocardial ischemic damage that occurs during coronary artery bypass grafting. Objectives. We aimed to investigate the effects of different propofol and/or desflurane administration protocols in terms of the prevention of ischaemia-reperfusion damage. Material and methods. Ninety patients, aged > 18 years, American Society of Anesthesiologists (ASA) category III, scheduled to undergo primary elective coronary artery bypass grafting (CABG), were included in the study. During maintenance, the patients in group 1 (n = 30) received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h); the patients in group 2 (n = 30) also received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h), but they were also given 6% desflurane inhalation for 15 min both before cross-clamping of the aorta and after removal of the clamp; the patients in group 3 (n = 30) received a propofol infusion (2-3 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h) and received the continuous 6% desflurane inhalation. Blood samples were drawn in the preoperative period (S1), during cardiopulmonary bypass, before cross-clamping the aorta (S2), after removal of the cross-clamp (S3) and 24 h after the operation (S4). Results. All groups were similar in terms of age and BMI (p > 0.05). TNF-á levels were higher at S3 compared to S1, S2 and S4 (p > 0.001). The TNF-á levels at S4 were lower in group 3 than those in group 1 and group 2 (p < 0.05). In all groups, h-FABP levels showed an increase in S3 but were significantly lower at S4 (p < 0.05). In group 3, h-FABP levels at S2 and S3 were significantly lower than those in group 1 (p < 0.05). There was a moderate correlation between h-FABP and TNF-á levels (Spearman's rho = 0.472, p < 0.001). Conclusions. On the basis of the measurement of h-FABP and TNF-á, low-dose propofol and continuous desflurane inhalation provide more effective preconditioning than propofol alone or a short course of desflurane in patients undergoing CABG.
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