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.

Özmen, Özgür; Bingöl, Fatih; Arslan, Zakir; Özel Bİngöl, Buket

This prospective study investigated the effects of dexamethasone and low-dose propofol infusion on postoperative nausea and vomiting in 90 patients undergoing tympanoplasty. The dexamethasone group (Group D) received 8 mg dexamethasone and the control group (Group C) 2 ml saline 15 min before the end of surgery, while the propofol group (Group P) received ıntrave-nous propofol infusion at a dose of 20 mcg/kg/min throughout surgery following induction of anaesthesia. Incidence rates and severity of nausea-vomiting and antiemetic requirements were recorded throughout the first postoperative 24 hours. Between hours 0 and 2, any incidence of postoperative nausea and vomiting was not observed in 23 (76.7%) patients in Group P, 17 (56.7%) in Group D and 8 (26.7%) in Group C. Differences were observed between the groups in hours 0-2 and 2-8 in terms of verbal descriptive scale values for postoperative nausea and vomiting (p<0.01 and p=0.004, respectively). Total incidence rates of postoperative nausea and vomiting at hours 2-8 h were 10.0% (n=3) in Group P, 36.7% (n=11) in Group D and 53.3% (n=16) in Group C, the difference being statistically significant in favour of Group P (p=0.032). At 0-24. hrs, the number of patients vomiting, despite treatment, were lower in Groups P and D (n=4, 13.3% and n=5, 16.7%, respectively) compared to Group C (n=14, 46.7%) (p=0.005). Antiemetic use was higher in Group C than in Groups D and P (p=0.001). Intraoperative low-dose propofol infusion is as effective as dexamethasone in reducing the incidence and severity of postoperative nausea and vomiting, as well as reducing post-tympanoplasty antiemetic requirements.

Onk, Didem; Özçelik, Fatih; Onk, Oruç Alper; Günay, Murat; Akarsu Ayazoğlu, Tülin; Çoban, Abdulkadir

Cardioprotective management has increasingly become a standard of care for preservation of myocardial reserve during cardiac surgery. This study investigates the usefulness of inflammatory cytokines and PAPP-A levels in predicting the appropriate preconditioning method. Ninety ASA III patients scheduled for CABG surgery were included and allocated into three groups. Group 1 (n=30) received propofol (2-3 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 2 (n=30) received propofol (5-6 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. Group 3 (n=30) received midazolam (0.04-0.06 mg.kg-1.h-1) and fentanyl (3-5 mcg.kg-1.h-1) infusions with 5% desflurane inhalation. TNF-α, PAPP-A and us-CRP levels were measured one day preo-peratively (S1), immediately prior to the cardiopulmonary bypass (S2), after completion of the cardiopulmonary bypass (S3) and 48 hours postoperatively (S4). In all groups, TNF-α increased at S2 and S3 and decreased at S4 (P<0.05), with the most prominent increase observed in Group 2. The highest increase in PAPP-A levels at S2 and S3 stages was observed in Group 2 whereas the lowest decrease at S4 stage was observed in Groups 1 and 3. In Group 1, us-CRP levels showed a significant increase at S3 compared to S1 and S2 (p<0.05) and decreased to levels close to S1 and S2. PAPP-A can be used with us-CRP and TNF-α to determine the optimal preconditioning method in the anaesthetic management of CABG surgery. Using these markers, we observed that midazolam-desflurane and low-dose propofol-desflurane were effective in anaesthetic preconditioning during CABG surgery.

Özmen, Özgür; Arslan, Zakir; Ekinci, Mürsel; Tör, İbrahim; Kara, Duygu; Karakaya, Muhammet Ahmet

The choice of anesthesia used in cesarean operations is determined by the patient’s clinical status, the experience of the anesthetist, the urgency of surgery and the patient’s wishes. This study evaluated anesthetic practices in cesarean surgery performed in the preceding 10 years in our Maternity Hospital, Turkey. Hospital computer system records and file archives between 2006 and 2015 were screened. Anesthesia techniques used in elective and emergency cesarean surgery were recorded. The distribution of these techniques by years was then analyzed. A total of 28.986 cesarean sections (cases) were performed in our hospital in 2006-2015. Eighty-four percent of them were emergency and 16% of them were elective CSs. General anesthesia was used in 4848 (17%) and regional anesthesia in 24.138 (83%) patients, while combined spinal-epidural anesthesia was used in 2% and epidural anesthesia in 1% of the patients. Regional anesthesia was used frequently in our clinic similar to European countries. Spinal anesthesia was the most commonly preferred method of regional anesthesia in our clinic. However, especially in emergency cases combined spinal-epidural or epidural anesthesia was not applied. We think that combined spinal-epidural anesthesia should be applied more frequently in elective cases.