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Öğe Comparison of interpleural bupivacaine plus adrenaline to bupivacaine plus adrenaline plus morphine injections in postoperative analgesia(1995) Kirmemis M.; Gunday I.; Karamanlioglu B.This study was performed on 20 ASA I-II patients operated with subcostal incision. The cases were divided into two groups to investigate the quality and the time course of two different combinations of analgesics. Interpleurally, bupivacaine (0.5 %, 150 mg) plus adrenaline (1/200.000, 0.15 mg) were administered to group I (n=10), and bupivacaine (0.5 %, 150 mg) pills adrenaline (1/200.000, 0.15 mg) plus morphine (2 mg) were administered to group II (n=10). Forced vital capacity (FVC) and forced expiration volume in the first second (FEV1) were measured before the premedication (stage I) in, both groups. Following surgical intervention; Visual analogue scala (VAS), FVC and FEV1 values were measured before the blockade (stage II), 30 minutes (stage III) and 120 minutes (stage IV) after the blockade respectively in both groups. In both groups, 1) VAS values decreased significantly at stages III and IV. 2) FVC and FEV1 values were found lower in stage II than stage I. Although the values obtained in the stages III and IV could not reach the values of stage I, FVC and FEV1 values showed improvement. There were no significant differences between group I and II in terms of VAS, FVC and FEV1. In group II, analgesia started significantly earlier and lasted significantly longer. As a result, interpleural injection of bupivacaine plus adrenaline after subcostal incision produced sufficient analgesia and helped to improve the impaired respiratory functions. An additional dose of morphine (2 mg) to bupivacaine and adrenaline injections (group II) caused analgesia to start earlier and last longer which may be a reason for preference.Öğe Comparison of maternal and neonatal effects of sevoflurane, isoflurane and helothane in elective cesarean section(1999) Alpaydin T.; Karamanlioglu B.; Pamukcu Z.In this study, we aimed to compare the maternal and neonatal effects of sevoflurane, isoflurane and halothane in elective cesarean section. The study was performed in 90 pregnants (Group A) in term undergoing elective cesarean section and their 90 neonates (Gr B). The pregnants and neonates were divided in to three equal (n: 30) subgroups according to the administration of volatile anaesthetics: Gr 1;1 % sevoflurane, Gr II; 0.75 % isoflurane, Gr III; 0,5 % halothane. In the Gr A, before and after intubation heart rate, systolic and diastolic arterial pressures were recorded. Induction-delivery (I-D) and uterine incision-delivery (U-D) intervals; before intubation and after clamping of umblical cord, arterial blood gas tensions; spontaneous eye opening and tracheal extubation times were recorded. In the Gr B, umbilical artery and vein (U-A, U-V) blood gas tensions and acid-base values were recorded. Apgar scores were evaluated at the 1st, 5th and 10th min. The relation between I-D, U-D intervals and U-A and U-V pH vahtes and Apgar scores at 1st minute was evaluated. In the Group A, maternal parameters values were found similar in three subgroups (p>0.05). In the Gr B, U-A and U-V blood gas tensions and Apgar scores at 1st, 5th and 10th min were not significant between three groups with the exception of the comparison of Gr I and III at the 10th min values (p=0.011). The relation between I-D intervals and U-A pH values and Apgar scores at 1st min was found to be insignificant in three subgroups. Although the relation between U-D intervals in Gr I, U-V pH values in Gr III and Apgar scores at 1st minute was found to be significantly (p=0.006, 0.032). As a result, we conclude that each of the three volatile agents have minimum adverse effects on pregnants and neonates and sevoflurane seem to be an acceptable alternative to isoflurane and halothane for elective cesarean section.Öğe Comparison of the effects of isoflurane, enflurane and halothane on the TSH, T3 and T4(1992) Karamanlioglu B.; Sengonul O.; Pamukcu Z.[No abstract available]Öğe Do Deferoxamine, Ticlopidin or Trimetazidine prevent Sevoflurane nephrotoxicity? An electron microscopic study(Cambridge University Press, 2003) Karamanlioglu B.; Aktas R.G.Introduction: Sevoflurane is a common anesthetic drug. Several biochemical, pharmacologic and physiologic studies have showed nephrotoxicity of Sevoflurane[1,2,3]. Histopathologic studies reported tubular damage and tubular cellular hyperplasia after the administration of Sevoflurane[4]. Deferoxamine(DFO) is known to protect against myoglobinuric acute renal failure[5]. It has been suggested that Ticlopidine(TIC) does not prevent nephropathies but has beneficial effects[6]. Fang et al. showed that TIC inhibited mesangial cell proliferation and collagen synthesis[7]. There is another study reporting that TIC induces acute interstitial nephrite and cause an increase of the number of lymphocytes and eosinophil leucocytes in interstitial tissue[8]. Trimetazidine(TMZ) has anti-ischemic effects and protects tissue damage in kidney[5, 9, 10, 11]. These studies lead us to investigate if DFO, TIC or TMZ can prevent the nephrotoxicity of Sevoflurane at morphologic level. Materials & Methods: Fifty male Wistar-Albino rats were used for this experimental study. They were divided into five groups randomly: Group I was control and had 1.5 cc saline two times a day. Group II had 15%Oxygen+85% Nitricoxide+3%Sevoflurane in a special designed chamber for 1 hour. Group III had i.m. 15 mg DFO(Desferal, Novartis) for 7 days and then they inhaled the same Sevoflurane combination as Group II for 1 hour. Group IV had oral 25 mg TIC(Ticlid, Sanofi) that was dissolved in 1.5 cc saline. After that, they had same Sevoflurane combination for 1 hour. Group V had oral 0,5 mg TMZ(Vastarel, Servier) that was dissolved in 1,5 cc saline. They also inhaled Sevoflurane combination at the same way with the other groups. Biopsy specimens from renal cortex of each rat were embedded in Araldite and the ultrathin sections were examined under transmission electron microscope. Results: Electron microscopic findings were as the follows: Group I: Glomeruli, proximal tubules and distal tubules showed normal electron microscopic features. Group II: Basement membranes of proximal and distal tubules were irregular. The relationships between the cells and the basement membranes were decreased. The foldings at the basal side of the cells were diminished. Frequency of the microvilli on the apical surface of the proximal cells was less. There were gaps between the epithelial cells. Basement membranes of glomeruli were regular. Pedicels of podocytes were irregular at some places. Mesangial matrix increased slightly. Nuclear chromatin of some endothelial cells, podocytes and mesangial cells were condensed. Group III: The electron microscopic findings in tubular cells were similar to the findings, which were observed in Group II. However, they were less significant. There were no changes in glomeruli. Group IV: The main significant ultrastuctural finding in tubular epithelial cells was the increase of foldings at the basal side. Fine structure of glomeruli showed no abnormalities. Group V: The foldings at the basal side of proximal and distal tubular cells were increased. There were big gaps between the epithelial cells. The raise in the number of lysosomes were evident. There were some changes in glomeruli, too: Mesangial matrix was increased. Pedicels of podocytes lost their regularity partly. Conclusions: Tubular cells are very sensitive to ischcmic damage. Our observations after the administration of Sevoflurane reflect the reversible tubular findings, which were seen after ischemia. Irreversible changes after ischemia were not clear at this experiment. Either DFO or TIC caused diminishment of the microscopic findings. We conclude that the anti-oxidant effects of these drugs might be useful to prevent nephrotoxicity of Sevoflurane. Fine structural changes after the treatment with TMZ were similar to the findings observed after Sevoflurane administration. This suggests that TMZ was not successful to prevent the nephrotoxicity of Sevoflurane. Our findings related with DFO and TIC are consistent with the previous studies. However, the results of this study did not show beneficial effects of TMZ as it has been reported previously at clinical studies. Attemption of different dosages and different duration times for the application of this drug with Sevoflurane might be helpful to verify if TMZ can prevent Sevoflurane nephrotoxicity.Öğe Effect of alfentanil and remifentanil infusions on hemodynamic and postoperative parameters in isoflurane anesthesia(1997) Memis D.; Alagol A.; Karamanlioglu B.; Alpaydin T.; Pamukcu Z.In our study, effects of alfentanil or remifentanil infusations on pre, per and postoperative hemodynamic parameters, early postoperative recovery criterias and on pain control was evaluated in patients undergoing TAH+BSO. Study was performed in patients with ASA I-III classification of 40 patients. Patients were divided into two groups: alfentanil (Group A) and remifentanil (Group R). In group A, anaesthesia was induced with alfentanil 20 ?g/kg continued with, 0.5 ?g/kg/min infusion, in Group R patients anaesthesia was induced with 1 ?g/kg remifentanil, continued with 0.1 ?g/kg/min infusion in isoflurane anaesthesia. SAP, DAP and HR were noted before induction and 1 min later, just after intubation, and 3 min later, when skin closure was beginned, at extubation, 15, 30, 45, 60, 90, 120 minutes after extubation. Recovery criterias were determined postoperatively, intensity of pain was determined by 'verbal pain score', sedation was evaluated with sedation scale. SAP, DAP and HR decreased 1 min. after induction of anesthesia, difference was not significant in other times (p>0.05). Spontan eye opening was earlier in Group R (p>0.05), postoperative pain management was better in Group A (p<0.05), there was no significant difference in sedation scores (p>0.05). As a result, alfentanil and remifentanil had similar hemodynamic stability, in postoperative pain management alfentanil, in early recovery criteria and side effects remifentanil was more advantageous when compared.Öğe The Effect of Intravenous Pantoprazole and Ranitidine for Improving Preoperative Gastric Fluid Properties in Adults Undergoing Elective Surgery(2003) Memiş D.; Turan A.; Karamanlioglu B.; Saral P.; Türe M.; Pamukçu Z.We studied pantoprazole, a new potent and fast-acting proton pump inhibitor. Its effects on preoperative gastric fluid volume and pH have not yet been determined. In this randomized, controlled trial, we examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. Ninety patients (ASA status I and II, scheduled for elective surgery) were studied. One hour before surgery, patients in Group I (n = 30) were given IV saline 5 mL, those in Group II (n = 30) were given 40 mg of pantoprazole IV, and those in Group III (n = 30) were given 50 mg of ranitidine IV. A nasogastric tube was inserted immediately after anesthesia induction. Gastric contents were aspirated, and volume and pH were recorded. The pH values determined in Group I were 3.73 ± 0.82; in Group II, they were 5.30 ± 1.84; and in Group III, they were 4.80 ± 1.40. There was no statistical difference between Groups 2 and 3, but there was a significant difference between Group I and Groups 2 and 3 (P < 0.0005). The volume of the gastric contents was 28. 67 ± 10.98 mL in Group I, 15.20 ± 15.52 mL in Group II, and 7.77 ± 11.17 mL in Group III. There was no statistical difference between Groups 2 and 3, but there was a statistically significant difference between Group I and Groups 2 and 3 (P < 0.0005). The proportion of patients considered "at risk" of significant lung injury should aspiration occur was 20% of Group I, 10% of Group II, and 3.3% of Group III. When statistically evaluated, there was no difference among groups. We concluded that the administration of IV pantoprazole and ranitidine 1 h before surgery is effective in reducing gastric pH and volume.Öğe The effect of midazolam on the levels of serum cortisol, fasting blood sugar, liver enzymes and apnea(1990) Karamanlioglu B.; Gunday I.; Sengonul O.[No abstract available]Öğe Effect of propofol on serum levels of total lipid, cholesterol and triglyceride(1992) Sinikoglu N.; Gunday I.; Karamanlioglu B.; Sengonul O.[No abstract available]Öğe The effect of tramadol or clonidine added to intraperitoneal bupivacaine on postoperative pain in total abdominal hysterectomy.(2005) Memis D.; Turan A.; Karamanlioglu B.; Tükenmez B.; Pamukçu Z.Recent studies suggest that intraperitoneal application of local anesthetics is useful in abdominal surgery. Tramadol and clonidine have specific effects on peripheral nerves when used alone. We aimed to evaluate the effects of intraperitoneal application of bupivacaine and the combinations of bupivacaine plus tramadol and bupivacaine plus clonidine on postoperative pain in total abdominal hysterectomy. After standard anesthetic procedure during closure of the abdomen, Group 1 (n = 20) was given 20 mL bupivacaine 0.5 percent, Group 2 (n = 20) was given 20 mL bupivacaine 0.5 percent plus 100 mg tramadol, and Group 3 (n = 20) was given 20 mL bupivacaine 0.5 percent plus 1 microg per kg clonidine, all into the peritoneal cavity. Postoperative pain was evaluated with the visual analog scale (VAS) at 30 minutes, and two, four, six, 12, and 24 hours after extubation. While patients were supine and seated, mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were noted. When VAS scores were 4 to 7, 0.5 mg per kg of meperidine was given intramuscularly (IM); above 7, 1 mg per kg of meperidine was given IM; and when VAS scores were 2 to 4, 500 mg acetaminophen was given orally. For evaluating quality of analgesia, rescue analgesic dose, analgesia time, and side effects were noted. The groups were similar in respect to SpO2; however, when Group 1 was compared to Groups 2 and 3 at 30 minutes, and two, four, and six hours, MAP and HR measurements were found to be significantly higher (p < 0.05). VAS values in sitting and supine positions at 30 minutes and two hours were significantly lower in Group 2 (p < 0.05) when compared to Group 1. VAS values for Group 3 at 30 minutes, and two and four hours in the supine position, and at 30 minutes and two hours in the sitting position, were found to be significantly lower than those in Group 1 (p < 0.05). There were no significant differences between Groups 2 and 3. The mean dosage of meperidine used was 76.7+/-10.5 mg in Group 1, 63.9+/-8.4 mg in Group 2, and 70 +/-5.2 mg in Group 3. When Group 1 was compared to Group 2, there were significant differences found (p < 0.05). First analgesic requirement time was found to be 30 (range, 30 to 30) minutes in Group 1, 120 (range, 30 to 240) minutes in Group 2, and 110 (range, 30 to 240) minutes in Group 3. There were significant differences found when Groups 2 and 3 were compared to Group 1 (p < 0.05). We concluded that the combinations of bupivacaine plus tramadol and bupivacaine plus clonidine administered intraperitoneally in total abdominal hysterectomy operations provide more effective analgesia than bupivacaine alone during the early postoperative period.Öğe Effects of halothane and isoflurane on lipid metabolism(1995) Bedirhan B.; Karamanlioglu B.; Sengonul O.This study was realized on 80 atherosclerotic and non-atherosclerotic patients to research effects of halothane and isoflurane on lipid metabolism. Patients were divided into two groups as halothane (H) and isoflurane (I). Each group consisted of 40 patients and also each group was divided into two subgroups as atherosclerotic (H1, I1) and non-atherosclerotic (H2, I2), equally. The plasma levels of cholesterol, HDL, LDL and triglyceride were investigated in venous blood samples that were taken before induction (stage I), at first (stage II), sixth (stage III), twenty-fourth (stage IV) and forty-eighth hours (stage V). The results were shown to us that, plasma levels of cholesterol, LDL were increased and HDL was decreased in group H1 and H2, significantly. In the group I1; level of cholesterol was increased, HDL was decreased but level of LDL didn't change. In the group I2; level of HDL showed significant decrease only at stage II. Triglyceride levels didn't show significant change in groups of H1, H2, I1, and I2. As a result of our study we can say that isoflurane is a better anaesthetic agent than halothane in atherosclerotic and non-atherosclerotic patients.Öğe Effects of lornoxicam on the physiology of severe sepsis.(2004) Memiş D.; Karamanlioglu B.; Turan A.; Koyuncu O.; Pamukçu Z.INTRODUCTION: The purpose of the present study was to evaluate the effects of intravenous lornoxicam on haemodynamic and biochemical parameters, serum cytokine levels and patient outcomes in severe sepsis. METHODS: A total of 40 patients with severe sepsis were included, and were randomly assigned (20 per group) to receive either lornoxicam (8 mg administered intravenously every 12 hours for six doses) or placebo. For both groups the following were recorded: haemodynamic parameters (heart rate, mean arterial pressure), nasopharyngeal body temperature, arterial blood gas changes (pH, partial oxygen tension, partial carbon dioxide tension), plasma cytokine levels (IL-1beta, IL-2 receptor, IL-6, IL-8, tumour necrosis factor-alpha), biochemical parameters (lactate, leucocytes, trombocytes, creatinine, total bilirubin, serum glutamate oxalate transaminase), length of stay in the intensive care unit, duration of mechanical ventilation and mortality. All measurements were obtained at baseline (before the start of the study) and at 24, 48 and 72 hours from the start of lornoxicam/placebo administration. RESULTS: No significant differences were found between the intravenous lornoxicam and placebo groups in major cytokines, duration of ventilation and length of intensive care unit stay, and inspired fractional oxygen/arterial oxygen tension ratio (P > 0.05). CONCLUSION: In these patients with severe sepsis, we found intravenous lornoxicam to exert no effect on haemodynamic and biochemical parameters, cytokine levels, or patient outcomes. Because of the small number of patients included in the study and the short period of observation, these findings require confirmation by larger clinical trials of intravenous lornoxicam, administered in a dose titrated manner.Öğe Epidural anaesthesia with 2 % carticaine and 0.5 % bupivacaine(1999) Arslan G.; Karamanlioglu B.; Pamukcu Z.In this study, we aimed to compare the quality of anaesthesia and side effects of single dose epidural carticaine and bupivacaine in patients scheduled for urinary, lower abdominal or extremity surgery. The study was planned on 63 cases of ASA I-II and 50 cases with successful sensory blockade were included in the study. The patients were divided into two groups. Group I was administered 6 mg/kg 2 % carticaine (n=25) and Group II was given 1.5 mg/kg 0.5 % bupivacaine (n=25) epidurally. Latent period time, onset time of sensory blockade in different dermatomes (T12, L1, L2, L5, S1), top dermation level and the time to reach this level, the degree of motor blockade and its onset time, quality of sensory and motor blockade and their side effects were recorded in both groups. The latent period time, onset time of sensory blockade in different dermatomes, time of reaching to the top level of sensory blockade and onset time of motor blockade were found to be shorter in the first group (p<0.001). The other parameters in both groups showed no different (p>0.05). In conclusion, 2% carticaine can be preferred during emergencies, operations with short duration and in cases which does not require postoperative analgesics since it has an early onset of sensory and motor blockade and reaches rapidly to desired dermatomes when applied epiduraly. As the other parameters are identical between the two groups, it has been decided that carticaine can be an alternative for bupivacaine.Öğe Evaluation of the effects of oral temazepam administration in premedication(1992) Guldiken G.; Pamukcu Z.; Karamanlioglu B.; Sengonul O.[No abstract available]Öğe A postoperative case with aplastic anemia (Case report)(1992) Karamanlioglu B.; Pamukcu Z.; Gunday I.; Sengonul O.; Vural O.A male case, 21 years old, was diagnosed to have an aplastic anemia, immediately after an inguinal hernie surgery during which a chloramphenicol ointment was applied on to his eyes. It was thought chloramphenicol is the reason for this case's aplastic anemia by the idiosyncrotic reaction. Therefore this case is reported under the light of the relevant upto date references.Öğe The prognostic value of atrial and brain natriuretic peptides, troponin I and C-reactive protein in patients with sepsis(2008) Yucel T.; Memiş D.; Karamanlioglu B.; Süt N.; Yuksel M.Aim: To investigate the plasma levels of atrial and brain natriuretic peptides (ANP and BNP), cardiac troponin I (cTnI) and C-reactive protein (CRP) as prognostic factors for survival in patients with sepsis. Method: Evaluation of serum levels of ANP, BNP, cTnI and CRP of patients an admission to an intensive care unit, two days later, and on the day of discharge from the intensive care unit or on the day of death. Results: ANP levels were significantly higher in the nonsurviving patients (day 1: 70.00±49.54 pg/mL; day 2: 138.85±143.15 pg/mL; and died/discharged day: 375.70±262.66 pg/mL) than surviving patients (day 1: 23.96±29.93 pg/mL; day 2: 10.06±6.03 pg/ML; died/discharged. day: 6.68±100.98 pg/mL, P<0.001). The BNP levels were significantly higher in the nonsurvivors (day 1: 254.78±308.62 pg/mL; day 2: 383.22±307.19 pg/mL; and died/discharged day: 696.47±340.33 pg/mL), than survivors (day 1: 13.72±12.95 pg/mL; day 2: 7.20±5.85 pg/mL; died/discharged day: 4.51±4.64 pg/mL, P<0.001). The cTnI levels were significantly higher in the nonsurviving patients (day 2: 0.16±0.38 ?g/L; died/discharged day: 0.78±2.48 ?g/L) than surviving patients (day 2: 0.04±0.07 ?g/L; died/discharged day: 0.02±0.01 ?g/L, P<0.05). The CRP levels were significantly higher in the nonsurvivors (day 2: 119.3±71.5 mg/L; and died/discharged day: 145.7±74.7 mg/L) than sumavors (day 2: 57.0±29.7 mg/L; died/discharged day: 26.8±24.0 mg/L, P<0,05). There were no significont differences between nonsurvivors and survivors for cTnI and CRP on day 1. Conclusion: With the exception of cTnI and CRP on day 1, all of the parameters were significantly powerful to determine nonsurvivors on all days. Among these variables, BNP was the most powerful diagnostic parameter for the prediction of nonsurvivors on all days. © 2008 Pulsus Group Inc. All rights reserved.Öğe The role of dimethyl sulphoxide and methylprednisolone in the prevention of halothane hepatotoxicity(1996) Karamanlioglu B.; Turan A.; Hyseyin G.; Sengonul O.; Pamukcu Z.In this experimental study, we aimed to investigate the effect of dimethyl sulphoxide (DMSO) and methylprednisolone (MP) on the prevention of halothane related hepatotoxicity. The study was performed on thirty male Wistar-albino rats equally divided into 3 groups. Enzyme induction was performed by administration of phenobarbital (1 mg/mL in the drinking water of the rats for 7 days. The rats were anaesthetized by inspiration of a mixture of 15% O2 + 85% N2O + 0.7% halothane (7 L/min) for 2.5 hours. The control group (n=10) was given only halothane. The DMSO group (n=10) was given 20% DMSO (4 g/kg) subcutaneously 2.5 hours before the anaesthesia and then halothane was applied. The MP group (n=10) was given MP (30 mg/kg) intravenously 2.5 hours before the anaesthesia and then halothane was applied. Thirty minutes after the anaesthesia, the rats were scarified and liver samples were taken for the determination of the free radicals and ultrastructural changes. A significant reduction in the value of malondialdehyde which was used for the determination of free radicals was observed in DMSO (22495.2 ± 3.76 nmol/g) and MP (24475.0 ± 3.15 nmol/g) groups in comparison to the control group (29952.0 ± 4.38 nmol/g) (p<0.0015, p<0.0032). Electron microscopic investigation of the control group revealed marked reversible and irreversible changes in the hepatocyte organelles. In DMSO group the hepatocyte organelles showed marked proliferation and in some of these organelles reversible damage was observed. In IMP group marked reversible damage was observed in addition, to proliferation of the hepatocyte organelles. As a result, in the DMSO and MP groups significant reduction of the free radicals, and observation of less hepatocytic damage in electron microscopy were determined compared to the control group. With regard to these results we concluded that DMSO and MP are useful chemical substances which can reduce the hepatotoxic effect of halothane.Öğe The value of omeprazole and H2 receptor blockers in the prophylaxis of aspiration in cesarean operation(1995) Karamanlioglu B.; Canogullari M.; Arslan G.; Alagol A.; Sengonul O.The effect of omeprazole famotidine, ranitidine and placebo in decreasing the risk of aspiration were investigated in 80 pregnant women undergoing elective cesarean operation and their 80 newborns. Group A consisted of pregnant women and divided into four subgroups. Subgroup AI were given omeprazole 40 mg, PO, two hours prior to anaesthetic induction and groups AII, AIII and AIV were given famotidine 40 mg PO, ranitidine 150 mg PO and isotonic saline respectively. Gastric fluids were aspirated through the nasogastric tube before and after induction and at the 30th minute of anaesthesia and volumes and pH values were recorded. Urine samples were taken with the same intervals and pH values were recorded. The volume of gastric fluid and pH were measured in all the newborns (group B) following birth and the values were evaluated according to the subgroups their mother included. Omeprazole, famotidine and ranitidine decreased gastric fluid volume and increased pH significantly when compared to placebo in all the women. Urine pH of the women and gastric fluid volume and pH of the newborns did not show significant differences. All drugs used were concluded to be equally effective in the prophylaxis of aspiration pneumonia.
