Background: We compared the efficacy of intravenous fentanyl, esmolol and lidocaine in preventing... more Background: We compared the efficacy of intravenous fentanyl, esmolol and lidocaine in preventing hemodynamic response to laryngoscopy, endotracheal intubation and extubation in abdominal surgeries. Methods: A hundred and twenty patients (aging from 18 to 65, ASA class I or II, Mallampati grade I) were randomly divided into 4 groups. Fentanyl 1µg kg-1 (n = 30), Esmolol 1 mg kg-1 (n = 30), Lidocaine 1 mg kg-1 (n = 30) and NaCl 0.9% 10 mL (Control group, n = 30) were administered before induction and extubation. Heart rate, systolic arterial pressure and diastolic arterial pressure were recorded before anesthesia induction and at laryngoscopy, at 1st, 3rd ,5th and 10th minutes of intubation, and then at the end of surgery before extubation, and at 1st, 3rd, 5th, and 10th minutes following extubation. Amounts of the administered drugs and side effects were recorded. Results: The heart rates and the arterial blood pressures values of the study groups after intubation and extubation were lower than those in the control group (P < 0.01). The heart rates, the systolic and diastolic arterial blood pressure values after intubation and ex-tubation at 1st, 3th, and 5th minutes were significantly lower in esmolol group when compared to fentanyl and lidocaine groups (P < 0.05). In all other measurement times, there was no any different of hemodynamic among the three groups. Conclusions: When administered before induction and emergency of anesthesia 1 mg kg-1 of esmolol and lidocaine, and 1µg kg-1 of fentanyl are effective in suppressing the hemodynamic response to laryngoscopy, intubation and extubation. Esmolol may be more effective to prevent those responses comparing fentanyl and lidocaine. Furthermore studies regarding the dose of those drugs should be required.
Journal of Academic Emergency Medicine Case Reports, Jan 6, 2016
Introduction: The radiological investigations that will be performed after the hemodynamic stabil... more Introduction: The radiological investigations that will be performed after the hemodynamic stabilization of trauma cases presenting to the emergency room are of vital importance when deciding on the treatment to be administered to the patient. Posteroanterior chest radiography was not applied in the proper position, to include all the soft tissues of the chest and shoulder, after an injury caused by a sharp object in our case. Therefore, a radiopaque foreign object retained within the body was not detected. Case Report: Our case was brought to the emergency room because of a stabbing injury, but no pathological findings were determined at the initial examination or based on the X-graphs taken. Approximately 1 year after discharge, the patient presented to another hospital because of a persistent swelling and pain in the left armpit. A metallic image consistent with a knife point 7-8 cm in length was determined to be under the left armpit. Conclusion: The radiographs not taken in the proper position may lead to undesirable consequences. Therefore, we recommend that great attention should be paid while taking the radiographs, ensuring the proper position and careful evaluation.
From this article we emphasise that internal urethrotomy under local urethral anasthesia and sedo... more From this article we emphasise that internal urethrotomy under local urethral anasthesia and sedoanalgesia is safe and reliable. It prevents the possible complications of spinal anaesthesia and lets the patients more speedy recovery. Therefore we advice this method for selected patients. Background: Urethral stricture is a common condition, and direct vision internal urethrotomy is prefered as the first treatment option by many urologists, for strictures shorter than 2 cm. This procedure is generally performed under general or spinal anaesthesia. Objectives: To investigate the feasibility of adding local urethral anaesthesia to intravenous sedation and analgesia (sedoanalgesia) methods in patients undergoing internal urethrotomy. Patients and Methods: A total of 21 and 15 patients with anterior urethral strictures underwent internal urethrotomy under local urethral anaesthesia, with or without sedoanalgesia, respectively. Patient discomfort and pain levels were evaluated using the visual analog scale (VAS). Statistical analyses were calculated with a Mann-Whitney U test to compare difference in VAS scores between the subjects in both groups. Results: Two of the 15 (13%) patients operated under local urethral anaesthesia without sedoanalgesia were converted to general anaesthesia due to patient intolerability. Mean pain VAS scores for patients operated under 2% lidocain urethral gel anaesthesia with or without sedoanalgesia were 2.86 cm and 4.5 cm, respectively (P = 0.001). In addition, a VAS score over 3 cm was found in 3 of the 21 (14%) patients with, and 13 of the 15 (86%) patients without sedoanalgesia (P = 0.001). Conclusions: The addition of intravenous sedoanalgesia improved the VAS scores of pain and discomfort, compared to patients operated under only local urethral anaesthesia. This may offer patients safer anaesthesia and shorter operative times with equilavent results in selected patients.
Harran Üniversitesi Tıp Fakültesi Dergisi, Dec 1, 2011
İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmek... more İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmektedir. Bu vasküler yaralanmalar, erken veya geç postoperatif dönemde tanı alabilir. Erken tanı ve tedavi bu tip olgularda hayati önem taşır. Kırk yaşındaki erkek hasta, lomber disk herniasyonu ameliyatı sonrası erken dönemde iyatrojenik vasküler yaralanma ön tanısı ile hastanemize dış bir merkezden refere edildi. Hastanın acil serviste yapılan ilk değerlendirilmesinde hemorajik şok, ciddi asidoz (pH:6,58) ve hipotermi mevcuttu. Hastaya bu bulgularla acil operasyon uygulandı. Eksplorasyonda, sol ana iliyak arterde yırtık tespit edildi ve damar grefti ile onarıldı. İntraoperatif şok ve asidoz başarıyla tedavi edildi. Postoperatif dönemde yoğun bakım takibi sonrası hasta sekelsiz taburcu edildi. Sonuç olarak; hemorajik şok ve eşlik eden ciddi asidoz tablosu olan hastalarda erken müdahale, hızlı kan ve sıvı transfüzyonu sekelsiz iyileşme sağlayabilir.
Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır r... more Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır restriktif akciğer hastalığı ve zor entübasyon bulguları gösteren 50 yaşında erkek hastanın anestezi yönetimi tartışıldı. Torakal deformite nedeniyle hastanın baş ekstansiyonu kısıtlı, supin pozisyonda uyuma ve nefes almada zorluk çekiyor. Ağız açıklığında ve baş ekstansiyonundaki kısıtlılık nedeniyle hasta larengeal maske kullanılarak entübe edildi. Bronşiyal sekresyonlarda artış ve bronkospazmı önlemek, solunum kaslarının fonksiyonunu optimum düzeyde geri döndürmek için sugammadex uygulamasını takiben ekstübe edildi.
Background: Foreign bodies cause an aseptic reaction that does not have specific symptoms and may... more Background: Foreign bodies cause an aseptic reaction that does not have specific symptoms and may also result in peritonitis, acute abdominal pain, an intraperitoneal abscess, or intestinal obstruction or perforation. We present a case of a surgical instrument left in the abdomen that passed into the transverse colon via migration after a surgery. Case description: A 36-year-old female patient was operated upon, with a diagnosis of a hydatid cyst in her liver. Approximately 3 years after the surgery, she excreted part of a surgical forceps with her stool while she was defecating. In upright direct abdominal radiography, a surgical instrument was observed in the abdomen. The patient was operated to remove the foreign body from the abdomen. The surgical instrument that was taken out had corroded and turned black. It was observed that the material that had dropped out of the anus and the material that was taken out during the operation were parts of the same surgical instrument. The ascending colon and the abdomen were stitched anatomically. Follow-ups were conducted after the operation, and the patient was discharged with recovery. Conclusions: It should be noted that a surgical instrument may be left inside the body of patients who have a history of surgery and that it can migrate.
Objective: To investigate if transurethral cystolithotripsy with a ureteroscope is feasible under... more Objective: To investigate if transurethral cystolithotripsy with a ureteroscope is feasible under local urethral anaesthesia, intravenous sedation and analgesia (sedoanalgesia). Methods: The prospective study was conducted from December 2009 to October 2010 and comprised 18 male patients with bladder calculi over 10mm in widest diameter regardless of etiology. The patients underwent transurethral holmium laser cystolithotripsy with a 9.5f semi-rigid ureteroscope. All patients received 2% idocaine gel local urethral anaesthesia, intravenous 0.03mg/kg midazolam and 7µg/kg alfentanil before the start of lithotripsy. Patients were discharged 1-3 hours after removal of the urethral foley catheter. Patients were asked to scale the discomfort and/or pain level by using visual analogue pain scale. Patients were followed up for at least 6 months. Results: The overall success rate was 89% (n=16). The mean stone diameter and total number of stones in the 16 patients was 21,48 ±6.7 (12-35) mm and 21 stones, respectively. The average age of the 16 patients was 52.3±17.6 (45-78) years and mean operative time from begining of intravenous sedoanalgesia until urethral foley catheter insertion was 19.2±18.9 (4-60) minutes. Mean pain score of the 16 patients after ureteroscopic cystolithotripsy was 1.75±0.6cm (1-6). No anaesthesia-related serious complications occurred. After a follow-up of 18 months, recurrent stone formation and urethral stricture was not located in any patient. Conclusions: Transurethral cystolithotripsy with a ureteroscope under local urethral anaesthesia and sedoanalgesia for stones less than 30mm might offer patients safer anaesthesia and shorter operative time with favourable results.
SummaryWe investigated the effect of rocuronium‐ and sugammadex‐induced mast cell increase and de... more SummaryWe investigated the effect of rocuronium‐ and sugammadex‐induced mast cell increase and degranulation in rat portal triads. Forty‐two rats, in six groups, received either rocuronium 1 mg.kg−1; sugammadex 15 mg.kg−1; sugammadex 100 mg.kg−1; rocuronium 1 mg.kg−1 and 5 min later, sugammadex 15 mg.kg−1; rocuronium 1 mg.kg−1 and 5 min later, sugammadex 100 mg.kg−1; or isotonic saline. Total mast cell numbers were significantly higher with rocuronium only, than in all other groups (p < 0.003), although in all active groups, the number was greater than the control. Total mast cell number was significantly higher with rocuronium and low‐dose sugammadex compared with low‐dose sugammadex only. The number of tryptase‐positive mast cells with rocuronium only was significantly higher than in all other groups (p < 0.003). Tryptase‐positive mast cell numbers in both groups receiving both rocuronium and sugammadex were significantly higher compared with both groups receiving sugammadex...
DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2016
We investigated the histopathological effects of metamizole sodium (MS) on the sciatic nerve. Mat... more We investigated the histopathological effects of metamizole sodium (MS) on the sciatic nerve. Materials and Methods: This study was performed using 48 adult male Wistar albino rats. Ten groups were constituted with 6 rats in each group. MS injection into the sciatic nerve (group 1), MS injection into the muscle [group 3 (50 mg/kg, 0.4 ml) and group 5 (50 mg/kg, 0.8 ml)], MS injection into the muscle cavity in the vicinity of the sciatic nerve [group 2 (50 mg/kg, 0.4 ml) and group 4 (50 mg/kg, 0.8 ml)], normal saline injection into the muscle in the vicinity of the sciatic nerve [group 6A (0.4 ml) and 6B (0.8 ml)], subjected to injury by drilling the entire layer of nerve without injecting any drug, normal saline injection in the sciatic nerve, and control group. Nerve and muscle samples were taken 7 days after administrations. Tissue sections were stained using a hematoxylin and eosin-Luxol® fast blue stain, assessed by a histologist. Results: The levels of axonal degeneration of the rats in groups 1, 2, 3, 4, 5, 6A, and 8 were found to be significantly higher compared to the levels of the rats in the control group (P<0.05). Myelin degeneration of the rats in all groups was found to be significantly higher compared to myelin degeneration of the rats in the control group (P<0.05). Conclusion: It was observed that MS could lead to injury in the sciatic nerve with a toxic effect due to diffusion.
Amaç: Bu çalışmanın amacı, supin pozisyonda alt ekstremite cerrahisi geçiren hastalarda, spinal a... more Amaç: Bu çalışmanın amacı, supin pozisyonda alt ekstremite cerrahisi geçiren hastalarda, spinal anestezinin göz içi basıncı (GİB) üzerine etkisinin değerlendirilmesidir. Gereç ve Yöntem: Spinal anestezi uygulamasından önce ve 20 dk sonra tüm hastaların GİB’leri Tono-pen XL ile ölçüldü. Kan ba- sıncı, periferik oksijen satürasyonu ve elektrokardiyografi monitörizasyonu, spinal anesteziden önce başlatıldı ve cerrahi boyunca her 5 dk’da bir tekrarlandı. GİB ölçümüyle eş zamanlı olarak ölçülen ortalama sistemik arteriyel basınç değerleri not edildi. GİB ve ortalama arteriyel basınçtaki değişiklikler t testi ile karşılaştırıldı. Bulgular: Çalışmaya 49 hastanın 98 gözü dahil edildi. Anestezi öncesi ortalama GİB 18.6±2.8 mmHg iken spinal anestezi uygu- lamasından 20 dk sonra 15.7±2.9 mmHg olarak ölçüldü (p<0.05). Anestezi öncesi ortalama sistemik arteriyel basınç 109.5±16.8 mmHg iken, anesteziden 20 dk sonra 91.6±15.3 mmHg olarak ölçüldü (p<0.05). Sonuç: Spinal anestezi supin pozisyo...
The Stevens-Johnson syndrome is a serious mucocutaneous vesiculobullous disease that begins acute... more The Stevens-Johnson syndrome is a serious mucocutaneous vesiculobullous disease that begins acutely and limits itself generally. It may develop by the use of several routinely used drugs. That's why the physicians who prescribe such drugs may be sued for malpractice. In our case, the Stevens-Johnson syndrome that has developed as a result of Lamotrigine use and become a matter in dispute will be examined from a medicolegal perspective.
In this case report, we have presented our anaesthetic management in a patient undergoing urgent ... more In this case report, we have presented our anaesthetic management in a patient undergoing urgent abdominal surgery who has undergone renal transplantation before, and has been in a chronic haemodialysis program two times a week. Anaesthesia was induced with sevoflurane in nitrous oxide-oxygen mixture via a mask and maintained with sevoflurane 1.5% in N2O:O2 (50%:50%). A bolus dose of atracurium 25 mg was administered intravenously and intubation was done. Standard monitoring consisted of an electrocardiogram, non-invasive arterial pressure and pulse oximetry. Serum creatinine, potassium, sodium and blood urea nitrogen levels and also creatinine clearance were measured preoperatively and in the first, second, third and seventh postoperative days. Surgical cholecystectomy was performed and the duration of anaesthesia was 60 minutes. We conclude that sevoflurane does not aggravate renal impairment in measured parameters (serum creatinine, blood urea nitrogen and creatinine clearense) of renal function and does not change the time for haemodialysis in the patient with renal insufficiency.
Turkiye Klinikleri Journal of Medical Sciences, 2013
Ketamine is a frequently used anesthetic with a prominent effect on blood glucose levels. Therefo... more Ketamine is a frequently used anesthetic with a prominent effect on blood glucose levels. Therefore, ketamine may alter the mode of action of pancreatic islet cells, and the prolonged use of this agent may cause functional or morphological alterations of the pancreatic tissue. This study compared prolonged and different doses of intraperitoneal ketamine administration on pancreatic islet cell morphology and secretory function in rats. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 30 rats in five groups were used. Rats in groups K40, K60, K80 and K100 received 40, 60, 80, and 100 mg/kg ketamine hydrochloride intraperitoneally (i.p.), respectively. Control group received 0.9% NaCl i.p.. Injections were repeated twice daily for 2 weeks. After 2 weeks, the animals were sacrificed under anesthesia, pancreas tissues were removed and examined using immunohistological staining, light microscopy, and electron microscopy. R Re es su ul lt ts s: : Prolonged use of ketamine caused histological alterations as observed by electron microscopy in all groups and by light microscopy in all groups except K40. Immunopositivities for insulin and glucagon was statistically significantly higher in the control group compared to study groups, but did not differ between study groups. C Co on nc cl lu us si io on ns s: : We demonstrated that the long-term ketamine use had pathological effects on the pancreas histology. Therefore, it should be kept in mind that ketamine causes pancreas damage and should be used cautiously. Further investigations are needed to find out whether these effects are permanent or not.
Harran Üniversitesi Tıp Fakültesi Dergisi, Dec 1, 2011
İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmek... more İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmektedir. Bu vasküler yaralanmalar, erken veya geç postoperatif dönemde tanı alabilir. Erken tanı ve tedavi bu tip olgularda hayati önem taşır. Kırk yaşındaki erkek hasta, lomber disk herniasyonu ameliyatı sonrası erken dönemde iyatrojenik vasküler yaralanma ön tanısı ile hastanemize dış bir merkezden refere edildi. Hastanın acil serviste yapılan ilk değerlendirilmesinde hemorajik şok, ciddi asidoz (pH:6,58) ve hipotermi mevcuttu. Hastaya bu bulgularla acil operasyon uygulandı. Eksplorasyonda, sol ana iliyak arterde yırtık tespit edildi ve damar grefti ile onarıldı. İntraoperatif şok ve asidoz başarıyla tedavi edildi. Postoperatif dönemde yoğun bakım takibi sonrası hasta sekelsiz taburcu edildi. Sonuç olarak; hemorajik şok ve eşlik eden ciddi asidoz tablosu olan hastalarda erken müdahale, hızlı kan ve sıvı transfüzyonu sekelsiz iyileşme sağlayabilir.
Background: We compared the efficacy of intravenous fentanyl, esmolol and lidocaine in preventing... more Background: We compared the efficacy of intravenous fentanyl, esmolol and lidocaine in preventing hemodynamic response to laryngoscopy, endotracheal intubation and extubation in abdominal surgeries. Methods: A hundred and twenty patients (aging from 18 to 65, ASA class I or II, Mallampati grade I) were randomly divided into 4 groups. Fentanyl 1µg kg-1 (n = 30), Esmolol 1 mg kg-1 (n = 30), Lidocaine 1 mg kg-1 (n = 30) and NaCl 0.9% 10 mL (Control group, n = 30) were administered before induction and extubation. Heart rate, systolic arterial pressure and diastolic arterial pressure were recorded before anesthesia induction and at laryngoscopy, at 1st, 3rd ,5th and 10th minutes of intubation, and then at the end of surgery before extubation, and at 1st, 3rd, 5th, and 10th minutes following extubation. Amounts of the administered drugs and side effects were recorded. Results: The heart rates and the arterial blood pressures values of the study groups after intubation and extubation were lower than those in the control group (P < 0.01). The heart rates, the systolic and diastolic arterial blood pressure values after intubation and ex-tubation at 1st, 3th, and 5th minutes were significantly lower in esmolol group when compared to fentanyl and lidocaine groups (P < 0.05). In all other measurement times, there was no any different of hemodynamic among the three groups. Conclusions: When administered before induction and emergency of anesthesia 1 mg kg-1 of esmolol and lidocaine, and 1µg kg-1 of fentanyl are effective in suppressing the hemodynamic response to laryngoscopy, intubation and extubation. Esmolol may be more effective to prevent those responses comparing fentanyl and lidocaine. Furthermore studies regarding the dose of those drugs should be required.
Journal of Academic Emergency Medicine Case Reports, Jan 6, 2016
Introduction: The radiological investigations that will be performed after the hemodynamic stabil... more Introduction: The radiological investigations that will be performed after the hemodynamic stabilization of trauma cases presenting to the emergency room are of vital importance when deciding on the treatment to be administered to the patient. Posteroanterior chest radiography was not applied in the proper position, to include all the soft tissues of the chest and shoulder, after an injury caused by a sharp object in our case. Therefore, a radiopaque foreign object retained within the body was not detected. Case Report: Our case was brought to the emergency room because of a stabbing injury, but no pathological findings were determined at the initial examination or based on the X-graphs taken. Approximately 1 year after discharge, the patient presented to another hospital because of a persistent swelling and pain in the left armpit. A metallic image consistent with a knife point 7-8 cm in length was determined to be under the left armpit. Conclusion: The radiographs not taken in the proper position may lead to undesirable consequences. Therefore, we recommend that great attention should be paid while taking the radiographs, ensuring the proper position and careful evaluation.
From this article we emphasise that internal urethrotomy under local urethral anasthesia and sedo... more From this article we emphasise that internal urethrotomy under local urethral anasthesia and sedoanalgesia is safe and reliable. It prevents the possible complications of spinal anaesthesia and lets the patients more speedy recovery. Therefore we advice this method for selected patients. Background: Urethral stricture is a common condition, and direct vision internal urethrotomy is prefered as the first treatment option by many urologists, for strictures shorter than 2 cm. This procedure is generally performed under general or spinal anaesthesia. Objectives: To investigate the feasibility of adding local urethral anaesthesia to intravenous sedation and analgesia (sedoanalgesia) methods in patients undergoing internal urethrotomy. Patients and Methods: A total of 21 and 15 patients with anterior urethral strictures underwent internal urethrotomy under local urethral anaesthesia, with or without sedoanalgesia, respectively. Patient discomfort and pain levels were evaluated using the visual analog scale (VAS). Statistical analyses were calculated with a Mann-Whitney U test to compare difference in VAS scores between the subjects in both groups. Results: Two of the 15 (13%) patients operated under local urethral anaesthesia without sedoanalgesia were converted to general anaesthesia due to patient intolerability. Mean pain VAS scores for patients operated under 2% lidocain urethral gel anaesthesia with or without sedoanalgesia were 2.86 cm and 4.5 cm, respectively (P = 0.001). In addition, a VAS score over 3 cm was found in 3 of the 21 (14%) patients with, and 13 of the 15 (86%) patients without sedoanalgesia (P = 0.001). Conclusions: The addition of intravenous sedoanalgesia improved the VAS scores of pain and discomfort, compared to patients operated under only local urethral anaesthesia. This may offer patients safer anaesthesia and shorter operative times with equilavent results in selected patients.
Harran Üniversitesi Tıp Fakültesi Dergisi, Dec 1, 2011
İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmek... more İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmektedir. Bu vasküler yaralanmalar, erken veya geç postoperatif dönemde tanı alabilir. Erken tanı ve tedavi bu tip olgularda hayati önem taşır. Kırk yaşındaki erkek hasta, lomber disk herniasyonu ameliyatı sonrası erken dönemde iyatrojenik vasküler yaralanma ön tanısı ile hastanemize dış bir merkezden refere edildi. Hastanın acil serviste yapılan ilk değerlendirilmesinde hemorajik şok, ciddi asidoz (pH:6,58) ve hipotermi mevcuttu. Hastaya bu bulgularla acil operasyon uygulandı. Eksplorasyonda, sol ana iliyak arterde yırtık tespit edildi ve damar grefti ile onarıldı. İntraoperatif şok ve asidoz başarıyla tedavi edildi. Postoperatif dönemde yoğun bakım takibi sonrası hasta sekelsiz taburcu edildi. Sonuç olarak; hemorajik şok ve eşlik eden ciddi asidoz tablosu olan hastalarda erken müdahale, hızlı kan ve sıvı transfüzyonu sekelsiz iyileşme sağlayabilir.
Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır r... more Bu yazıda, torasik spinal rekonstrüksiyon operasyonu planlanan, ankilozan spondilite bağlı ağır restriktif akciğer hastalığı ve zor entübasyon bulguları gösteren 50 yaşında erkek hastanın anestezi yönetimi tartışıldı. Torakal deformite nedeniyle hastanın baş ekstansiyonu kısıtlı, supin pozisyonda uyuma ve nefes almada zorluk çekiyor. Ağız açıklığında ve baş ekstansiyonundaki kısıtlılık nedeniyle hasta larengeal maske kullanılarak entübe edildi. Bronşiyal sekresyonlarda artış ve bronkospazmı önlemek, solunum kaslarının fonksiyonunu optimum düzeyde geri döndürmek için sugammadex uygulamasını takiben ekstübe edildi.
Background: Foreign bodies cause an aseptic reaction that does not have specific symptoms and may... more Background: Foreign bodies cause an aseptic reaction that does not have specific symptoms and may also result in peritonitis, acute abdominal pain, an intraperitoneal abscess, or intestinal obstruction or perforation. We present a case of a surgical instrument left in the abdomen that passed into the transverse colon via migration after a surgery. Case description: A 36-year-old female patient was operated upon, with a diagnosis of a hydatid cyst in her liver. Approximately 3 years after the surgery, she excreted part of a surgical forceps with her stool while she was defecating. In upright direct abdominal radiography, a surgical instrument was observed in the abdomen. The patient was operated to remove the foreign body from the abdomen. The surgical instrument that was taken out had corroded and turned black. It was observed that the material that had dropped out of the anus and the material that was taken out during the operation were parts of the same surgical instrument. The ascending colon and the abdomen were stitched anatomically. Follow-ups were conducted after the operation, and the patient was discharged with recovery. Conclusions: It should be noted that a surgical instrument may be left inside the body of patients who have a history of surgery and that it can migrate.
Objective: To investigate if transurethral cystolithotripsy with a ureteroscope is feasible under... more Objective: To investigate if transurethral cystolithotripsy with a ureteroscope is feasible under local urethral anaesthesia, intravenous sedation and analgesia (sedoanalgesia). Methods: The prospective study was conducted from December 2009 to October 2010 and comprised 18 male patients with bladder calculi over 10mm in widest diameter regardless of etiology. The patients underwent transurethral holmium laser cystolithotripsy with a 9.5f semi-rigid ureteroscope. All patients received 2% idocaine gel local urethral anaesthesia, intravenous 0.03mg/kg midazolam and 7µg/kg alfentanil before the start of lithotripsy. Patients were discharged 1-3 hours after removal of the urethral foley catheter. Patients were asked to scale the discomfort and/or pain level by using visual analogue pain scale. Patients were followed up for at least 6 months. Results: The overall success rate was 89% (n=16). The mean stone diameter and total number of stones in the 16 patients was 21,48 ±6.7 (12-35) mm and 21 stones, respectively. The average age of the 16 patients was 52.3±17.6 (45-78) years and mean operative time from begining of intravenous sedoanalgesia until urethral foley catheter insertion was 19.2±18.9 (4-60) minutes. Mean pain score of the 16 patients after ureteroscopic cystolithotripsy was 1.75±0.6cm (1-6). No anaesthesia-related serious complications occurred. After a follow-up of 18 months, recurrent stone formation and urethral stricture was not located in any patient. Conclusions: Transurethral cystolithotripsy with a ureteroscope under local urethral anaesthesia and sedoanalgesia for stones less than 30mm might offer patients safer anaesthesia and shorter operative time with favourable results.
SummaryWe investigated the effect of rocuronium‐ and sugammadex‐induced mast cell increase and de... more SummaryWe investigated the effect of rocuronium‐ and sugammadex‐induced mast cell increase and degranulation in rat portal triads. Forty‐two rats, in six groups, received either rocuronium 1 mg.kg−1; sugammadex 15 mg.kg−1; sugammadex 100 mg.kg−1; rocuronium 1 mg.kg−1 and 5 min later, sugammadex 15 mg.kg−1; rocuronium 1 mg.kg−1 and 5 min later, sugammadex 100 mg.kg−1; or isotonic saline. Total mast cell numbers were significantly higher with rocuronium only, than in all other groups (p < 0.003), although in all active groups, the number was greater than the control. Total mast cell number was significantly higher with rocuronium and low‐dose sugammadex compared with low‐dose sugammadex only. The number of tryptase‐positive mast cells with rocuronium only was significantly higher than in all other groups (p < 0.003). Tryptase‐positive mast cell numbers in both groups receiving both rocuronium and sugammadex were significantly higher compared with both groups receiving sugammadex...
DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2016
We investigated the histopathological effects of metamizole sodium (MS) on the sciatic nerve. Mat... more We investigated the histopathological effects of metamizole sodium (MS) on the sciatic nerve. Materials and Methods: This study was performed using 48 adult male Wistar albino rats. Ten groups were constituted with 6 rats in each group. MS injection into the sciatic nerve (group 1), MS injection into the muscle [group 3 (50 mg/kg, 0.4 ml) and group 5 (50 mg/kg, 0.8 ml)], MS injection into the muscle cavity in the vicinity of the sciatic nerve [group 2 (50 mg/kg, 0.4 ml) and group 4 (50 mg/kg, 0.8 ml)], normal saline injection into the muscle in the vicinity of the sciatic nerve [group 6A (0.4 ml) and 6B (0.8 ml)], subjected to injury by drilling the entire layer of nerve without injecting any drug, normal saline injection in the sciatic nerve, and control group. Nerve and muscle samples were taken 7 days after administrations. Tissue sections were stained using a hematoxylin and eosin-Luxol® fast blue stain, assessed by a histologist. Results: The levels of axonal degeneration of the rats in groups 1, 2, 3, 4, 5, 6A, and 8 were found to be significantly higher compared to the levels of the rats in the control group (P<0.05). Myelin degeneration of the rats in all groups was found to be significantly higher compared to myelin degeneration of the rats in the control group (P<0.05). Conclusion: It was observed that MS could lead to injury in the sciatic nerve with a toxic effect due to diffusion.
Amaç: Bu çalışmanın amacı, supin pozisyonda alt ekstremite cerrahisi geçiren hastalarda, spinal a... more Amaç: Bu çalışmanın amacı, supin pozisyonda alt ekstremite cerrahisi geçiren hastalarda, spinal anestezinin göz içi basıncı (GİB) üzerine etkisinin değerlendirilmesidir. Gereç ve Yöntem: Spinal anestezi uygulamasından önce ve 20 dk sonra tüm hastaların GİB’leri Tono-pen XL ile ölçüldü. Kan ba- sıncı, periferik oksijen satürasyonu ve elektrokardiyografi monitörizasyonu, spinal anesteziden önce başlatıldı ve cerrahi boyunca her 5 dk’da bir tekrarlandı. GİB ölçümüyle eş zamanlı olarak ölçülen ortalama sistemik arteriyel basınç değerleri not edildi. GİB ve ortalama arteriyel basınçtaki değişiklikler t testi ile karşılaştırıldı. Bulgular: Çalışmaya 49 hastanın 98 gözü dahil edildi. Anestezi öncesi ortalama GİB 18.6±2.8 mmHg iken spinal anestezi uygu- lamasından 20 dk sonra 15.7±2.9 mmHg olarak ölçüldü (p<0.05). Anestezi öncesi ortalama sistemik arteriyel basınç 109.5±16.8 mmHg iken, anesteziden 20 dk sonra 91.6±15.3 mmHg olarak ölçüldü (p<0.05). Sonuç: Spinal anestezi supin pozisyo...
The Stevens-Johnson syndrome is a serious mucocutaneous vesiculobullous disease that begins acute... more The Stevens-Johnson syndrome is a serious mucocutaneous vesiculobullous disease that begins acutely and limits itself generally. It may develop by the use of several routinely used drugs. That's why the physicians who prescribe such drugs may be sued for malpractice. In our case, the Stevens-Johnson syndrome that has developed as a result of Lamotrigine use and become a matter in dispute will be examined from a medicolegal perspective.
In this case report, we have presented our anaesthetic management in a patient undergoing urgent ... more In this case report, we have presented our anaesthetic management in a patient undergoing urgent abdominal surgery who has undergone renal transplantation before, and has been in a chronic haemodialysis program two times a week. Anaesthesia was induced with sevoflurane in nitrous oxide-oxygen mixture via a mask and maintained with sevoflurane 1.5% in N2O:O2 (50%:50%). A bolus dose of atracurium 25 mg was administered intravenously and intubation was done. Standard monitoring consisted of an electrocardiogram, non-invasive arterial pressure and pulse oximetry. Serum creatinine, potassium, sodium and blood urea nitrogen levels and also creatinine clearance were measured preoperatively and in the first, second, third and seventh postoperative days. Surgical cholecystectomy was performed and the duration of anaesthesia was 60 minutes. We conclude that sevoflurane does not aggravate renal impairment in measured parameters (serum creatinine, blood urea nitrogen and creatinine clearense) of renal function and does not change the time for haemodialysis in the patient with renal insufficiency.
Turkiye Klinikleri Journal of Medical Sciences, 2013
Ketamine is a frequently used anesthetic with a prominent effect on blood glucose levels. Therefo... more Ketamine is a frequently used anesthetic with a prominent effect on blood glucose levels. Therefore, ketamine may alter the mode of action of pancreatic islet cells, and the prolonged use of this agent may cause functional or morphological alterations of the pancreatic tissue. This study compared prolonged and different doses of intraperitoneal ketamine administration on pancreatic islet cell morphology and secretory function in rats. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 30 rats in five groups were used. Rats in groups K40, K60, K80 and K100 received 40, 60, 80, and 100 mg/kg ketamine hydrochloride intraperitoneally (i.p.), respectively. Control group received 0.9% NaCl i.p.. Injections were repeated twice daily for 2 weeks. After 2 weeks, the animals were sacrificed under anesthesia, pancreas tissues were removed and examined using immunohistological staining, light microscopy, and electron microscopy. R Re es su ul lt ts s: : Prolonged use of ketamine caused histological alterations as observed by electron microscopy in all groups and by light microscopy in all groups except K40. Immunopositivities for insulin and glucagon was statistically significantly higher in the control group compared to study groups, but did not differ between study groups. C Co on nc cl lu us si io on ns s: : We demonstrated that the long-term ketamine use had pathological effects on the pancreas histology. Therefore, it should be kept in mind that ketamine causes pancreas damage and should be used cautiously. Further investigations are needed to find out whether these effects are permanent or not.
Harran Üniversitesi Tıp Fakültesi Dergisi, Dec 1, 2011
İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmek... more İyatrojenik vasküler yaralanma, lomber disk herniasyon ameliyatı esnasında nadir de olsa görülmektedir. Bu vasküler yaralanmalar, erken veya geç postoperatif dönemde tanı alabilir. Erken tanı ve tedavi bu tip olgularda hayati önem taşır. Kırk yaşındaki erkek hasta, lomber disk herniasyonu ameliyatı sonrası erken dönemde iyatrojenik vasküler yaralanma ön tanısı ile hastanemize dış bir merkezden refere edildi. Hastanın acil serviste yapılan ilk değerlendirilmesinde hemorajik şok, ciddi asidoz (pH:6,58) ve hipotermi mevcuttu. Hastaya bu bulgularla acil operasyon uygulandı. Eksplorasyonda, sol ana iliyak arterde yırtık tespit edildi ve damar grefti ile onarıldı. İntraoperatif şok ve asidoz başarıyla tedavi edildi. Postoperatif dönemde yoğun bakım takibi sonrası hasta sekelsiz taburcu edildi. Sonuç olarak; hemorajik şok ve eşlik eden ciddi asidoz tablosu olan hastalarda erken müdahale, hızlı kan ve sıvı transfüzyonu sekelsiz iyileşme sağlayabilir.
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