Selim Turhanoglu

Oral ketamine premedication can prevent emergence agitation in children after desflurane anaesthesia.

Background : The purpose of the present study was to determine whether oral ketamine premedication affected the incidence of emergence agitation in children.

Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy.

Summary  We evaluated the effect of low‐dose bupivacaine plus fentanyl administered intrathecally in elderly patients undergoing transurethral prostatectomy. Patients were randomly assigned to one of two groups. Group F received plain bupivacaine 4 mg with 25 µg of fentanyl and sterile water to a total of 1.5 ml, and Group B received only 0.5% plain bupivacaine 7.5 mg for spinal anaesthesia. Sensory block was adequate for surgery in all patients. The mean level of motor block was higher and the duration of motor block was longer in Group B (p < 0.0001). Hypotension and shivering were significantly more common in Group B (p < 0.05). The addition of fentanyl 25 µg to plain bupivacaine 4 mg provides adequate analgesia for transurethral prostatectomy with fewer side‐effects in elderly patients when compared with the conventional dose of bupivacaine.

Intraoperative intravenous ketamine in combination with epidural analgesia: postoperative analgesia after renal surgery.

We designed this double-blinded, randomized, controlled study to evaluate the effect of small-dose ketamine IV in combination with epidural morphine and bupivacaine on postoperative pain after renal surgery. An epidural catheter was inserted, and the administration of morphine and bupivacaine was started before surgery. Forty patients were assigned to one of two groups (ketamine or control). The ketamine group was administered a ketamine bolus and infusion during surgery. The median visual analog pain scale (VAS) scores at rest were significantly lower in the ketamine group during the first 6 h (P < 0.01). VAS pain scores on coughing were also significantly lower in the ketamine group (P < 0.01). Cumulative postoperative total analgesic consumption was less in the ketamine group on Days 1 and 2 (P < 0.001). The first analgesic demand time was shorter in the control group (9.2 ± 11.5 min) than in the ketamine group (22.3 ± 17.1 min) (P < 0.0001). The incidence of nausea and pruritus was more frequent in the control group (P < 0.05). In conclusion, postoperative analgesia was more effective when spinal cord and brain sensitization were blocked by a combination of epidural morphine/bupivacaine and IV ketamine.

Effects of different doses of oral ketamine for premedication of children

Background and objective: A need exists for a safe and effective oral preanaesthetic medication for use in children undergoing elective surgery. The study sought to define the dose of oral ketamine that would facilitate induction of anaesthesia without causing significant side-effects. Methods: We studied 80 children undergoing elective surgery under general anaesthesia who received oral ketamine 4, 6 or 8 mg kg−1 in a prospective, randomized, double-blind placebo controlled study. We compared the reaction to separation from parents, transport to the operating room, the response to intravenous cannula insertion and application of an anaesthetic facemask, the induction of anaesthesia and recovery from anaesthesia. Results: In the group receiving ketamine 8 mg kg−1, the children were significantly calmer than those of the other groups, and anaesthesia induction was more comfortable. Recovery from anaesthesia was longer in the group receiving ketamine 8 mg kg−1 compared with the other groups, but no differences between the groups were observed after 2 h in the recovery room. Conclusions: It is concluded that oral ketamine 8 mg kg−1 is an effective oral premedication in inpatient children undergoing elective surgery.

Effects of high‐dose propofol on succinylcholine‐induced fasciculations and myalgia

Background: The purpose of this prospective study was to determine the effects of high‐dose propofol on the incidence of fasciculations and myalgia, and to evaluate changes in creatine kinase levels following the administration of succinylcholine in 90 women who underwent laparoscopy.

Paraplegia associated with combined spinal‐epidural anaesthesia caused by preoperatively unrecognized spinal vertebral metastasis

We describe a case of paraplegia following combined spinal‐epidural anaesthesia. It was postoperatively determined that a tumour of the vertebrae which was compressing the spinal cord was responsible for this complication. We suggest that the pre‐existing pathology of the spine must be borne in mind as a differential diagnosis of acute postoperative paraplegia.

Effects of whole blood, crystalloid, and colloid resuscitation of hemorrhagic shock on renal damage in rats: an ultrastructural study.

PURPOSE The aim of this study was to determine the effects of whole blood, crystalloid, and colloid treatment on histopathologic damage of kidney induced by hemorrhagic shock in rats. METHODS Fifty-six male Sprague Dawley rats were divided into 8 groups. The carotid artery was cannulated, and systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), and rectal temperature (RT) were observed during the procedure. The jugular vein also was cannulated, and the SAP was decreased by aspiration of 75% of blood through the jugular vein in the control (nonresuscitated) and study (resuscitated) groups, whereas blood was not diminished in the sham group. The hemorrhagic shock was permitted to last 45 minutes; then, the study group rats were resuscitated with heparinized shed autologous whole blood (WB), normal saline (NS), Lactated Ringers solution (LR), hydroxyethyl starch 6% (HES6), hydroxyethyl starch 10% (HES10), or dextran 40 (D40). Histopathologic evaluation was performed under light and electron microscope. RESULTS The RT, SAP, and DAP decreased, and HR increased significantly in the control and study groups during the shock period compared with those of sham group. After volume resuscitation, these parameters changed to preshock levels. Electron and light microscopic examinations of kidneys showed severe proximal tubular degeneration with moderate glomerular damage in the control group; moderate proximal tubular degeneration with mild glomerular damage in the NS, LR, HES6, and HES10 groups; and mild proximal tubular degeneration with no evidence of glomerular damage in the WB and D-40 groups. CONCLUSIONS The characteristic ultrastructural features of hemorrhagic shock appear to be severe tubular degeneration and mild to moderate changes in glomeruli. Resuscitation of hemorrhagic shock with whole blood or dextran 40 solution appears to be most favorable therapy in preventing ultrastructural renal damage in rats.

Which administration route of fentanyl better enhances the spread of spinal anaesthesia: intravenous, intrathecal or both?

Background:  To enhance the spread of spinal anaesthesia, fentanyl may be administered intrathecally (i.t.) or intravenously (i.v.). The purpose of this prospective study was to investigate the effects of fentanyl administered i.v., i.t. or concurrently by both i.v. and spinal routes on the spread of spinal anaesthesia.

Yarı Oturur Pozisyonda İntraoperatif Venöz Hava Embolisi

The aim of this study was to determine the effect of carbamazepine onserum lipid levels in epileptic patients who were on long-termcarbamazepine monotherapy. The study group were comprised of 30epileptic patients (10 female, 20 male) who have been on carbamazepinemonotherapy for at least one year whereas control group consisted of 30 ageand sex matched healthy controls. Serum cholesterol (total cholesterol,HDL cholesterol, LDL cholesterol) and triglyceride levels were measuredand LDL/HDL ratio was calculated in all subjects. Serum HDL cholesteroland triglyceride levels of study group were significantly higher than controlgroup whereas serum LDL cholesterol levels and LDL/HDL ratios of studygroup were lower than control group. Mean total cholesterol level of studygroup was lower than control group, however the difference did not reachstatistical significance level. Because of its effect on cholesterol levels, longterm carbamazepine could possibly have a positive influence in decreasingthe risk of developing aterosclerosis and coronary heart disease. Long termprospective follow-up studies would be helpful to us in enlightening this issuedefinitely.