6 results on '"Keskinbora, Kader"'
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2. Anestezi idame ve derlenmesinde sevofluran ve propofolün etkilerinin karşılaştırılması
- Author
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Keskinbora, Kader, Karaca, Saffet, and Anesteziyoloji Ana Bilim Dalı
- Subjects
Anestezi ve Reanimasyon ,Anesthesiology and Reanimation ,Anesthesia-inhalation ,Propofol ,Anesthetics - Abstract
ÖZET Kan - gaz dağılım katsayısı bilinen tüm inhalasyon ajanlarından daha düşük olan sevofluranın, hemodinamik stabilite, hızlı ve güvenli uyanma ve derlenme sağladığı ileri sürülmektedir. Biz bu çalışmada intravenöz anestezide adeta standart ajan olarak kullanılan propofol ile yeni bir inhalasyon ajan olan sevofluranı hemodinami parametreleri ve derlenme özellikleri açısından karşılaştırdık. Bu amaçla; laparoskopik kolesistektomi olacak 25-65 yaşlan arasında ASA I- II gruplarından 40 hastayı çalışma kapsamına aldık. Hastalar rastgele iki gruba ayrıldılar. 25 ng/kg Alfentanil, 2mg/kg propofol ve 0.1 mg/kg ve vekuronyum bromid ile indüksiypn ve entübasyon gerçekleştirilen hastalardan propofol grubuna idamede ilk 10 dakika 10 mg/kg, ikinci 10dakika 8mg/ kg, ve daha sonra 6 mg/kg propofol + %50 02/hava, sevofluran grubuna idamede %2 vol sevofluran + % 50 02 / hava uygulandı. Ayrıca her iki gruba idamede Alfentanil 25 [j.g/kg/ saat infüzyonu yapıldı. İdame ve derlenme dönemindeki (entübasyondan 5 dk sonra, insüflasyondan önce ve sonra, ekstübasyondan önce ve sonra, ekstübasyondan 5 dk ve 15 dk sonra) hemodinamik parametreler (kalp atım hızı, arter basınçları (sistolik, diastolik, ortalama) SP02 ve ETC02) kaydedildi. Safra kesesi batından dışarı çıkarıldığında, her iki grupta da Alfentanil infüzyonu kesildi. Son göbek cilt sütürü atıldıktan sonra ise sevofluran grubunda sevofluran inhalasyonu, propofol grubunda propofol infüzyonu kesildi ve yine her iki grupta idamedeki ajanlar kesildikten sonra, ekstübasyon zamanı ve spontan gözlerini açma zamanı kaydedildi. Ayrıca hastalara ALDRETE ve KROULİK'inderlenme skoru ve minimental (kognitif) testler uygulanarak derlenme özellikleri değerlendirildi. İki grubu birbirleriyle karşılaştırdığımızda idame döneminde (entübasyondan 5 dk sonra) kalp atım hızı ve arter basınçları arasında anlamlı bir fark bulamadık. Ama grupları kendi içlerinde karşılaştırdığımızda propofol grubunda kalp atım hızı insüflasyondan önce en düşük, ortalama arter basınçları entübasyondan 5 dk sonra ve insüflasyondan önce en düşük değerleri saptadık. Sevofluran grubunda ise kalp atım hızı insüflasyondan önce en düşük, ortalama arter basıncı ise entübasyondan 5 dk sonra en düşük değeri saptadık. Her iki grupta da bulduğumuz bu düşük değerlere idamede kullandığımız narkotik analjezik infüzyonuna bağladık. { Her iki grupta insüflasyon sonrası ortalama arter basınçlarında bulduğumuz yükselmeleri ameliyat tekniği olan laparoskopiye bağlı patofizyolojik değişiklikler ile açıkladık. Derlenme döneminde ise ekstübasyon zamanı ve spontan gözlerini açma zamanı açısından propofol grubu daha iyiydi. Ama ALDRETE derlenme skoru ve kognitif fonksiyonlar açısından iki grup arasında anlamlı bir fark yoktu. Sevofluran, hoş kokusu ve kısa derlenmesi ile diğer inhalasyon ajanlarına göre daha az emetik pontansiyeline rağmen bulantı kusmaya daha fazla neden olmuştu. Sonuçta, sevofluranın idamede hemodinamik stabilite, hızlı ve güvenli derlenme sağlayarak propofole alternatif olabileceği kanısındayız. SUMMARY Sevoflurane, a new inhaled anesthetic, has a low blood solubility which provides for both hemodinamic stability in maintenance and recovery times. This study was designed to compare the maintenance, emergence and safety characteristics of sevoflurane anestesia with those of propofol, a standard intravenous, anesthetic, in patients undergoing elective laparaskopik cholesistectomy operation. Forty ASA physical status I or II adult patient, aged 25-65 years, scheduled for laparoskopic cholesistectomy operation were studied. Patients were randomly assigned to two groups. Alfentanyl 25jig/kg, propofol 2 mg /mg and vecuronium 0.1mg/kg were given intravenously to all of the patients in the induction of the anesthesia and than all of them were intubated. In propofol group, anesthesia was maintained with propofol infusion and 50% 02/ air. And in sevofluran group with sevoflurane 2% vol and 50% O2/ air. Both groups received Alfentanyl 25 /igfkg I hour infusion. i In maintenance and recovery periods (five minutes after intubation, before insuflation, affer insuflation, before extubation, after extubation, five minutes and fifteen minutes after extubation) hemodynamic parameters (heart rate, arterial presures (systolic, diastolic, mean) hemoglabin saturation and end - tidal C02) were recorded. When the gallbladder was taken out from the abdomen, Alfentanyl infusion was stopped in both groups. After the last suturation of the skin, inhalation of sevofluran and infusion of propofol were discontinued. The time of discontinuation of the anesthetic agent, the time for extubation and the times at which the patient opened their eyes spontaneously were recorded. The immediate postoperative 65recovery and the quality of overall postoperative recovery were classified by various tests; minimental (cognitive) test, postoperative scores for the visual anolog scales (VAS), the modified ALDRETE and KROULIK's score. In maintenance period (especially in 5 min after intubation) heart rates and mean arterial pressures did not differ between gropups. But in both group, heart rate and mean arterial pressures were found to be significantly low before the insuflation. We related these findings with administration of narcotic analgesic in maintainance period. i In both group, elevation of mean arterial pressure after insuflation was due to pathophysiologic alteration of laporoskopic operation technique. Compared to sevoflurane group, the emergence times from cessation of the administration of the anesthetic agent to spontaneous eye opening and extubation were shorter in the propofol groups. Cognitive functions recovered at same rate. And the modified Alderete score were good in both groups. Sevoflurane less emetic potential compared to other inhaled anesthetics because it is less purgent and has a short emergence time which may be asociated with less depression of coqnitive function in the post operative period. Although the difference was non significant between two groups according to neusea and vomiting, clinically the incidence was low in propofol group. In coclusion, we have demonstrated that sevoflurane compares favorably with propofol for both hemodynamic stability in maintenance and emergence from anesthesia. 66 81
- Published
- 1998
3. Kronik Posttorakotomi Ağrı Tedavisinde Gabapentin ve Amitriptilinin Etkinliğinin KarşılaŞtırılmasının Erken Dönem Sonuçları.
- Author
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Keskinbora, Kader and Aydınlı, Işık
- Subjects
- *
ANALGESICS , *THERAPEUTICS , *OPERATIVE surgery , *PAIN management , *LUNG surgery , *DRUG side effects - Abstract
Aim: Chronic postthoracotomy pain (CPTP) seems to be a combination of both nociceptive and neuropathic pain. The mechanism of CPTP based on neuropathic origin results in amitryptiline and gabapentine to be regarded attractive adjuvant analgesics. Aim of this trial is to compare the efficacy of gabapentine and amitryptiline in CPTP. Material and Method: 40 patients with chronic nonmalignant postthoracotomy pain (burning, stabbing and shooting pain) received gabapentine or amitryptiline as a single drug therapy. Study drugs were increased to effective and tolerable doses gradually throughout the study (4 weeks). Assessment variables were the intensity of burning, stabbing and shooting pain (assessed on VAS), side effects and patients' satisfaction (assessed with 7-points Likert's scale). The assessments were done before the study drugs treatments, at one and 4 weeks of study. Results: The burning, stabbing and shooting pain scores mean VAS values were lower in gabapentine group compared with amitryptiline group (p<0,05). Side effects were also high (55 %) in amitryptiline group (p<0,001). Patients satisfaction measured with Likert's scale was statistically significantly high in gabapentine grup (6,35±0,7; 50 % improvements) compared with amitryptiline group (4,55±0,9; 25 %). Conclusion: Gabapentin appears safe and well tolerated when used for chronic postthoracotomy pain. Gabapentin as one of the first line agents used in neuropathic pain are preferable in postthoracotomy pain. [ABSTRACT FROM AUTHOR]
- Published
- 2009
4. [Long-term results of suprascapular pulsed radiofrequency in chronic shoulder pain].
- Author
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Keskinbora K and Aydinli I
- Subjects
- Adolescent, Adult, Aged, Chronic Disease, Female, Humans, Male, Middle Aged, Pain Measurement, Peripheral Nerves pathology, Rupture, Time Factors, Treatment Outcome, Young Adult, Nerve Block methods, Radio Waves, Rotator Cuff innervation, Rotator Cuff Injuries, Shoulder Pain therapy
- Abstract
Objectives: Suprascapular nerve block has been shown to be effective in acute, postoperative and chronic shoulder pain. The understanding of providing analgesia without destruction of neural tissue makes pulsed radiofrequency (PRF) lesioning attractive as a nondestructive method. In this study, the effectiveness of suprascapular PRF in chronic shoulder pain in both the short- and long-term was assessed., Methods: Forty patients suffering from shoulder pain of at least two months' duration, diagnosed with rotator cuff rupture by MRI scanning and with no response to systemic or physical therapy, were enrolled. After a favorable response to a diagnostic suprascapular nerve block, PRF application was done. Pain assessment was done using a standardized 7-point Likert scale and shoulder joint function assessment by Oxford Shoulder Score (OSS). The outcome measures were assessed in the third week as short-term and in six months as long-term., Results: Thirty-two patients completed the study. Eight patients were excluded from the study because of vagotony due to sitting position (20%). In comparison with baseline, Likert score of chronic shoulder pain was good (6.73+/-0.78; 6.50+/-1.07) (for both, p=0.000) and mean OSS was 16.28+/-3.15; 13.81+/-2.23 (for both, p<0.001) in the two assessment periods., Conclusion: Suprascapular nerve PRF lesioning was effective in chronic shoulder pain of rotator cuff lesion, and this effect was maintained in the long-term period. The improvement in shoulder joint function in parallel with decreased chronic shoulder pain was also notable.
- Published
- 2009
5. [Comparison of efficacy of gabapentin and amitriptyline in the management of peripheral neuropathic pain].
- Author
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Keskinbora K, Pekel AF, and Aydinli I
- Subjects
- Amines administration & dosage, Amitriptyline administration & dosage, Anticonvulsants administration & dosage, Cyclohexanecarboxylic Acids administration & dosage, Double-Blind Method, Female, Gabapentin, Humans, Male, Middle Aged, Neuralgia pathology, Pain Measurement, Patient Satisfaction, Treatment Outcome, gamma-Aminobutyric Acid administration & dosage, Amines therapeutic use, Amitriptyline therapeutic use, Anticonvulsants therapeutic use, Cyclohexanecarboxylic Acids therapeutic use, Neuralgia drug therapy, gamma-Aminobutyric Acid therapeutic use
- Abstract
In this single center, double blind and randomized trial gabapentin as a new anticonvulsant was compared in efficacy and safety with amitriptyline which is a classic agent in neuropathic pain treatment. Fourty six patients with neuropathic pain which was burning, stabbing and shooting in quality were allocated to take gabapentin (group GBP) and amitriptyline (group AMI) monotherapy. The assesment variables were burning, stabbing, shooting pain on visual analog scale (VAS; 0: no pain, 10: worst pain imaginable), allodynia as present or not by lightly touching the skin with cotton. Primary efficacy variable was the degree of burning, stabbing and shooting pain improvement that was accepted as the difference of beginning and 4th week's VAS of all pain qualities. The secondary efficacy variable was the patient satisfaction scale determined as whether possible side effects of study drugs affect the patients' daily life. The degree of pain improvement was only seen in shooting pain and was statistically significantly high in group GBP. The patient satisfaction scale was also high in group GBP. Both gabapentin and amitriptyline provided effective pain control in peripheral neuropathic pain. Additionally gabapentin was more effective especially in paroxysmal shooting pain than other pain qualities. And also gabapentin was tolerated well.
- Published
- 2006
6. [An atypical opioid analgesic: tramadol].
- Author
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Keskinbora K and Aydinli I
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- Administration, Oral, Analgesics, Opioid chemistry, Analgesics, Opioid pharmacokinetics, Humans, Tramadol chemistry, Tramadol pharmacokinetics, Analgesics, Opioid administration & dosage, Pain, Intractable prevention & control, Tramadol administration & dosage
- Abstract
Tramadol, a centrally acting analgesic, consists of two enantiomers, both of which contribute to analgesic activity via different mechanisms. (+) Tramadol and the metabolite (+) -O- desmethyl-tramadol (M1) are agonists of the mu opioid receptor. (+) Tramadol also stimulates presinaptic release of serotonin and inhibits serotonin reuptake whereas (-) tramadol inhibits norepinephrine reuptake. Thus tramadol enhances inhibitory effects on pain transmission both by opioid and monoaminergic mechanisms. The complementary and synergistic actions of the two enantiomers improve the analgesic efficacy and tolerability profile of the racemate. Following oral administration the bioavailability of tramadol is high and with new slow release preparations twice daily administration enables effective pain control. The recommended maximum daily dose of tramadol is 400 mg/day. Tramadol is characterised by low plasma protein binding and quite extensive tissue distribution. Elimination is primarily by the hepatic route (metabolism by CYP2D6) and partly by the renal route. It is effective in different types of moderate-to-severe acute and chronic pain, including neuropathic pain, low back pain, osteoarthritis pain and breakthrough pain. It also causes fewer opioid-type adverse effects, e.g. nausea, drowsiness, vomiting, dry mouth and constipation. Although trials in literature demonstrate immune-stimulating effects of tramadol, there are also trials suggesting immunesuppressive effects that are lesser than morphine. Owing to its pharmacological properties, tramadol is more appropriate than NSAIDs for patients suffering from gastrointestinal and renal problems. Besides its proven clinical efficacy tramadol is a safe drug as respiratory depression, cardiovascular side effects, drug abuse and dependence are of minor clinical relevance, unlike some other opioids.
- Published
- 2006
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