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Öğe Comparison of Recovery Characteristics, Postoperative Nausea and Vomiting, and Gastrointestinal Motility With Total Intravenous Anesthesia With Propofol Versus Inhalation Anesthesia With Desflurane for Laparoscopic Cholecystectomy: A Randomized Controlled Study(Elsevier Science Inc, 2009) Akkurt, B. Cagla Ozbakis; Temiz, Muhyittin; Inanoglu, Kerem; Aslan, Ahmet; Turhanoglu, Selim; Asfuroglu, Zeynel; Canbolant, ElifBACKGROUND: Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. OBJECTIVE: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. METHODS: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 mu g/kg) or desflurane (4%-6%) and alfentanil (20 mu g/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. RESULTS: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements In a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after Surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). CONCLUSION: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study. (Curr Ther Res Clin Exp. 2009;70:94-103) (C) 2009 Excerpta Medica Inc.Öğe Disease activity in rheumatoid arthritis as a predictor of difficult intubation?(Lippincott Williams & Wilkins, 2008) Akkurt, B. Cagla Ozbakis; Guler, H.; Inanoglu, K.; Turhanoglu, A. Dicle; Turhanoglu, S.; Asfuroglu, Z.Background and objectives: Rheumatoid arthritis is a lifelong systemic disease that can affect any Joint with a synovium. Managing intubation in patients with rheumatoid disease is a special challenge in these patients especially if specific joints, which play an important role during intubation, are affected. We aimed to investigate if there was a correlation between the activity and duration of the disease and the commonly used predictors of difficult intubation in rheumatoid arthritis. Methods: Sixty-six patients with the diagnosis of rheumatoid arthritis and 60 control patients were Included in the study. Patient characteristics were recorded. Body mass index, disease activity scores, Mallampati classification, sternomental distance, thyromental distance, inter-incisor distance and atlanto-occipital joint extension were measured for each patient. Every patient was asked to complete the Stanford Health Assessment Questionnaire (HAQ score). Disease activity score (DAS 28 score) including 28 joints was used to assess the activity of the disease. Correlation between the predictors of difficult intubation and activity was assessed and was compared with the control group. Results: Mallampati scores were higher (P = 0.000), sternomental distance (P = 0.005) and inter-incisor distance (P = 0.003) were shorter and also occlusal surface-upper teeth angle (P = 0.000) and mouth corner-tragus line angle were smaller in the rheumatoid arthritis group compared with controls (P = 0.000). We did not observe a correlation between the disease activity scores and the Mallampati score (P = 0.619), sternomental distance (P = 0.195), thyromental distance (P = 0.174), inter-incisor distance (P = 0.764), angle I (P = 0.372) and angle II (P = 0.609). There was no correlation between the HAQ score and the Mallampati score (P = 0.872), sternomental distance (P = 0.455), thyromental distance (P = 0.841), inter-incisor distance (P = 0.162), angle I (P = 0.768) and angle II (P 0.287). There was no correlation between the duration of the disease and the Mallampati score (P = 0.619), sternomental distance (P = 0.505), thyromental distance (P = 0.426), inter-incisor distance (P = 0.813), angle I (P = 0.377) and angle II (P = 0.600). Conclusion: Tests of disease activity and the duration of the disease were not found to be correlated with the predictors of difficult intubation in this study. Thus, performing the predictive tests for difficult intubation especially in patients with very low scores or short disease is recommended.Öğe Intravenous ketamine and local bupivacaine infiltration are effective as part of a multimodal regime for reducing post-tonsillectomy pain(Int Scientific Information, Inc, 2009) Inanoglu, Kerem; Akkurt, B. Cagla Ozbakis; Turhanoglu, Selim; Okuyucu, Semsettin; Akoglu, ErtapBackground: The aim of this study was to investigate the effects of a multimodal analgesic regimen, including intravenous ketamine and peritonsillar infiltration of bupivacaine, on post-tonsillectomy pain in children. Material/Methods: Ninety children aged 2-12 years, undergoing tonsillectomy, were enrolled in this randomized, controlled and double-blinded study. Group I (n=30) received intravenous and peritonsillar saline, group II (n=30) received intravenous saline and peritonsillar bupivacaine, and group III (n=30) received intravenous 0.5 mg/kg ketamine and peritonsillar 0.25% bupivacaine (3-5 ml per tonsil). Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24 h postoperatively. Results: No difference was found in the demographic data among the groups. Group I patients who received intravenous and peritonsillar saline solution as placebo had higher pain scores at 15(th) min, and Ist and 4(th) h than group II, and at all time intervals, than group III (P<0.05). Patients in group III also had significantly lower pain scores than group II at all time intervals except at 15(th) min (P<0.05). Analgesic requirements and the time to first analgesia were also significantly (P<0.05) better in the ketamine group. Conclusions: Intravenous ketamine and peritonsillar infiltration with bupivacaine are safe and effective as part of a multimodal regime in reducing post-tonsillectomy pain.Öğe Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: A randomized controlled study(Elsevier Ireland Ltd, 2006) Akoglu, Ertap; Akkurt, B. Cagla Ozbakis; Inanoglu, Kerem; Okuyucu, Semsettin; Dagli, SafakObjective: To compare the effects of ropivacaine and bupivacaine on post-tonsillectomy pain in children. Methods: Forty-six children aged 2-12 years, undergoing tonsillectomy were enrolled in the study. Group 1 (n = 16) received bupivacaine, group 2 (n = 15) received ropivacaine, and a group 3 (control) (n = 15) received 9% NaCl (saline) infiltrated around each tonsil. Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24 h postoperatively. Results: No difference was found in the demographic data among the groups. The pain scores were similar between the bupivacaine and ropivacaine groups (p > 0.05). The pain scores in both analgesia groups were significantly (p < 0.05) lower 1, 4, 12, 16, and 24 h postoperatively compared to the control group. Analgesic requirements and the time to first analgesia were also significantly (p < 0.05) different between the analgesia and control groups. Conclusion: Local ropivacaine infiltration is a safe and effective method and equivalent to bupivacaine for post-tonsillectomy pain. (C) 2005 Elsevier Ireland Ltd. All rights reserved.
