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  • Küçük Resim
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    The analgesic efficacy of preoperative versus postoperative lornoxicam in varicocele repair
    (Elsevier Science Inc, 2007) Inanoglu, Kerem; Gorur, Sadik; Akkurt, Cagla Ozbakis; Guven, Oguz E.; Kararmaz, Alper
    Study Objective: To determine whether intravenous injection of lornoxicam 30 minutes before skin incision provides better pain relief after varicocelectomy than postoperative administration of lornoxicam. Design: Prospective, double-blind, randomized clinical investigation. Setting: Operating room and postoperative recovery area. Patients: 44 ASA physical status I and 11 adult male patients undergoing varicocelectomy. Interventions: Patients were randomized either to receive 8 mg lornoxicam infusion 30 minutes before skin incision, followed by saline infusion immediately after skin closure (group 1), or to receive the identical injections but in reverse order (group 2). All patients received local anesthesia with bupivacame. Measurements: Postoperative pain scores were evaluated hourly for the first 8 hours after surgery, then at 12, 16, 20, and 24 hours after surgery, using a 10-cm visual analog scale. Time to first analgesic request and patient's global assessments also were recorded. Main Results: Patients in group 1 reported significantly lower pain scores (P < 0.05) at all time intervals except at 24 hours and better global assessment (P = 0.001) than did group 2. There were significantly fewer patients in the preemptive group than group 2 who required rescue analgesic within the first 24 hours (0% vs 22.7%; P = 0.024). Mean time to first analgesic request was also significantly longer in the preemptive group (P = 0.001). Conclusion: Intravenous lornoxicam administered before surgery has a better analgesic effect for varicocelectomy than when administered postoperatively. (c) 2007 Elsevier Inc. All rights reserved.
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    Öğe
    Negative pressure pulmonary edema (NPPE) after discectomy in general anesthesia with endotracheal intubation: Case report
    (2006) Akkurt, B. Cagla O.; Kararmaz, Alper; Inanoglu, Kerem; Serarslan, Yurdal
    Background: Negative-pressure pulmonary edema (NPPE) is a rare and serious complication after general anesthesia. Although it is generally seen after upper airway surgery, it can be seen in different types of surgery also. We report a young, healthy case that developed pulmonary hemorrhage and alveolar edema after extubation of the trachea. Case Report: A 27-year-old ASA II male with a history of smoking, underwent elective discectomy. Following uneventful surgery under general anesthesia, the patient was taken to supine position. He developed a marked inspiratory effort and he bit the endotracheal tube during position changing. Immediately after extubation, the patient developed respiratory distress. Due to desaturation the patient was reintubated An intense hemorrhagic fluid was suctioned in the endotracheal tube. The chest radiograph showed bilateral pulmonary infiltrates. After 24 hours of mechanical ventilation, the patient's symptoms improved and he was extubated. He was discharged from the hospital on the fourth postoperative day. Conclusions: Although it is rare, NPPE can be seen following operations other than upper airway surgery.
  • Küçük Resim
    Öğe
    Yarı oturur pozisyonda intraoperatif venöz hava embolisi
    (2008) Özbakış Akkurt, Buket Çağla; İnanoğlu, Kerem; Karazincir, Olgun; Kararmaz, Alper; Turhanoğlu, Salim
    Venöz hava embolisi, nöroşirurji operasyonlarında özellikle oturur, yarı oturur ve hatta supin pozisyonlarda oluşabilen sonucunda morbidite ve mortalitesi yüksek olan bir komplikasyondur. Parietal bölgede glial tümör nedeniyle yarı oturur pozisyonda operasyona alınan hastada aniden end tidal CO2, oksijen saturasyonu ve kan basıncının düştüğü görüldü. Hastada sol akciğerinde havalanma azlığı ve kalbin oskültasyonunda pansistolik üfürüm saptandı. Venöz hava embolisi geliştiği düşünülen hastanın santral venöz kateterinden hava aspire edildi ve hemodinamik stabilite tekrar sağlandı. Operasyonun sonunda hasta uyandırılarak ekstübe edildi. Bu olguda hastanın iyi monitorize edilmesi ve erken müdahale edilmesi sayesinde oluşabilecek komplikasyonlar engellenebilmiştir. Nöroşirurjinin oturur pozisyonlarındaki operasyonlarının yanısıra yarı oturur ve supin pozisyonlardaki operasyonlarında da standart monitorizasyonun yanında mutlaka santral venöz kateterizasyon ve arterial monitorizasyonun yapılarak yakın takip edilmesinin olası komplikasyonların erken tanı ve tedavisi açısından önemli olduğunun bir kez daha vurgulanmasında yarar olduğunu düşünüyoruz.