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Öğe Authors's reply to Preventing atelectasia at robotic surgery(Elsevier Science Inc, 2017) Oksar, Menekse; Balbay, Mevlana Derya; Kanbak, Orhan[Abstract Not Available]Öğe CHANGES IN TRYPTASE LEVELS DURING CARDIAC SURGERY IN PATIENTS AT LOW RISK FOR ALLERGIC REACTIONS(Dnipro State Medical Univ, 2022) Oksar, Menekse; Baytan, Hasibe G.; Turhanoglu, Selim; Aybek, Tayfun; Ardicoglu, Nazife Y.; Ozcan, OguzhanTryptase test can be used as a clinical marker of mast cell activation. The present study is was aimed to identify variations in serum tryptase levels and their possible relationships with allergic reactions to protamine in low-risk patients undergoing cardiac bypass surgery. Thirty patients according to American Society of Anesthesiologists physical status III who underwent cardiac bypass surgery were enrolled. This prospective, non-randomised, clinical study was conducted in an operating room. Venous blood samples for tryptase measurements were obtained from cardiac bypass surgery patients upon admission to the operating room and immediately before and 30 min after the initiation of protamine administration. Signs of allergic reactions were recorded and management steps based on rapid effect response-based clinical assessments for diagnosis and treatment decisions during protamine administrations were described. Serum tryptase levels and clinical signs of allergic reactions, primarily mean arterial pressure (MAP), were recorded. Serum tryptase levels increased significantly and progressively during the bypass procedure (study power, 80%; sample size, 28; power of analysis, 99.8% with alpha=0.05); however, tryptase levels did not reach a sufficiently high level to confirm an allergic reaction. The MAP and heart rate decreased in 50% of the patients. Although tryptase increased significantly when compared with baseline levels, protamine-associated increases were not significant and failed to provide an unequivocal indication of an allergic response to protamine.Öğe The effect of neuromuscular agent on postoperative shivering in patients undergoing retrograde intrarenal surgery: A randomized controlled clinical trial(Anestezi Dergisi, 2019) Baran, Ilkay; Oksar, Menekse; Altinsoy, SavasObjective: Shivering, and active movements, are very effective mechanisms for heat generation and warming in ambulatory mobile patients with open conscious. This study aimed to test the hypothesis that intraoperative hypothermia and postoperative shivering may be present in adults for whom neuromuscular blocker (NMB) was used during general anesthesia. Method: Eighty patients who underwent retrograde intrarenal surgery (RIRS) were randomly divided into two groups as those receiving or not receiving neuromuscular blocking agent (NMB) [Group R (NMB+), N=40; Group K (control), N=40)]. Laryngeal mask (LMA) was used for airway control in all patients and a standard anesthetic protocol was performed except for NMB administration. Data obtained from the monitoring of skin and internal temperatures and shivering tests were performed prior to anesthesia induction (t0), when NMB was delivered (t1), intraoperative 15 (t2), 30 (t3), and 60 (t4) and postoperative 0 (t5), 10 (t6), 15 (T7), 30 (t8), and 60 (t9) minutes. Results: In group R, at t0, t1, t2, t3 and t5 skin temperatures were significantly higher than group K, but there was no difference between the groups in terms of internal temperatures (t5, t6 and t7 in those who have tremors in group R were significantly higher than group K (Chi-Square p<0.05). In both groups, there is a statistically significant difference in skin temperature compared to t0. Accordingly, there was a significant difference in t7,8,9 in Group K and t1 in group R relative to t0. In Group R, the internal temperature was significantly lower in t3 than in t2, and t3, while in group K was significantly lower than t1 and t2. Conclusion: An understanding of postoperative shivering and the mechanisms that cause it is an important issue. A possible association with the use of neuromuscular blocker over hypothermia is worth investigating for patients with intraoperative heat management and low respiratory and cardiac reserve. The data obtained from this study did not support a relationship between NMB use and intraoperative hypothermia, but clearly showed a relationship with postoperative shivering. However, there is a need to study the possible effects of neuromuscular blockers on body temperature and peripheral defense mechanisms perhaps also on central mechanisms in adults. © Copyright Association of Anesthesiologists and Reanimation Specialists.Öğe The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial(Elsevier Science Inc, 2017) Koyuncu, Onur; Leung, Steve; You, Jing; Oksar, Menekse; Turhanoglu, Selim; Akkurt, Cagla; Dolapcioglu, KenanObjectives: To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen. Design: Randomized, double-blinded study. Patients: 120 patients ASA I-II who underwent abdominal hysterectomy. Interventions: All the patients were given 1 g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCI (8 mg, 2 ml IV) (Group I, N = 60) and saline (2 ml IV) (Group II, N = 60) at the skin closure. Measurement: Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted. Main results: Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1 h [by 13 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [QI, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P = 0.95. Conclusions: Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived. (C) 2017 Elsevier Inc. All rights reserved.Öğe Is it a matter of habit?(Elsevier Science Inc, 2015) Yenidunya, Mehmet; Oksar, Menekse[Abstract Not Available]Öğe Perioperative Effects of Induction with High-dose Rocuronium during Laparoscopic Cholecystectomy(Aves, 2020) Turhanoglu, Selim; Tunc, Mehmet; Oksar, Menekse; Temiz, MuhyittinObjective: We aimed to investigate the effects of high-dose rocuronium administration on intra-abdominal pressure (IAP) and surgical conditions during anaesthesia induction and laparoscopic cholecystectomy anaesthesia induction, respectively. Further, we aimed to determine postoperative nausea and vomiting (PONV) and pain scores following the laparoscopic cholecystectomy. Methods: Patients with American Society of Anesthesiologists (ASA) score of I-III, aged 18 to 75 years and who were scheduled for surgery under general anaesthesia were included in the study. Patients were randomised and a high-dose of 1.2 mg kg(-1) rocuronium was given to Group A and 0.6 mg kg(-1) rocuronium to Group B. The intraoperative train of four (TOF) ratio and post-tetanic count (PTC) were measured. Surgery was initiated with a low IAP of 7 mmHg. The surgeon evaluated surgical conditions with a 4-step surgical field scale and increased the IAP when necessary. PONV at 4, 12 and 24 hours and postoperative pain at 2 and 24 hours and 3 days were evaluated. Results: There were no significant differences in the demographic and haemodynamic parameters between the groups. In high-dose rocuronium Group A, IAP values were significantly lower in the first 20 minutes compared to Group B. The duration of operations was significantly shorter in Group A (29.00 +/- 7.39 minute vs. 34.63 +/- 12.00 minute, p=0.044). PONV in the first 12 hours was significantly lower in Group A (p<0.05). Conclusion: High-dose rocuronium-induced deep neuromuscular block helped perform laparoscopic cholecystectomy operations with lower values of IAP compared to a normal dose rocuronium. It also shortened duration of operation and reduced PONV and pain.Öğe Sedation for Percutaneous Endoscopic Lumbar Discectomy(Hindawi Limited, 2016) Oksar, MenekseAlthough anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation. In addition, although minimally invasive spinal surgery progresses slowly and different techniques are used with no agreement on the terminology used to describe these techniques thus far, the anesthetist needs to understand the surgical and anesthetic requirements for each type of intervention in order to take necessary precautions. This paper reviews the literature on this topic and discusses the anesthetic necessities for percutaneous endoscopic laser surgery. © 2016 Menekse Oksar.Öğe Severe hypoxemia follows hypoxic pulmonary vasoconstriction and/or hypoxic pulmonary vasoconstriction inhibition by inhaled anesthetics: prognostic potential of 100% shunt fractions(Elsevier Science Inc, 2017) Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim[Abstract Not Available]Öğe Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy(Elsevier Science Inc, 2016) Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim; Temiz, Muhyittin; Oran, Mustafa CemilObjective: To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique sub costal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. Design: A prospective, randomized, double-blinded clinical study. Setting: Operating room, postoperative recovery area, and ward. Patients: In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. Intervention: The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n = 20), group 2 received OSTAP blocks (n = 20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n = 20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20 mL of lidocaine (5 mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24 hours. Measurements: The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. Main Results: The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. Results: The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24 hours. Conclusions: TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption. (C) 2016 Elsevier Inc. All rights reserved.
