Tıpta Uzmanlık Tezleri
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Browsing Tıpta Uzmanlık Tezleri by Subject "Anestezi ve Reanimasyon = Anesthesiology and Reanimation"
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Publication Open Access Fasya iliaka kompartman bloğu için en uygun lokal anestezik volümü: Üç farklı volümün karşılaştırılması(Bezmialem Vakıf University, 2019) Dağlı Aslan, Hazan; ESEN, AsımOBJECTIVE: Fascia iliaca compartment block (FICB) is a recently preferred block to reduce postoperative pain in lower extremity surgeries. In our study, we aimed to find the most effective pain-reducing volume of FICB with USG in patients with total hip arthroplasty. MATERIALS AND METHODS: After the approval of the ethics committee, 45 ASA I-II-III patients with total hip arthroplasty were included in the study. All patients underwent general anesthesia and were maintained with inhalation anesthesia. The patients were divided into three groups with closed envelope extraction method. LA solution was prepared in 30 ml in Group 1, 40 ml in Group 2 and 50 ml in Group 3. FICB was performed with suprainguinal approach with USG in supine position at the end of the operation. In the recovery room, tramadoll iv-PCA device was connected to the patients. VAS≤5 until the recovery room, patients were made to patients requiring additional analgesics were followed. The compilation of input patient rooms, 1, 6, 12, 18, 24 hours VAS, satisfaction surveys and tramadol consumption values were recorded. RESULTS: Our study was carried out on a total of 45 patients, ranging from 18 to 85 years, 10 (22.2%) males and 35 (77.8%) females. The mean age of the patients was 60.7 ± 11.30 years. Cases were examined under three groups of 15 persons. There was no statistically significant difference between age, weight, height, BMI and gender distributions and duration of anesthesia and mean duration of surgery according to the groups (p> 0.05). VAS values, total tramadol consumption levels, bolus numbers, and bolus numbers of the patients in Group 2 at the 1., 6., 12., 18. and 24. hours were found to be significantly higher than the group 3 (p<0.05). No complication was observed in all three groups. CONCLUSION: FICB is an effective compartment block providing postoperative analgesia in total hip arthroplasty. In this study, the lowest pain scores and analgesic requirement were obtained in the group using 40 ml LA containing 2 mg/kg bupivacaine.Publication Metadata only Hipotansif anestezinin serebral perfüzyon ve kandaki antioksidan düzeyleri ile HIF1a düzeyi üzerine etkisinin değerlendirilmesi / Effect of hypotensive anesthesia on cerebral perfusion and bloodantioxidant levels and HIF 1a(Bezmialem Vakıf University, 2020) Şencan Özden, Ayşe; DAŞKAYA, HayrettinBackround and Aim: Controlled hypotension is the voluntary reversible reduction of arterial blood pressure. Hypotensive anstehesia is a method of anesthesia in which blood pressure is reduced in a controlled manner, especially in certain surgeries. İt reduces intraoperative bleeding and need for blood transfusion and provides a clean surgical vision in narrow-field surgeries or with high bleeding potential. Hypotensive anesthesia can be performed according to mean blood pressure (MBP) or systolic blood pressure (SBP). Near İnfrared Spectroscopy (NIRS) allows continuous and non-invasive monitoring of cerebral oxygenation. HIF 1a, TAS and TOS are laboratory markers that predict tissue oxygenation and perfusion. The aim of this study to evaluate the patients who underwent controlled hypotensive anesthesia under standardized depth of anesthesia; preoperative and postoperative blood HIF 1a, TAS, TOS measurement and serebral perfusion evaluation with NIRS and to investigate tissue hypoxia secondary to hypotensive anesthesia and the cahanges of the mediators at the tissue level and which blood pressure parameters are related. Materials and Methods: A total of 60 ASA 1-2 patients aged between 18-75 who underwent elective rhinoplasty and ortognatic surgery were included the study. Standard anesthesia induction and propofol and remifentanil infusion were applied to all patients with TIVA technique. The patients were divided into two groups. One group received hypotensive anesthesia according to MBP an done group received SBP. Continuous regionel cerebral oxygen saturation was monitored by NIRS in both groups. Blood samples were taken from all patients before anesthesia induction and at the and of the operation and stored for TAS, TOS, HIF 1a. At the and of the operation patients were fallowed in the post anesthesia care unit for 30 minutes and pain and nause vomiting scores were evaluated. İn addition, surgical satisfaction and bleeding scores and anesthetic consumption of both groups were recorded. Results: In our study, no statistically significant difference was found between the RsO2 values of the two groups. However, the number of patients with cerebral desaturation was higher in SBP group. There was no statistically significant difference between input and output TAS, TOS, HIF 1a values in MBP and SBP group. Output TOS of SBP group; output HIF 1a levels of MBP group werw significantly lower than those of input levels. The surgical satisfaction score of the MBP group was significantly higher and the bleeding score was significantly lower. Conclusion: Hypotensive anesthesia can be performed according to both MBP and SBP. However, in our study that follow-up MBP is more adventageous/protective, although it is not supported by very strong data. We recommend hypotensive anesthesia compared to MBP; but further studies are needed.Publication Metadata only Rinoplasti olgularında TİVA (total intravenöz anestezi) ve inhalasyon anestezisinin tiyol/disülfit dengesi üzerine etkisinin araştırılması / Investigation of the effect of TİVA (total intravenous anesthesia) and inhalation anesthesia on the thiol / disulphite balance in rhinoplasty cases(Bezmialem Vakıf University, 2020) İncekara, Zeynep Nur; KARAASLAN, KazımIntroduction: Total intravenous anesthesia (TIVA) and inhalation anesthesia are two anesthesia methods that can be preferred for the maintenance of anesthesia. Sevoflurane and propofol are drugs used frequently in these methods. This study aims to investigate and compare the effects of inhalation anesthesia using sevoflurane and TIVA using propofol on oxidative stress in patients undergoing controlled hypotensive anesthesia. Methods: Our study was planned as a randomized controlled prospective study to be performed in patients between the ages of 18-55 who will undergo elective rhinoplasty, with an ASA score of 1. 62 patients were included in our study. Patients with a history of smoking, alcohol, and drug use, who had a Body Mass Index (BMI)> 30, and those whose blood pressure values were out of the targets determined in 3 consecutive measurements were excluded from the study. Bispectral Index (BIS) and Train of Four (TOF) monitoring were performed in all patients undergoing standard anesthesia induction. While anesthesia was maintained with TIVA (Group 1, n = 30) in one group of patients who were divided into two groups with closed envelope method, inhalation anesthesia (Group 2, n = 32) method was used in the other group. In both groups, the blood pressure target was determined to be in the range of MAP 50-65 mmHg. Blood was collected and stored to measure TAS, TOS, Catalase, Myeloperoxidase, Total Thiol, Native Thiol and Disulfide parameters before and after induction at 5, 30, 60 and 120 minutes. Hemodynamic data (HR, SBP, DBP, MAP, SpO2) and BIS values of the patients were recorded at 5-minute intervals. The time from the end of surgery to extubation was recorded as the extubation time. At the end of the surgery, the surgical field opinion and satisfaction assessment were made by Boezaart Scoring and the survey presented to the surgeon, respectively. The patients were followed up in the recovery unit for 30 minutes; numerical pain scores and nausea-vomiting scores were recorded. Results: There was no remerkable difference between demographic data (age, gender, BMI), duration of surgery and anesthesia, BIS values and hemodynamic and biochemical parameters before induction of both groups. The extubation time and need for additional opioid use in Group 2 were statistically significantly higher than Group 1. There was no significant difference between the Boezaart Scoring and the surgical satisfaction values of the groups. TAS, TOS, OSİ, Catalase, Myeloperoxidase, Total Thiol, Native Thiol, Disulfide, Disulfide / Total Thiol, Disulfide / Native Thiol values decreased in both groups compared to initial values. There was no significant difference between the two groups in the evaluated parameters at all times. Conclusion: We concluded that TIVA using propofol and inhalation anesthesia using sevoflurane had a protective effect from the oxidative stress caused by surgery and there was no significant difference between the two methods in cases with rhinoplasty which underwent controlled hypotension. However, there is a need for randomized controlled studies in larger patient groups. Key Words: TIVA, inhalation, propofol, sevoflurane, oxidative stress, thiol-disulphide