LOMBER DİSK CERRAHİSİ GEÇİREN YAŞLI VE GENÇ HASTALARDA TOTAL İNTRAVENÖZ ANESTEZİ YÖNTEMİNİN POSTOPERATİF KOGNİTİF FONKSİYONLARA ETKİSİ

Çalışmamızda, propofol ve remifentanili kullanıldığımız TİVA’nın, genç ve yaşlı hastalarda kognitif fonksiyonlara etkisinin MMDT ve S–100 beta proteini ölçümüyle araştırılması amaçlandı. Risk grubu ASA I-II olan elektif disk cerrahisi geçirecek 40 hasta çalışmaya dahil edildi. Operasyondan bir gün önce MMDT uygulanan hastalardan indüksiyon öncesi S–100 beta proteni ölçümü için kan alındı. İndüksiyonda her iki gruba remifentanil infüzyonu 0,2 μg/kg/dk’dan başlandı, propofol 1 mg/kg iv bolus verildikten sonra BİS değeri 60’a düşene dek 10 mg’lık doz eklemeleri yapıldı, 0,1 mg/kg pankuronyum sonrasında endotrakeal entübasyon gerçekleştirilerek propofol infüzyonuna 8 mg/kg/dk’dan başlandı. Hastalar prone pozisyona geçirilerek cerrahi başlatıldı. KAH, OAB, SpO2 ve BİS değerleri indüksiyon öncesinde kaydedildi; indüksiyondan 1 dk sonra, entübasyondan 1 dk sonra, ve otuzuncu dk’ya kadar her beş dk’da ve sonrasında onbeş dk’da bir bu parametreler ve ek olarak EtCO2 kaydedildi. Postoperatif ağrı kontrolü iv 20 mg tenoksikam ve 0,05 mg/kg morfin hidroklorürle sağlandı. Ekstübasyonu takiben 30 dk gözlenen hastalardan postoperatif 24. saatte tekrar S–100 beta proteini ölçümü için kan alındı ve hastalara MMDT uygulandı. Operasyon öncesi ve sonrası MMDT sonuçlarının ve S–100 beta protein ortalamalarının zaman içerisindeki değişimleri, gruplar arası ve grup içi istatistiksel olarak anlamlı farklı bulunmadı. Sonuç olarak, anestezik ajanlar arasında POKD gelişiminde en çok üzerinde durulan propofolü remifentanil ile kullandığımız TİVA’nın, lomber disk cerrahisi geçiren genç ve yaşlı hastalarda, POKD gelişimi üzerinde etkisinin olmadığı saptandı.The effect of TIVA method with the use of propofol and remifentanyl, to the cognitive functions of two age intervals (+ 65 and below), by the MMSE and S-100 beta protein scaling is observed over 40 patients, all going to have elective disc surgery in the risk group of ASA I-II. The day before the surgery, MMSE had been applied. Following the S-100 beta protein scaling, the induction had been embarked by remifentanyl infusion with the dose of 0,2 μg/kg/min in each of the group. The additions of 10 mg are applied till the BIS rate has decreased to 60 after propofol 1mg/kg iv bolus was given. Following 1 mg/kg pancuronium and endotracheal intubation, the propofol infusion has been embarked. After the intubation, the surgery has been initiated in the prone position. The rates of HR, MAP, SpO2 and BIS were scaled before induction, 1 min after the induction, 1 and 5 min after intubation and also at each 5 min intervals till the 30th min during the intubation. Then the scales were recorded with the intervals of 15 mins. Also EtCO2 was recorded in all intubated patients. For the postoperative pain, 20 mg tenoxicam and the dose of 0,05 mg/kg morphine HCl were given iv. Following the extubation the patients were observed for about 30 min. At the 24th postoperative hour, the level of S-100 beta protein was scaled and also MMSE was applied. Due to the variation up to the time, the comparison of the pre&postoperative MMSE results and S-100 beta protein averages statistically gave no significant difference between and in the groups. In conclusion, among the anesthesia agents, the TIVA method, as highlighted in respect of the POCD progress, that is realized with propofol and remifentanly, was determined as having no effect over the postoperative early phase cognitive functions by the results of the assessment with the MMSE and S- 100 beta protein, at the elderly (65 and above) or the young (below 65) patients who had lomber disc surgery

The effect of total intravenous anesthesia on the postoperative cognitive functions of young and elderly patients after lumbar disk surgery

Background/aim: The negative effects of surgery and anesthesia on cognitive functions and their relationships with many factors are well known. In the present study we aimed to investigate the effect of the total intravenous anesthesia (TIVA) method on the postoperative cognitive functions between young and elderly patients scheduled to undergo lumbar disk surgery. Materials and methods: The TIVA method was applied to 40 patients less than 65 years old (young, Group Y) and >= 65 years old ( old, Group O), whose Mini Mental State Examination (MMSE) results and serum S-100 beta protein levels were compared preoperatively and postoperatively at the 24th hour. Results: Postoperative cognitive dysfunction was not observed in any of the groups in the early stage. MMSE results and mean S-100 beta protein levels determined before and after the operation did not have statistically significant differences between the groups over time. Conclusion: In the present study, the TIVA method did not affect postoperative early cognitive functions in either old or young patients who underwent lumbar disk surgery

The Complication Profiles Following Surgical Dislocation of the Hip

The complication profiles of 45 hips of 44 cases that applied surgical dislocation by various indications in our institute between 2006-2013 were retrospectively reviewed. Our series consisted of 27 males and 17 females. Mean age of the cases was 31,9 (range, 11-58) years with mean follow-up time of 56,9 months (range, 13-106). The number of cases with detected complication was 27. Within our series 14 hips developed only 1 complication, 1 hip had 2, 10 hips had 3 and 2 hips had 4 individual complication profiles. Regarding Dindo-Clavien classifications of complication profiles, 17 hips were evaluated as Grade I (38%), 3 hips were Grade IIa (7%), 2 hips were Grade IIb (4%) and 5 hips were Grade III (11%). The presence of few number of or the absence of major complications in a surgical method does not make it absolutely safe. Surgical dislocations can be applied only when trochanteric complications are considered and the patients should be well informed by their orthopeadic surgeons

Acute infectious exacerbations in chronic obstructive lung disease and effects of azithromycine, sultamycilline, ciprofloxacin and cefaclor monohydrate Kronik obstruktif akciger hastaligi olgularinda akut infeksiyon doneminde patojen ajanin saptanmasi ve azitromisin, sultamisilin, siprofloksasin ve sefaklor monohidratin etkinligi

Background and Design. Lower respiratory tract infections cause great morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to find out the causative organism and the effects of azithromycine, ampicillin sulbactam (sultamycilline), ciprofloxacin and cefaclor monohydrate therapy in COPD. One hundred and sixteen patients with COPD in acute exacerbation were randomized into four groups for antibiotic treatment following lung function test and sputum. Results. The most common strains were H. influenzae (30.8%), S. pneumoniae (12.0%) and M. catarrhalis (7.7%). Conclusion. H. influenza is the most common causative organism in acute infectious attacks of COPD. Azithromycine, ampicilline sulbactam (Sultamycilline), ciprofloxacin and cefaclor monohydrate are of value in the treatment of acute infectious attacks of COPD