Efecto de diferentes dosis de esmolol sobre la respuesta hemodinámica, BIS y respuesta de movimiento durante la intubación orotraqueal: estudio prospectivo, aleatorizado y doble ciego

ResumenObjetivoEstudio prospectivo, aleatorizado y doble ciego para identificar la dosis ideal de perfusión de esmolol con el fin de suprimir el aumento de los valores del BIS y los movimientos y respuestas hemodinámicas a la intubación traqueal.Materiales y métodos120 pacientes fueron aleatoriamente ubicados en uno de los 3 grupos usando el método doble ciego. El propofol (2,5mgkg−1) se administró para la inducción de la anestesia. Después de la pérdida de la conciencia y antes de la administración del rocuronio (0,6mgkg−1), se aplicó un torniquete a un brazo y se insufló a 50mmHg por encima de la presión sistólica. Los pacientes fueron divididos en 3 grupos; se administró una dosis de 1mgkg−1h−1 de esmolol como carga, y se inició la perfusión de 50μgkg−1min−1 de esmolol en el grupo ES50, de 150μgkg−1min−1 en el grupo Es150, y de 250μgkg−1min−1 en el grupo ES250. Cinco minutos después del inicio de la perfusión, la tráquea se intubó, y se registró el total de movimientos al primer minuto después de la intubación orotraqueal.ResultadosLa incidencia de la respuesta de movimientos y los valores máximos de ΔBIS fueron comparables en los grupos ES250 y Es150, pero esos valores fueron significativamente más elevados en el grupo ES50 que en los otros 2 grupos. En los 3 grupos, los valores de frecuencia cardíaca y presión arterial promedio fueron significativamente mayores en el primer minuto postintubación, comparados con los valores preintubación (p<0,05). No hubo diferencia significativa entre los grupos con relación a la frecuencia cardíaca y a la presión arterial promedio durante el período de estudio.ConclusiónEn la práctica clínica, creemos que después de una dosis con carga de 1mgkg−1, una dosis de 150μgkg−1min−1 de esmolol i.v. es suficiente para suprimir la respuesta a la intubación traqueal sin aumentar los efectos colaterales.AbstractObjectiveA prospective, randomized and double-blind study was planned to identify the optimum dose of esmolol infusion to suppress the increase in bispectral index values and the movement and hemodynamic responses to tracheal intubation.Materials and methods120 patients were randomly allocated to one of three groups in a double-blind fashion. 2.5mgkg−1 propofol was administered for anesthesia induction. After loss of consciousness, and before administration of 0.6mgkg−1 rocuronium, a tourniquet was applied to one arm and inflated to 50mmHg greater than systolic pressure. The patients were divided into 3 groups; 1mgkg−1h−1 esmolol was given as the loading dose and in Group Es50 50μgkg−1min−1, in Group Es150 150μgkg−1min−1, and in Group Es250 250μgkg−1min−1 esmolol infusion was started. Five minutes after the esmolol has been begun, the trachea was intubated; gross movement within the first minute after orotracheal intubation was recorded.ResultsIncidence of movement response and the ΔBIS max values were comparable in Group Es250 and Group Es150, but these values were significantly higher in Group Es50 than in the other two groups. In all three groups in the 1st minute after tracheal intubation heart rate and mean arterial pressure were significantly higher compared to values from before intubation (p<0.05). In the study period there was no significant difference between the groups in terms of heart rate and mean arterial pressure.ConclusionIn clinical practise we believe that after 1mgkg−1 loading dose, 150μgkg−1min−1 i.v. esmolol dose is sufficient to suppress responses to tracheal intubation without increasing side effects

COMPARISON OF EPIDURAL AND COMBINED SPINAL-EPIDURAL ANALGESIA IN PARTURIENTS RECEIVING PATIENT CONTROLLED EPIDURAL ANALGESIA DURING LABOR

Amaç: Doğum ağrılarının giderilmesinde Kombine Spinal - Epidural Analjezi (KSEA), Epidural Analjeziye (EA) bir alternatif olarak sunulmaktadır. Bu çalışmada, doğum eyleminin birinci evresinde KSEA veya EA uygulanan gebelerde analjezik yöntemin, doğum eylemi üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve yöntem: Fakülte Etik Kurul onayı alındıktan sonra, ASA I-II'ye uyan 130 nullipar gebe kombine spinal-epidural (n=65) veya epidural (n=65) analjezi uygulanmak üzere çalışmaya alındı. KSEA grubunda, intratekal aralığa 20 μg fentanil + 1 ml %0,25 bupivakain uygulandı; epidural kateter yerleştirildi. Epidural grupta %0,125 bupivakain + 50μg fentanil (toplam 10 ml) epidural aralığa enjekte edilerek analjezi sağlandı. Her iki grupta analjezi idamesinde Hasta Kontrollü Epidural Analjezi (HKEA) (%0,125 bupivakain + 2 μg/ml fentanil-10 ml bolus + 30 dk. kilit süresi) uygulandı. Serviksin dilatasyon ve efasman derecesi, fetus başının seviyesi, oksitosin infüzyon hızı, doğumun I ve II evre süreleri, yeni doğanın Apgar skoru, doğum şekli ve anne memnuniyeti; ayrıca hemodinamik parametreler, ağrı skorları, motor blok ve yan etkiler kaydedildi. Veriler istatistiksel olarak değerlendirildi. Bulgular: Oksitosin infüzyon hızının Grup EA'da 3-8. saatlerde daha yüksek olduğu (p<0,05), serviks dilatasyonunun KSEA grubunda daha hızlı ilerlediği, efasman dereceleri arasında fark olmadığı saptandı. KSEA grubunda fetus başının daha hızlı iniş yaptığı belirlendi (p<0,05). Motor blok görülme oranı, doğum şekli, Apgar Skorları, anne memnuniyeti gruplar arasında farklı değildi. Sonuç: Geleneksel EA ile kıyaslandığında, KSE analjezi uygulanan nullipar gebelerde, serviks dilatasyonu ve fetus başının seviyesinin daha hızlı indiği ve bu yöntemin geleneksel epidural analjeziye bir alternatif olabileceği kanaatına varıldı. Objective: Combined spinal-epidural analgesia (CSEA) technique is proposed as an alternative to conventional epidural analgesia (EA) for pain of labor. In this study we aimed to compare the effects of CSEA with those of epidural analgesia on the progress of labor during the first stage of labor. Material and method: After approval by the local ethics committee, one hundredthirty nulliparous parturients were randomly allocated to receive either CSEA (n=65) combined spinal-epidural analgesia 1 ml of bupivacaine 0.25% with 20 μg fentanyl were injected into the subarachnoid space and the epidural catheter was inserted. The initial dose consisted of 0.125 % bupivacaine+50μg fentanyl in 10 ml of saline in the epidural group. Both groups received epidural top-ups of 10 ml 0.125 % bupivacaine+2μg/ml fentanyl via Patient Controlled Epidural Analgesia (PCEA) pump. Data were collected on cervical dilation, effacement, station, oxytocin infusion rates, length of 1st and 2nd stage of labor, Apgar scores, mode of delivery, mother satisfaction, hemodynamic parameters, side effects, pain and degree of motor block. Results: The mean cervical dilation rates and progress of station were significantly faster in patients receiving CSEA. Oxytocin infusion rates were higher in patients receiving EA. Progress of effacement, the incidence of side effects, and mode of delivery and Apgar scores were similar between groups. Parturients in both groups were equally satisfied. Conclusion: In nulliparous parturients, CSEA is associated with rapid progress of cervical dilation and station when compared to conventional EA; and can be an alternative to EA in our opinion

Pazarlamada postmodern yaklaşım açısından müşteri deneyimi yönetimi ve bir uygulama

ÖZETPAZARLAMADA POSTMODERN YAKLAŞIM AÇISINDAN MÜŞTERİ DENEYİMİ YÖNETİMİ VE BİR UYGULAMAÜrün ve hizmetlerin birbirine çok benzediği ve teknoloji sayesinde de oldukça kolay taklit edilebildiği, tüketicilerin istek ve ihtiyaçlarının değiştiği ve güçlü olan taraf haline geldiği günümüzün yeni rekabet ortamında, pazarlama da tüm bu değişikliklere paralel olarak postmodern bir biçime dönüşmektedir. Yeni rekabet ortamında firmaların müşteri sadakati yaratabilmeleri, müşterileri ile uzun vadeli ve güvenli ilişkiler yaratabilmeleri için müşteri deneyimi yönetimi yeni rekabet aracı olmaktadır. Firmalar, deneyimsel pazarlama aracılığıyla müşterileri ile aralarında duygusal bağ kurarak, rakiplerinden farklılaşabileceklerdir. Bu çalışmanın amacı, müşteri deneyimi yönetiminin, müşteri sadakati yaratmadaki önemini ortaya koyarak, müşteri deneyimi yönetiminin uygulama biçimlerini irdelemektir.Çalışmada, değişen pazarlama koşulları içerisinde, müşteri sadakati yaratırken müşteri deneyimi yönetiminin nasıl uygulandığı anlatılmış, uygulama kısmındaki sonuçlarla da pekiştirilmiştir.Anahtar Kelimeler: Müşteri Deneyimi Yönetimi, Deneyimsel Pazarlama, Deneyim Ekonomisi, Postmodern Pazarlama.ABSTRACTCUSTOMER EXPERIENCE MANAGEMENT IN TERMS OF POSTMODERN APPROACH IN MARKETING AND AN APPLICATIONIn today’s competitive environment- where the products and services are pretty much alike and can be acted easily because of developping technology, where the consumer’s demand and needs has been changed and the customers have turned into the powerful side- marketing is turning into postmodern, at the same time with this changes. In this competitive environment, customer experience management is new competitive tool for the firms can create customer loyalty and long term and depandable relations. Firms can differentiate themselves from their competitors with building emotional relations with customers by experiential marketing. The goal of this thesis is to demonstrate the significance of customer experience management in creating customer loyalty and analyze the ways of applying customer experience management.In this thesis, in marketing conditions which has been changed, the ways of applying customer experience management in creating customer loyalty have been indicated, with all these being reinforced by the results in the application part. Key Words: Customer Experience Management, Experiential Marketing, Experience Economy, Postmodern Marketing

Küresel yakın alan ölçümünü uzak alana çeviren bir algoritma geliştirilmesi ve analizi.

This thesis focuses on the improvement of a far field transformation algorithm of spherical near field scanning by using different quadrature techniques for numerical integration process. In this thesis, spherical vector wave expansion of E field is studied and numerical calculation for expansion coefficients of E field is performed. In the scope of this study quadrature techniques like Gauss, Trapezoid and Simpsons are investigated and advantages and disadvantages of these techniques are discussed. A decision criteria of quadrature technique for a particular function is also discussed and efficiency of these techniques is compared. Spherical far field transformation algorithm considered in this study is applied to electric and magnetic Hertzian dipoles (directed on z axis and located at (0,0,0)) and expansion coefficients are calculated with Gauss, Trapezoid and Simpsons quadrature. Also, expansion coefficients of Hertzian dipoles directed along the x axis and shifted along the z axis are calculated by using coordinate transformation and rotation. After the calculations of expansion coefficients, far field transformation is performed by using derived algorithm and far field radiations are plotted. This study is mainly devoted on the far field transformation of a spherically scanned near field data and transformation of this data is performed by applying near field to far field transformation algorithm with Trapezoid and Simpsons quadrature techniques and effectiveness of these two techniques is discussed. This study also includes the derivation of probe compensation algorithm to eliminate the probe effects from transformed data. In chapter 5, probe compensated coefficients are calculated by considering the coefficients of the probe and using the coordinate transformation and rotation. (See Appendix A and Appendix B). Far field pattern by using compensated coefficients is also analyzed to visualize the probe compensation effect.Thesis (M.S.) -- Graduate School of Natural and Applied Sciences. Electrical and Electronics Engineering

Fear of COVID-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress

WOS:000556433300001This study aimed to investigate the mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. The participants consisted of 960 individuals, including 663 females (69.1%) and 297 males (30.9%). The age of the participants ranged between 18 and 76 (29.74 +/- 9.64). As a result of the correlation analysis, a positive relationship was found between fear of COVID-19 and intolerance of uncertainty, depression, anxiety, and stress, and a negative relationship was determined between the fear of COVID-19 and positivity. The result of the analysis for the study model indicated that there was a mediating role of intolerance of uncertainty, depression, anxiety, and stress in the relationship between the fear of COVID-19 and positivity. Eliminating uncertainty from the fear of COVID-19 will contribute to reducing depression, anxiety and stress, and increasing positivity