COMBINED SPINAL EPIDURAL ANESTHESIA IN A GERIATRIC PATIENT UNDERGOING COLORECTAL SURGERY

Kolorektal cerrahi olgularını daha çok geriyatrik hasta popülasyonu oluşturmaktadır. Ülkemizde de geriyatrik hasta popülasyonu giderek artış göstermektedir. 79 yaşında, fiziksel durum sınıflaması ASA-II olan erkek hastaya sigmoid kanseri nedeniyle sigmoid rezeksiyon ve kolorektal anastomoz planlandı. İzotonik NaCl solüsyonu ile 10 ml/kg intravenöz sıvı yüklemesini takiben L3-L4 aralığından direnç kaybı tekniğiyle epidural aralığa girildi ve iğne-içinden-iğne tekniği kullanılarak 27G Quincke iğne ile subaraknoid mesafeye ulaşıldı. Berrak beyin omurilik sıvısı gelişi gözlendikten sonra 10 mg %0,5 hiperbarik bupivakain + 25 μg fentanil karışımı intratekal uygulandı. On dakika sonra duyusal blok seviyesinin T6 olduğu gözlenen olguya epidural kateterden 10 ml %2 prilokain + 9 ml %0,5 izobarik bupivakain + 50 μg fentanil karışımından 5 ml volüm verildi. Epidural ilaç uygulamasından 15 dakika sonra duyusal blok seviyesinin T4 olduğu saptandı. Yaklaşık 1,5 saat süren ve hemodinamik olarak stabil seyreden operasyonda epidural kataterden ek doz uygulanmadı. Operasyon sonunda duyusal blok seviyesinin T4 olduğu saptandı. Bu olguda, düşük doz lokal anestezik + opioid ile uygulanan kombine spinal epidural anestezi yöntemi ile stabil hemodinami, yeterli kas gevşemesi ve hasta-cerrah memnuniyeti sağlanmıştır. Colorectal surgery patients are mostly in the geriatric age group. In our country, geriatric patient population is gradually increasing. For the 79 years old male patient, evaluated in the ASA II classification of physical status, sigmoid resection and colorectal anastomosis was planned due to sigmoid cancer. Following intravenous isotonic NaCl loading at 10 ml/kg, epidural space was located and entered at L3-L4 level using the loss of resistance technique, and subarachnoid space was reached with a 27G Quincke needle using the needle-throughneedle technique. After clear cerebrospinal fluid was detected, 10 mg 0.5% hyperbaric bupivacaine and 25 μg fentanyl combination was administered intrathecally. Sensory block level was observed at T6 within 15 minutes, and the patient was given 5 ml of the mixture of 10 ml 2% prilocaine + 9 ml 0.5% isobaric bupivacaine + 50 μg fentanyl through epidural catheter. 15 minutes after the epidural injection, T4 level of sensory block was determined. In operation which lasted approximately 1.5 hours, the patient remained hemodynamically stable, and no additional epidural injection was administered. At the end of the operation, T4 level of sensory block was determined. In this case, combined spinal epidural anesthesia method was performed with low-dose local anesthetic and opioid and we achieved stable intraoperative hemodynamics, adequate muscle relaxation, and patient-surgeon satisfaction as wel

Investigation of the effect of sevoflurane administeration during day and night period on melatonin levels in rats

Amaç: Bu çalışmanın amacı ratlarda gece-gündüz sevofluran uygulamasının melatonin düzeyi üzerine etkisinin araştırılmasıdır. Gereç ve Yöntem: Çalışmaya 15 günlük 24 adet rat alındı ve rastgele 4 gruba ayrıldı. Ratlara bahar döneminde 19:00-01:00 (gece grubu) ve 07:00-13:00 (gündüz grubu) saatleri arasında %2,6 sevofluran ve 6 L•dk-1 akım hızında oksijenuygulandı. Kontrol gruplarına ise aynı zaman süresince 6 L•dk-1 akım hızında oksijen uygulandı. Altı saatlik sürenin sonunda kan örnekleri alındıktan sonra ratlar sakrifiye edildi. Alınan kanlardan santrifüj edilerek elde edilen plazmalarda melatonin düzeyleri radioimmüno assay (RIA) yöntemi ile ölçüldü.Bulgular: Grup gece sevofluran (Grup GC-S) ile Grup gece kontrol (Grup GC-K) plazma melatonin düzeyleri karşılaştırıldığında; Grup GC-S plazma melatonin düzeyi anlamlı yüksek bulunmuştur (p=0,002). Grup gündüz sevofluran (Grup GN-S) ile grup gündüz kontrol (GN-K) plazma melatonin düzeyleri karşılaştırıldığında; Grup GN-S plazma melatonin düzeyi anlamlı yüksek saptanmıştır (p=0,002). Grup GC-K ile GN-K plazma melatonin düzeyleri karşılaştırıldığında Grup GC-K plazma melatonin düzeyi anlamlı yüksek bulunmuştur (p=0,002). Sonuç: Çalışmamızda 15 günlük ratlarda altı saatlik % 2,6 konsantrasyonda uygulanan sevofluranın gündüz ve gece uygulamasının plazma melatonin düzeyini artırdığını, saptadık Aim: The aim of this study is to investigate the effects of night-day on melatonin level under sevoflurane administration in rats.Material and Methods: 15 days old 24 rats were included and divided into 4 groups by randomisation. 2,6 % sevoflurane 6 L•min-1 of oxygen was administered to rats between 07:00 pm-01:00 am (night group) and 07:00 am-01:00 pm (day group) in spring and 6 L•min-1 of oxygen was administered to control groups during the same time periods. At the end of 6 hours rats were sacrified after blood samples were taken. Blood samples were centrifuged and plasma melatonin levels were measured by radioimmuno assay Results: When Group night sevofluran (N-S) was compared with Group night control (N-K), significant difference was found on melatonin levels (p=0,002). When plasma melatonin levels compared between Group day sevoflurane (D-S) and Group day control (N-K) , melatonin level of Group Day sevofluran was found highly significant (p=0,002). Similarly, when plasma melatonin levels compared between (N-K) and (D-K), melatonin level of N-K was found significantly high (p=0,002).Conclusion: In this study, it has been ascertained that 2.6% sevoflurane administered for six hours during the day and night period increased melatonin levels significantly in 15 days old rats

The association of RANK gene C421T and C575T polymorphisms with bone mineral density in postmenopausal Turkish women

WOS: 000324635900028PubMed ID: 23553199To investigate the association between C421T polymorphism within exon 4, C575T polymorphism within exon 6 of the RANK gene and bone mineral density (BMD) variations in postmenopausal Turkish women. One hundred seventy-eight postmenopausal women (patients = 100 and controls = 78) who applied to Ege University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, for osteoporosis examination were analyzed. BMDs of the lumbar spine and femoral sites were measured. Patient and control groups were established based on their T-score values being above and/or below -1. After venous blood sampling, C421T and C575T polymorphisms of the RANK gene were assessed through PCR process following DNA extraction. Genotype frequencies for the C421T and C575T polymorphisms were compared between the control group and the patient group. No significant difference was detected between the two groups for both polymorphisms. There was also no significant difference between the control and patient groups in terms of the combined genotype (p = 0.752) and the combined haplotype analysis of the C421T and C575T polymorphisms (p = 0.723). In the control and patient groups separately, no significant differences in BMD values either at the femoral sites or at the lumbar spine were detected between the combined genotypes of the two polymorphisms. The genotypes, combined genotypes and allele frequencies of C421T and C575T polymorphisms of the RANK gene have not been found to be associated with BMD in Turkish women. Further studies including both sexes and more cases are required.Turkish Osteoporosis SocietyThis study was supported financially by Turkish Osteoporosis Society

Day and night administration of sevoflurane effect of melatonin levels in rats

Day And Night Administration Of Sevoflurane Effect Of Melatonin Levels İn Rats</p

Evaluation of subclinical myocardial dysfunction using speckle tracking echocardiography in patients with radiographic and non-radiographic axial spondyloarthritis

Objective: To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE)

Obituaries: Ahmet ACAR

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