The efects of ketamine administration before spinal anesthesia on postoperative analgesia in elderly patients undergoing hip surgery

Giris ve amaç: Yaslı hastalarda ortopedik acil olguların büyük kısmını kalça kırıgı operasyonları olusturur. Bu olgularda spinal veya epidural anestezi yöntemleri tercih edilmesine karsılık, hastalara pozisyon verilmesi sırasında siddetli agrı olusabilmektedir. Çalısmamızın amacı, kalça kırıgı olan yaslı hastalarda, spinal anestezi öncesi verilen ketamin, fentanil veya meperidinin, postoperatif analjezi üzerine etkisini arastırmaktır. Gereç ve yöntem: Agustos 2000-Ekim 2001 tarihleri arasında kalça kırıgı nedeniyle spinal anestezi altında artroplasti uygulanan 89 yaslı hasta retrospektif olarak incelendi. Hastalar spinal anesteziden hemen önce agrı sagaltımı için intravenöz olarak yapılan analjeziklere göre 4 gruba ayrıldı: Grup 1 (Ketamin grubu), Grup 2 (Fentanil grubu) , Grup 3 (Meperidin grubu) ve Grup 4 (Kontrol grubu). Postoperatif ilk analjezik ihtiyaç zamanı ve ilk 24 saatte kullanılan analjezik miktarları kaydedildi. Bulgular: Olguların yasları 65-99 arasında degismekteydi. Ilk analjezik ihtiyaç zamanı ketamin grubunda (192 dk.), fentanil (132 dk.), meperidin (129 dk.) ya da kontrol (118 dk.) gruplarına göre daha fazla iken (p=0.035), postoperatif ilk 24 saatteki analjezik tüketimi ise daha az olarak bulundu (p=0.035; p0.001). Sonuç: Travma sonrası artroplasti uygulanan yaslı hastalarda spinal anesteziden hemen önce kullanılan ketamin, aynı amaçla kullanılan opioidlere göre postoperatif dönemde daha iyi agrı sagaltımı saglayabilmektedir.Aim and objective: Hip fracture represents the most leading cause of orthopedics urgent casesfor elderly people. Although spinal or epidural anesthesia is preferred in those cases, the pain due to position can cause some difficulty. The aim of our study is to investigate the analgesic effect of ketamine, fentanyl, or meperidine administration when given to facilitate the position before spinal anesthesia on postoperative analgesia in elderly patients underwent hip surgery. Material Methods: Eighty-nine elderly patients who underwent hip surgery by spinal anesthesia were investigated between August 2000 and October 2001 retrospectively. The patients were divided into four groups according to the application of analgesics before spinal anesthesia: Group 1 (Ketamine group), Group 2 (Fentanyl group), Group 3 (Meperidine group) and Group 4 (Control group). The time of first analgesic request for postoperative period and total analgesic consumption at postoperative 24 hour were recorded in all patients. Results: The age range of patients was between 65 and 99. The time to first request for analgesia was significantly longer in the ketamine (192 min) group compared to the fentanyl (132 min), meperidine (129 min) and control groups (118 min) (p=0.035). The analgesic requirements first 24 h were significantly lower in ketamine group compared to other groups (p0.001). Conclusions: Intravenously administration of ketamine before spinal anesthesia may provide better analgesia compared to other opioids during postoperative period in elderly underwent hip surgery

Observing of loosing weight of mothers in first year after parturitionAnnelerin, doğum sonu ilk yılda kilo verme durumlarının incelenmesi

Gained weight during pregnancy which have not been loosed following parturition or growing fat after parturition, effect the life of women on physiological, psychological and social aspects. It is aimed to observe loosing weight that were gained during pregnancy, in first year after parturition in this study.This is a croos –sectional type research. Sampling of the research is composed from mothers who were given birth one year ago and has accepted to attend this research who were admitted to three different family health centers between January 2014 - March 2015 that were randomly determined in Center of Manisa Provence (n=232).  Data collecting form of the research  is generated by the researchers in the direction of related literature.  Number, percentage, mean values and the chi-square test were used for analyzing of data.Average age of mothers is 27.8±5.3 and average number of parturiton is 2.0±1.1. Average gained weight during pregnancy is determined as 12.4±4.5 kg.  BMI (Body mass index) of mothers is 25.99±3.85 and 48.3 % of them are overweight according to BMI. It’s determined that while 16.8 % of mothers loosed the weight that was gained during pregnancy, the others couldn’t loose that weight or gained more weight according to the research for situation of loosing weight  in first year after parturation. A meaningful relationship is not found between loosing weight after parturation and age of mothers, education levels, number of liveborns, number of living children, delivery method, nursing, routine daily houseworks, total fluid intake, gaining weight during pregnancy (p>0.05). A statistically meaningful relationship is found between  loosing weight after parturation and doing exercise or fitness, average sleeping time, BMI before pregnancy. (p<0.05).It’s determined that most of the mothers couldn’t loose weight which were gained during pregnancy or gained more weight at first year after parturation. Also it’s determined that  sleeping adequately and regular physical exercises have positive effect on loosing weight after parturation.   ÖzetGebelikte alınan kiloların doğum sonu dönemde verilememesi ya da doğum sonu alınan kilolar kadın yaşamını fizyolojik, psikolojik ve sosyal yönden etkilemektedir. Bu çalışma, kadınların gebelik süresince aldığı kiloları doğum sonu ilk bir yılda verme durumlarını incelemek amacıyla yapılmıştır.Araştırma kesitsel tiptedir. Araştırmanın örneklemini Manisa ili kent merkezinde bulunan ve rastgele belirlenmiş üç Aile Sağlığı Merkezine Ocak 2014 – Mart 2015 tarihleri arasında başvuran ve araştırmaya katılmaya kabul eden, bir yıl önce doğum yapmış anneler oluşturmuştur (n=232). Araştırmada veri toplama formu, ilgili literatür doğrultusunda araştırmacılar tarafından oluşturulmuştur. Verilerin analizinde sayı, yüzde, ortalama değerleri ve ki-kare testi kullanılmıştır.Annelerin yaş ortalaması 27.8±5.3 olup doğum sayısı ortalaması 2,0±1,1’dir. Annelerin gebelik boyunca aldıkları kiloların ortalaması 12.4±4.5 kg bulunmuştur. Annelerin doğumdan bir yıl sonraki ortalama beden kitle indeksleri (BKI) 25.99±3.85 olup %48.3’ü BKI’ye göre fazla kiloludur. Gebelik süresince alınan kiloların doğum sonu ilk yılda verilme durumu incelendiğinde, annelerin %16.8’sinin gebelikte aldığı kiloları verdiği, diğer gebelerin ise gebelikte aldığı kiloları vermediği ya da kilo aldığı saptanmıştır. Annelerin yaş, eğitim, canlı doğum sayısı, yaşayan çocuk sayısı, doğum şekli, emzirme, günlük ev işlerini yapma, sıvı alımı, gebelikte kilo alımı ile doğumdan sonra kiloların verilme durumu arasında anlamlı bir ilişki bulunmamıştır (p>0.05). Annelerin egzersiz/ spor yapma durumu, ortalama uyku süresi, gebelik öncesi BKI ile doğum sonu dönemde kilo verme arasında istatistiksel olarak anlamlı ilişki saptanmıştır. (p<0.05).Annelerin çoğunun, gebelik döneminde aldığı kiloları doğumdan sonraki ilk bir yılda vermediği ya da kilo aldığı; doğum sonu dönemde yeterli uyumanın ve düzenli egzersizlerin kilo vermeyi pozitif yönde etkilediği belirlenmiştir.

Sporadik İzole Fokomeli

Konjenital ekstremite anomalilerinin intrauterin dönemde ultrasonografi ile erken tespiti gerekli danışmanlığın verilebilmesi açısın- dan önemlidir. Bu makalede sporadik fokomeli olduğu düşünülen postmortem muayene sonuçlarıyla da bu tanı ile uyumlu olduğu görülen bir olgunun sunulması amaçlanmıştır. 20 yaşında, primigravid, kendisinin ve eşinin soygeçmişinde bilinen konjenital ano- mali öyküsü saptanmayan olgunun 22. gebelik haftasındaki obstetrik ultrasonografisinde fetal ekstremite anomalileri izlendi. Tanıyı doğrulayan postmortem radyolojik ve genetik incelemeler yapıldı. Eşlik eden ek malformasyon saptanmadı. Düşük materyalinden yapılan kromozom analizinde herhangi bir sayısal veya gross yapısal kromozom anomalisi gözlenmedi. Patolojik ultrasonografik ve sitogenetik bulgular ile tanı konulan iskelet anomalilerinin postnatal olarak da doğrulanması ailelere verilecek genetik danışma ve olası diğer gebelikler için uygun izlem olanakları sağlayacaktı

Evaluation of efficacy of caudal analgesia on pediatric surgery

Amaç: Retrospektif olarak, hastanemizde 2006 yılının Ocak-Haziran ayları arasında, pediatrik cerrahide inguinal, ürogenital ve rektal bölgede elektif cerrahi operasyon geçirmis 125 olguda genel anestezi indüksiyonu sonrasında yapılan kaudal blogun, intraoperatif, postoperatif dönemde analjezik etkinligini ve komplikasyonlarını degerlendirmeyi amaçladık. Gereç ve yöntem: Retrospektif olarak pediatrik cerrahide elektif cerrahi operesyon geçirmis kaudal blok uygulanmıs hasta dosyalarında yer alan anestezi izlem, anestezi derlenme odası hasta takip ve hemsire gözlem formları incelenerek, demografik veriler, operasyon türü, indüksiyon ve idamede uygulanan anestezik ajanlar, anestezi sekli, kaudal blokta uygulanan lokal anestezigin türü, miktarı, konsantrasyonu; intraoperatif, postoperatif dönemde uygulanan analjezik ihtiyaçları ile verilme zamanları ve komplikasyonlar kaydedilmistir. Bulgular: Yas ortalamaları 41.57±38.55, yas aralıgı 1-132 ay olup, cinsiyet 118 erkek (%94.4) ve 7 kız (%5.6), vücut agırlıkları ortalama 14.60±7.81 kg olarak bulundu. Kaudal blokla %0.25 bupivakainden 1ml/kg uygulanan hastaların anestezi süreleri ortalama 61.50±42.07 dak. olarak bulunmustur. Intraoperatif dönemde herhangi bir analjezik yapılmamıs olup postoperatif analjezi süreleri ortalama 412.88±163.13 dak. olarak saptanmıstır. Postoperatif dönemde herhangi bir komplikasyon bildirilmemistir. Sonuç: Kaudal blok pediatrik cerrahide inguinal, ürogenital, rektal bölgede yapılan operasyonlarda intraoperatif ve postoperatif dönemde analjezi saglamada etkili bir yöntem oldugunu gözlemledik.Objective: We aimed to retrospectively evaluate analgesic effect and complications in intraoperative and post operative periods of caudal block performed after induction of general anesthesia in 125 pediatric patients who underwent elective surgical operations on the inguinal, urogenital and rectal regions in 2006. Material and Methods: Data were collected from anesthesia monitoring forms, recovery room monitoring forms and nursing monitoring forms about demographics, types of operations, anesthetic agents used for induction and maintenance of anesthesia, types of anesthesia, types, doses and concentrations of local anesthetics used for caudal block, analgesics given in intraoperative and postoperative periods, time of analgesic administration and complications. Results: The patients were aged 1-132 months, with a mean of 41.57±38.55 months. Out of 125 patients, 118 (94.4%) were male and 7 (5.6%) female with a mean weight of 14.60±7.81 kg. Duration of anesthesia was 61.50±42.07 min in patients administered 0.25% bubivacain for caudal block. No analgesics were administered during operation and mean duration of analgesia in the postoperative period was 412.88±163.13 min. No complications were noted in the postoperative period. Conclusion: It can be concluded that caudal block decreases the need for general anesthesia in the intraoperative period and provides effective analgesia in the postoperative period in operations on the inguinal, urogenital and rectal regions

Evaluation of the effects of remifentanyl and alfentanyl on spirometric parameters in endotracheal intubations

Amaç: Çalısmamızın amacı remifentanil ve alfentanil kullanılan hastalarda endotrakeal entübasyona yanıt olarak olusan solunumsal degisikliklerin etkilerini spirometrik olarak arastırmaktır. Gereç ve yöntem: Çalısma retrospektif olarak hasta dosyalarındaki anestezi takip fisleri taranarak, genel anestezi altında opere olan 18-60 yas arası 40 olgu seçilerek 2 esit grup olusturularak gerçeklestirildi. Remifentanil (Ultiva®,) grubunda (Grup R) remifentanil; entübasyondan önce 1 µg/kg IVbolus, entübasyondan sonra 0.25 g/kg/dak. infüzyonla, alfentanil (Rapifen®) grubunda (Grup A) alfentanil; entübasyondan önce 20 g/kg IV bolus ve entübasyondan sonra 1 µg/kg/dak infüzyonla uygulanmıs. Ilaç verildikten sonra, entübasyondan hemen önce ve sonra, intraoperatif 5., 10. dakikalarda spirometreyle pik inspiratuvar basınç (PIP), plato basıncı (Pplato), havayolu direnci (Raw), akciger kompliyans (C) degerleri kaydedilmistir. Bulgular: Gruplar arasında pik inspiratuar basınç, plato basıncı, kompliyans degerleri arasında anlamlı fark saptanmazken; havayolu direnci bazal degerleri arasında alfentanil grubunda daha düsük olmak üzere istatiksel olarak anlamlı fark saptandı (P<0.05). Çalısmamızda remifentanil ve alfentanilin endotrakeal entübasyonda spirometrik parametreler; pik inspiratuar basınç, plato basıncı, havayolu direnci, kompliyans degerleri üzerinde anlamlı fark olusturmadıgı saptanmıstır. Sonuç: Remifentanil ve alfentanilin elektif cerrahi uygulanan vakalarda solunumsal yan etkilere yol açmaksızın genel anestezi uygulamalarında güvenle kullanılabilecegini gözlemledik.Objective: The aim of this study was to evaluate respiratory changes on spirometry which occur in response to endotracheal intubations in patients receiving remifentanyl and alfentanyl. Materials and methods: This is a retrospective study. Spirometric data were derived from anaesthesia monitoring forms in patient files. The study included 40 patients aged between 18 and 60 years. They were assigned into two groups i.e. Group remifentanyl (R) (n=20) and Group alfentanyl (A) (n=20). Group R received intravenous bolus 1 µg/kg remifentanyl before intubations and 0.25 µg/kg/min remifentanyl after intubations and Group A received IV bolus 20 µg/kg alfentanyl before intubations and 1 µg/kg/min alfentanyl after intubations. Peak inspiratory pressure (PIP), plateau pressure (Pplateau), airway resistance (Raw) and pulmonary compliance (C) measured just before and soon after Remifentanyl and Alfentanyl were given and in the intraoperative fifth and tenth minutes were obtained. Results: There was no significant difference in peak inspiratory pressure, plateau pressure and pulmonary compliance between the groups, but the difference in baseline airway resistance between the groups was significant (P<0.05). In fact, Group A had a lower airway resistance at baseline. Also, there was no significant difference between remifentanyl and alfentanyl in the spirometric parameters of peak inspiratory pressure, plateau pressure, airway resistance and pulmonary compliance upon endotracheal intubations. Conclusion: It can be concluded that remifentanyl and alfentanyl do not cause respiratory side-effects in patients who undergo elective operations and can be administered safely for general anesthesia

Postresectional lung injury in thoracic surgery pre and intraoperative risk factors: a retrospective clinical study of a hundred forty-three cases

<p>Abstract</p> <p>Introduction</p> <p>Acute respiratory dysfunction syndrome (ARDS), defined as acute hypoxemia accompanied by radiographic pulmonary infiltrates without a clearly identifiable cause, is a major cause of morbidity and mortality after pulmonary resection. The aim of the study was to determine the pre and intraoperative factors associated with ARDS after pulmonary resection retrospectively.</p> <p>Methods</p> <p>Patients undergoing elective pulmonary resection at Adnan Menderes University Medical Faculty Thoracic Surgery Department from January 2005 to February 2010 were included in this retrospective study. The authors collected data on demographics, relevant co-morbidities, the American Society of Anesthesiologists (ASA) Physical Status classification score, pulmonary function tests, type of operation, duration of surgery and intraoperative fluid administration (fluid therapy and blood products). The primary outcome measure was postoperative ARDS, defined as the need for continuation of mechanical ventilation for greater than 48-hours postoperatively or the need for reinstitution of mechanical ventilation after extubation. Statistical analysis was performed with Fisher exact test for categorical variables and logistic regression analysis for continuous variables.</p> <p>Results</p> <p>Of one hundred forty-three pulmonary resection patients, 11 (7.5%) developed postoperative ARDS. Alcohol abuse (p = 0.01, OR = 39.6), ASA score (p = 0.001, OR: 1257.3), resection type (p = 0.032, OR = 28.6) and fresh frozen plasma (FFP)(p = 0.027, OR = 1.4) were the factors found to be statistically significant.</p> <p>Conclusion</p> <p>In the light of the current study, lung injury after lung resection has a high mortality. Preoperative and postoperative risk factor were significant predictors of postoperative lung injury.</p

Karbon destekli platin nanoparçacıklı katalizörlerin metanol yükseltgenme tepkimesine karşı aktiviteleri : başlangıç metal bileşiklerinin ve yeni sürfaktantın rolleri

In this thesis, carbon supported platinum nanoparticle catalysts were prepared using PtCl4 and H2PtCl6 as starting materials and 1-heptanethiol, tert-nonyl mercaptan, 1-hexadecanethiol, 1-octadecanethiol as surfactants. These new catalysts were employed for methanol oxidation reaction which are used for direct methanol fuel cells. Tert-nonyl mercaptane was used for the first time in this type of reaction and the other surfactants were used for comparison of the catalysts performance. Cyclic voltammetry (CV), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and transmission electron microscopy (TEM) were used in order to determine the nature of the catalysts. The average platinum crystallite particle sizes of all prepared catalysts were determined by both X-ray diffraction and transmission electron microscopy. It was found that platinum crystallizes in face-centered cubic structure and the surfactant play an important role on the size of platinum nanoparticles, branch surfactant, such as tert-nonyl mercaptane, causes an increase in the size of platinum nanoparticles, about 3 nm, compared to linear surfactant, such as 1-heptanethiol, about 2 nm. The oxidation states of platinum and their ratios were determined by XPS technique. These results indicated that platinum has two different oxidation states, zero and +4, and Pt(0) to Pt(IV) ratio is about 7.5 to 2.5. In addition to this, O 1s region of XPS was also examined and found that the surface of all of the catalysts covered by adsorbed hydroxide except the catalyst which was prepared by PtCl4 and tert-nonyl mercaptane (Catalyst IIa), where adsorption of water were observed and the catalyst which was prepared by H2PtCl6 and tert-nonyl mercaptane (Catalysts IIb), where adsorption of 65% of hydroxide and 35% of water were identified. Electrochemical studies indicated that Catalyst IIa has the maximum activity (342 A/gPt at 0.612 V) towards methanol oxidation reaction while Catalyst IIIb (H2PtCl6 and 1-hexanethiol were used to prepare this catalyst) has the minimum activity (91A/gPt at 0.580V). XRD, TEM and XPS results indicated that the optimum catalyst for methanol oxidation reaction contains about 3 nm of platinum nanoparticles, adsorbed hydroxide and water on the surface of catalyst, but sulphur. These results are in agreement with the proposed mechanism.M.S. - Master of Scienc

Temiz enerji üretiminde kullanılan doğrudan metanol yakıt pilleri için yeni karbon destekli/desteksiz metal nanoparçacıklı katalizörlerin hazırlanması, karakterizasyonu, aktivitelerinin tayini ve uygulaması

TÜBİTAK MAG Proje01.04.200

Employment intensity of economic growth in Southern Europe: evidence from multidimensional panel data

This paper examines the employment intensity of economic growth in Southern Europe during the so-called “post-crisis” recovery years. A labor demand estimation model based on multidimensional panel data from 2010 to 2019 was utilized. Findings from our macroeconomic analysis of eight different industries refute the predictions of neoclassical labor theory in the region. The results further indicate the presence of jobless growth in the areas of overall employment, fulltime employment, and overall employees. They also signal that economic growth may have created job opportunities in part-time and youth employment, and among temporary employees, rather than full-time jobs. The paper links these findings to particular characteristics of the regional labor market, discusses their.Publisher's VersionWOS:00102269520000