The comparison of atracurium and cisatracurium induced neuromuscular block during sevoflurane and isoflurane anaesthesia [Sevofluran ve isofluran anestezisi sirasinda atrakuryum ile cisatrakuryumun olusturdugu noromuskuler blokun karsilastirilmasi]

Eighty adult patient accepted to study undergoing elective orthopedic, laparascopic or plastic surgery following informed patient consent and approval by our ethical committee. Patients were monitored at the theatre with ECG, systemic BP, SpO2 and T without any premedication. Anaesthesia induction was obtained with thiopenthone (5 mg/kg) and maintained with 2% sevoflurane or 1% isoflurane + 66% N2O in oxygen. Peripheric nerve stimulator was set on following anaesthesia induction. Approximately 5 minutes was awaited for stable neuromuscular calibration. The patients were then assigned randomly four groups equally. To group I 2% sevoflurane + atracurium (0.5 mg/kg), to group II 2% sevoflurane + cisatracurium (0.1 mg/kg), to group III 1% isoflurane + atracurium (0.5 mg/kg), and to group IV 1% isoflurane + cisatracurium (0.1 mg/kg) were applied. The onset time (T95) clinical duration(T25), recovery index (T75-25), spontaneous recovery time (T4/T1 70%) and endotracheal intubation conditions were assessed in four groups. All patients were intubated when 95% neuromuscular block obtained. Goldberg scale was used for determination of intubation condition. Haemodynamic and demographic data did not show any difference among the groups. Intubation condition were statistically significant better in group II and IV than group I and III (p<0.05). T95 values were found statistically significant shorter in group I and in group III than group II and IV (p<0.05). T25, T75-25 and T4/T1 values did not show any difference among the groups. In conclusion the onset of action of atracurium was faster than ciasatracurium whereas cisatracurium induced intubation conditions were better than atracurium. T25, T775-25 and T4/T1 = 70% values were found similar in all groups and 2% sevoflurane or 1% isoflurane did not alter atracurium and cisatracurium induced neuromuscular block

Late glacial-Holocene shelf evolution of the Sea of Marmara west of Istanbul

We present an investigation the Late Quaternary seismic stratigraphy of the shelf area of the northern the Sea of Marmara extending from its northern coast (between Silivri and Kumkapi) to approximately 100. m depth, using shallow high-resolution seismic reflection data along 73. N-S and 15 E-W lines. Seismic sequence analysis is used to identify the depositional systems, associated sedimentation conditions, and relative sea level changes. Seismic stratigraphic interpretations indicate the presence of four distinct seismic units (SU I, II, III and IV) underlying the shelf area. Seismic units are bounded by erosional unconformities overlying an acoustic basement. Seismic unit I constitutes the acoustic basement (AB), which is characterized by chaotic, subparallel, and wavy reflections that out locally off the rocky shorelines and along the crests of the positive structures where the sedimentary cover is absent. Seismic unit II is interpreted to represent the pre-Holocene deposits and exhibits subparallel reflections. Seismic unit II is interpreted to have been subjected to sub-aerial erosion during the Last Glacial Maximum. Seismic unit III-IV are interpreted to have formed during the Holocene (Flandrian) transgression and have parallel/subparallel internal reflection patterns. The top of seismic unit IV forms the present-day sea floor. As a result of the presence of fill, seismic facies within seismic unit IV reflect differences in depositional processes. The bathymetry of the study area has a close relation with sedimentation dynamics, tectonic, wave and flow dynamics and palaeotopograpy. Particularly, sudden dip changes determined at the shelf area might have been due to fault and/or fault systems that control the bottom topography. Seismic activity in the Sea of Marmara region has a key role the northern branch of the North Anatolian Fault Zone (NAFZ) affecting on the tectonic activity of the study area. The last two earthquakes in Izmit and Duzce, Turkey, in 1999 have been originated from NAFZ. The presence of several faults on various scales in the seismic profiles of the study area is identified. The active normal faults in the Holocene units that disturb the seafloor are determined. Most of these faults are intense in the eastern part of research area. The isopach map of Holocene sediment (seismic unit III and IV) indicates that the maximum sediment accumulations (up to 36. m) occur in the offshore areas of Bakirköy and Kumkapi. Young sediment thicknesses are common on the shoreline areas in the investigated area. © 2014 Elsevier Ltd.The authors acknowledge the support provided by University of Cukurova in Turkey (Grant No. FBE2002D234). The authors greatly appreciate the help of the Lieutenant Erkan Gezgin, Assoc. Prof. Dr. Mehmet Karakilcik and geophysical engineer Mehmet Şimşek for providing the seismic data. We also thank the Turkish Navy Department of Navigation, Hydrography and Oceanography

The effects of telmisartan on mechanical responses of left ventricular papillary muscle in rats with streptozotocin-induced diabetes mellitus

PubMedID: 19855921The purpose of this study was to investigate the effects of telmisartan (5 × 10-5 M) on the mechanical response of left ventricular papillary muscle in rats with streptozotocin-induced diabetes mellitus. We studied 32 rats; 16 were rendered diabetic by a single intravenous injection of streptozotocin (45 mg kg-1 i.v.) and 16 formed a non-diabetic control group. Diabetic animals were divided into two groups: diabetic-telmisartan group and the diabetic-control group. Non-diabetic controls were further divided into the non-diabetic-telmisartan group and the non-diabetic-control group. We found: (1) Muscle twitch tension (P 0) and contraction and relaxation rates were significantly lower in diabetic controls than in the other groups. (2) Telmisartan significantly increased P 0 in both diabetic and non-diabetic rats. (3) Times to peak tension and half-relaxation were significantly greater in groups DC and DT than in the non-diabetics. In conclusion, our data suggest that telmisartan attenuates diabetes-induced impairment of diabetic rat papillary muscles, and may thus be able to reduce cardiac complications in diabetes. © 2009 Springer-Verlag

A comparative study of the analgesic effect of patient-controlled morphine, pethidine, and tramadol for postoperative pain management after abdominal hysterectomy

PubMedID: 18165596We designed this prospective, randomized, double-blind study to compare the analgesic effectiveness and side effects of IV patient-controlled morphine, pethidine, and tramadol for postoperative pain management. One-hundred-twenty- six ASA physical status I or II patients undergoing abdominal hysterectomy were randomly allocated to receive IV-patient controlled morphine (M), pethidine (P), or tramadol (T) for postoperative analgesia. The cumulative analgesic consumption over 24 h was 25.7 ± 9.5 mg for morphine, 266 ± 90 mg for pethidine, and 320 ± 10 mg for tramadol. The average supplementary fentanyl dose used was significantly higher in group T than in groups M and P (P < 0.05). In conclusion, morphine, pethidine, and tramadol resulted in equivalent pain scores and side effects, but tramadol group T required more rescue analgesic doses of fentanyl. © 2008 by International Anesthesia Research Society

Addition of remifentanil to patient-controlled tramadol for postoperative analgesia: A double-blind, controlled, randomized trial after major abdominal surgery

PubMedID: 18533063Background and objective: We have investigated whether, after major abdominal surgery, the addition of remifentanil to tramadol for intravenous patient-controlled analgesia improved analgesia and lowered pain scores, compared to a patient-controlled analgesia containing only tramadol. Methods: Sixty-two patients were allocated randomly to receive an intravenous patient-controlled analgesia with tramadol alone (T), or tramadol plus remifentanil (TR), in a double-blind randomized study. Whenever patients complained of pain, they were allowed to use bolus doses of tramadol (0.2 mg kg-1) or tramadol (0.2 mg kg-1) plus remifentanil (0.2 µg kg-1) mixture every 10 min without a time limit and background infusion. Discomfort, sedation, pain scores, total and bolus patient-controlled analgesia tramadol consumption, and side-effects were recorded for up to 24 h after the start of patient-controlled analgesia. Results: Pain scores at rest were statistically significantly lower in the TR group at 6, 12 and 24 h than in T group (P &lt; 0.05). Pain scores at movement and patient comfort scores were also found to be significantly lower in the TR group at 2, 6, 12 and 24 h than in the T group (P &lt; 0.05). Although the TR group consumed less tramadol, there were no statistically significant differences in the cumulative tramadol consumptions between the groups at any time. However, the number of patients requiring rescue analgesia and average supplementary doses used was significantly higher in the T group than in the TR group (P &lt; 0.05). Conclusions: After major abdominal surgery, adding remifentanil (0.2 µg kg-1) to tramadol (0.2 mg kg-1), with 10-min lockout times, for patient-controlled analgesia offered better postoperative pain relief and patient comfort, without causing any sedation or respiratory depression. © 2008 Copyright European Society of Anaesthesiology

A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery

WOS: 000177547900017PubMed ID: 12190807Background: We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient-controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol. Methods: Sixty-six patients were allocated randomly to receive a PCA with tramadol alone (T), tramadol plus magnesium (TM) or tramadol plus ketamin (TK), in a double-blind randomized study. Postoperative analgesia was started when the verbal rating scale (VRS) score was 2 or more. Following a loading dose of the study solution (which contained 1 mg/kg tramadol), a background infusion of 0.4 mg/kg/h was started. Patients were allowed to use bolus doses of 0.2 mg/kg every 20 min without a time limit. Discomfort, sedation, pain scores, total and bolus PCA tramadol consumption, and side-effects, were recorded for up to 24 h after the start of PCA. Results: Pain and discomfort scores were lower (P < 0.01) in groups TM and TK at 15, 30, 60 and 120 min than in group T. The addition of magnesium or ketamine significantly reduced the consumption of tramadol at 6, 12 and 24 h (P < 0.01). The incidence of nausea did not differ between the groups. Conclusion: Adding magnesium or ketamine to tramadol improved analgesia and patient comfort and decreased the amount of tramadol required for postoperative pain management after major abdominal surgery

The comparison of caudal ropivacaine and bupivacaine for postoperative pain relief in children [Cocuklarda postoperatif agri tedavisinde kaudal ropivakain ve bupivakain' in karsilastirilmasi]

The study was performed in thirtyfour children, aged between 1 and 9, undergoing for elective inguinal hernid repaired. Anaesthesia was obtained with halothan (3%) and N2O (67%) in oxygen and maintained with halothan (1- 2%) and N2O (67%) in oxygen. Succinylcholine was administered in patient who needed endotracheal entubation or muscle relaxation. At the end of the operation, the patients were divided into two groups, randomly. Patients in group I (n=7) received 0.5 mL/kg bupivakain (0.25%) and patients in group II (n=17) were applied 0.5 mL/kg ropivacaine (0.25 %), caudally. All patients were under observation following caudal application and at the end of anaesthesia. The level of analgesia was assessed using paediatric objective pain score at 15th min., 1st, 2nd. 3rd and 4th hours postoperatively. Bromage's modified motor block scale was used for the assessment of motor block. There was no difference between groups in weight and age. POPS hadn't any difference between the groups at 15th min. 1st, 2nd, 3rd and 4th hours postoperatively. POPS decreased at 1st and 2nd hours compared with 15thmin value, however, there was no difference at 3rd and 4th hours. POPS was not higher than 5 point in any patient. Motor block was not seen. SAP, DAP and HR were the same in both groups. No side of effects related to local anaesthesia were observed in our patients. We concluded that ropivacaine (0.25%) is as efficacious as bupivacaine (0.25%) in producing postoperative analgesia for inguinal hernia in paediatric patients

Comparative determination of continuous epidural analgesia during labor using 0.125 % bupivacaine or mixture of 0.125 % bupivacaine and 0.05 mg fentanyl [Dogumda epidural % 0.125 bupivakain+0.05 mg fentanil ile % 0.125 bupivakain infuzyonunun karsilastirmali degerlendirilmesi]

We aimed to compare the analgesic effect of continuous epidural infusion of 0.125 % bupivacaine+0.05 mg fentanyl vs 0.125 % bupivacaine alone in the pain relief of labor. In the study forty, ASA class I or II primipare volunteers with vertex presentation when servical dilatation was reached to 2-7 cm were taken in the study to compare the efficiency and safety of continuous epidural infusions of 0.125 % bupivacaine+0.05 mg fentanyl vs 0.125 % bupivacaine alone. After an epidural catheter was placed, patients were randomly assigned into two groups. Group I (n = 20) received a loading dose of 6 ml of 0.125 % bupivacaine with 50 microgram fentanyl, followed by a constant epidural infusion of 0.125 % bupivacaine with 50 microgram/mL fentanyl at a rate of 12 mL/hr. Group II (n = 20) received a loading dose of 6 mL of 0.125 % bupivacaine alone followed by a constant epidural infusion of 0.125 % bupivacaine at a rate of 12 mL/hr. When servical dilatation completed, epidural infusion was stopped. The groups were compared with their analgesic efficiency, hemodynamic parameters, delivery time, effects on feotus and side effects in the 1st and IInd labor period. VAS values were used to determine the analgesic efficiency. According to our findings, the VAS value was found statisticaly significantly lower in bupivacaine/fentanyl combination than bupivacaine alone in the first period of labor (p0.05). In conclusion, epidural bupivacaine/fentanyl infusion provided superior analgesia than only bupivacaine infusion for analgesia during labor without adversly affecting the mother or neonate