Effects of Different Anesthetic Techniques on Serum Leptin, C-reactive Protein, and Cortisol Concentrations in Anorectal Surgery

Aim: To compare the effects of intratracheal general anesthesia (ITGA) and regional (saddle block) anesthesia on leptin, C-reactive protein (CRP), and cortisol blood concentrations during anorectal surgery. Methods: Fifty-eight patients suffering from hemorrhoidal disease, pilonidal sinus, anal fissure, or anal fistula were included the study. Patients were randomly assigned into one of the two groups (n = 29). Patients in one group received ITGA. After thiopental and fentanyl induction, vecuronium was used as a muscle relaxant. Anesthesia was maintained with sevoflurane. In the other group we applied saddle block, injecting hyperbaric bupivacaine into the subarachnoid space, through the L3-L4 intervertebral space, in the sitting position. Blood samples were collected for leptin, CRP, and cortisol analysis before the induction of anesthesia at 3 and 24 hours postoperatively. Results: Preoperative leptin, CRP, and cortisol concentrations were comparable between the groups. There was no significant difference in postoperative levels of leptin and CRP in both groups. Although not significant, leptin and CRP concentrations were lower in the saddle block group at three hours postoperatively (mean ± SD, 6.95 ± 8.59 and 6.02 ± 12.25, respectively) than in the ITGA group (mean ± SD, 9.04 ± 9.89 and 8.40 ± 15.75, respectively). During early postoperative period, cortisol increased slightly in the ITGA group and remained at similar level in the saddle block group, but later decreased in both groups. Cortisol levels in the saddle block group were significantly lower than in the ITGA group at 3 hours postoperatively (343.7 ± 329.6 vs 611.4 ± 569.8; P = 0.034). Conclusion: Saddle block, a regional anesthetic technique, may attenuate stress response in patients undergoing anorectal surgery, by blocking afferent neural input during early postoperative perio

Effects of Different Anesthetic Techniques on Serum Leptin, C-reactive Protein, and Cortisol Concentrations in Anorectal Surgery

Aim: To compare the effects of intratracheal general anesthesia (ITGA) and regional (saddle block) anesthesia on leptin, C-reactive protein (CRP), and cortisol blood concentrations during anorectal surgery. Methods: Fifty-eight patients suffering from hemorrhoidal disease, pilonidal sinus, anal fissure, or anal fistula were included the study. Patients were randomly assigned into one of the two groups (n = 29). Patients in one group received ITGA. After thiopental and fentanyl induction, vecuronium was used as a muscle relaxant. Anesthesia was maintained with sevoflurane. In the other group we applied saddle block, injecting hyperbaric bupivacaine into the subarachnoid space, through the L3-L4 intervertebral space, in the sitting position. Blood samples were collected for leptin, CRP, and cortisol analysis before the induction of anesthesia at 3 and 24 hours postoperatively. Results: Preoperative leptin, CRP, and cortisol concentrations were comparable between the groups. There was no significant difference in postoperative levels of leptin and CRP in both groups. Although not significant, leptin and CRP concentrations were lower in the saddle block group at three hours postoperatively (mean ± SD, 6.95 ± 8.59 and 6.02 ± 12.25, respectively) than in the ITGA group (mean ± SD, 9.04 ± 9.89 and 8.40 ± 15.75, respectively). During early postoperative period, cortisol increased slightly in the ITGA group and remained at similar level in the saddle block group, but later decreased in both groups. Cortisol levels in the saddle block group were significantly lower than in the ITGA group at 3 hours postoperatively (343.7 ± 329.6 vs 611.4 ± 569.8; P = 0.034). Conclusion: Saddle block, a regional anesthetic technique, may attenuate stress response in patients undergoing anorectal surgery, by blocking afferent neural input during early postoperative perio

Sezaryen sonrası ağrı tedavisinde epidural %0.2 ropivakain ile %0.2 ropivakain ve 0.75 mcgr/ml sufentanil kombinasyonunun karşılaştırılması

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi79069

Comparison of epidural 0.2% ropivacaine 0.2% ropivacaine with 0.75 mcgr/ml sufentanil for postcaserean analgesia

YÖK Tez ID: 171398ÖZET Kaya T, 'Sezaryen sonrası ağrı tedavisinde epidural %0.2 ropivakain ile %0.2 ropivakain ve 0.75 mcgr/ml sufentanil kombinasyonunun karşılaştırılması'. Kırıkkale Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı Uzmanlık Tezi. Kırıkkale 2005. Sezaryen operasyonları sonrası uygulanacak analjezi tekniklerinin, hastaların bebeklerinin bakımına izin verecek erken mobilizasyon ile birlikte etkin bir analjezi sağlaması gerekmektedir. Yeni bir amid lokal anestezik olan ropivakainin klinik uygulamaya girmesi ile bupivakaine göre daha az motor güçsüzlük oluşturduğu gösterilmiştir. Epidural ropivakainin önerilen minimum etkili konsantrasyonu %0.2'dir. Fakat optimal analjezi sağlanabilen konsantrasyonlar alt ekstremitelerde motor blok oluşmasına ve erken postoperatif mobilizasyonun gecikmesine neden olabilir. Sufentanil yüksek lipid çözünVlüğü olan ve epidural aralıkta güvenle kullanılabilecek bir opioiddir. Bix çalışmada, hasta kontrollü epidural analjezi (HKEA) sistemi ile uygulanan, tek başına %0.2 ropivakain ile %0.2 ropivakain ve 0.75 mcgr/ml sufentanil karışımının analjezik etkinliği, motor blok ve yan etkilerinin incelenmesi amaçlandı. Etik kurul onayı alındıktan sonra elektif sezaryen planlanan ASA I grubu 50 gebe çalışmaya alındı. Intravenöz yol açılıp hastalara kristaloid infüzyonu yapıldıktan sonra tüm hastalara kombine spinal epidural anestezi (KSEA) uygulandı. Cerrahi bittikten sonra hastalar Grup I ve Grup II olarak iki gruba ayrıldı. Grup l'de (n:25) %0.2 ropivakain ve 0.75mcgr/ml sufentanili 2.5 ml/saat bazal infüzyon, 1.25 ml bolus doz 30 dk'lık kilit sürelerinde uygulandı. Grup ll'deki hastalar (n:25) %0.2 ropivakaini 2.5 ml/saat bazal infüzyon, 1.25 ml bolus doz 30 dk'lık kilit sürelerinde aldı. Postoperatif 2, 4,6,8,10, 12, 16, 20, 24. saatlerde; ağrı (VAS: Visuel Analog Skalası), motor blok düzeyleri (Bromage skalası), bulantı ve kaşıntı insidansları, solunum sayısı, non invaziv kan basıncı, kalp hızı değerleri kayıt edildi, istatistiksel incelemede Student-t testi kullanıldı. P < 0,05 değeri anlamlı kabul edildi. İki grup arasında demografik veriler açısından farklılık bulunmadı. Grupların hemodinamik karşılaştırılmasında; kalp hızı, ortalama arter basıncı ve solunum sayıları benzer bulundu. Motor blok düzeyi ve VAS skorları Grup N'de 2. ve 4. saatlerde anlamlı derecede yüksekti (p < 0.5). Kaşıntı Grup l'de belirgin olarak yüksek bulundu. Bu çalışmada sezaryen sonrası ağrı için epidural kateterden uygulanan %0.2 ropivakain ve 0.75 mcgr/ml sufentanil kombinasyonunun daha az motor blok yaptığı ve daha fazla etkin analjezi sağladığı sonucuna varıldı. Anahtar kelimeler: Ropivakain, sufentanil, Hasta kontrollü epidural analjezi (HKEA) vıABSTRACT Kaya T, 'Comparison of epidural 0.2% ropivakain and 0.2% ropivakain in combination with 0.75 mcgr/ml sufentanil for postcesarean analgesia'. Kırıkkale University, School of Medicine, Department of Anaesthesiology and Reanimation, Thesis, Kırıkkale, 2005. Analgesic technigues after caeserean section must be effective producing early mobilization to enable these women to care efor their babies. After ropivacaine, a newly amide local anesthesic was introduced in clinical practice, less motor weakness with ropivacaine than bupivacaine was reported. The minimal effective consantration of epidural ropivacaine is approximately 0.2%. Unfortunately, optimal analgesia can be achieved at concentrations that produce motor blockade of the lower extremitieis, causing delay of early postoperative mobilization. Sufentanil a highly lipid-soluble opioid, can be used in the epidural space with safety. The aim of this study was the comparison of 0.2% ropivacaine alone or 0.2% ropivacaine plus 0.75 mcgr/ml sufentanil using Patient Controlled Epidural Analgesia (PCEA) system after caesarean section in term of analgesic efficacy, motor weakness and side effects. After obtaining Ethics Commitee approval, 50 women ASA I, undergoing elective caesarean surgery were enrolled in the study. All patients had a combined spinal-epidural anesthesia (CSEA) after intravenous access had been established and infusion of crystalloid commenced. When surgery was completed, patients randomly assigned into two groups. In Group I (n=25) 0.2% ropivacaine plus 0.75 mcgr/ml sufentanil, bolus 1.25 ml, lockout 30 min, with 2.5 ml background infusion were applied. The patients in Group II (n=25) received 0.2% ropivacaine, bolus 1.25 ml, lockout 30 min, with 2.5 ml background infusion. The vıımeasurements of pain at rest on a 100 mm VAS, motor block using a Bromage scale, respiratory rate, pulse rate, non-invazive blood pressure and the incidence of nause and pruritus were recorded. The data were analyzed with student-t test. P < 0,05 was considered statistically significant. There was no difference between the groups in demographic data. The values of heart rate, respiratory rate and mean arterial pressure were similar in both groups. The incidence of motor weakness and VAS pain scores were significantly higher in Group II at 2. and 4. h (p < 0.05). Pruritus was observed significantly more frequently in Group I than Group II (p < 0.05). We concluded that 0.2% ropivacaine plus 0.75 mcgr/ml sufentanil using PCEA after ceasarean sections had less motor weakness and more effective analgesia. Key Words: Ropivacaine, sufentanil, Patient Controlled Epidural Analgesia (PCEA) Vll

The Effect of the Item-Attribute Relation on the DINA Model Estimations in the Presence of Missing Datan

WOS: 000474694300016The objective of this study is to investigate the relation between the number of items and attributes and to analyze the manner in which the different rates of missing data affect the model estimations based on the simulation data. A Q-matrix contains 24 items, and data are generated using four attributes. A dataset of n = 3,000 is generated by associating the first, middle, and final eight items in the Q-matrix with one, two, and three attributes, respectively, and 5%, 10%, and 15% of the data have been randomly deleted from the first, middle, and final eight-item blocks in the Q-matrix, respectively. Subsequently, imputation was performed using the multiple imputation (MI) method with these datasets, 100 replication was performed for each condition. The values obtained from these datasets were compared with the values obtained from the full dataset. Thus, it can be observed that an increase in the amount of missing data negatively affects the consistency of the DINA parameters and the latent class estimations. Further, the latent class consistency becomes less affected by the missing data as the number of attributes associated with the items increase. With an increase in the number of attributes associated with the items, the missing data in these items affect the consistency level of the g parameter (guess) less and the s parameter (slip) more. Furthermore, it can be observed from the results that the test developers using the cognitive diagnosis models should specifically consider the item-attribute relation in items with missing data

The Analysis of OECD Member States Human Development Levels For the Year 2006

İnsani Gelişmişlik Endeksi (İGE), ülkelerin gelişmişlik düzeylerinin analizinde kullanılan en önemli göstergelerden birisidir. İGE değerinin hesaplanmasında; Yaşam Beklentisi Endeksi, Eğitim Endeksi ve Refah Endeksi olmak üzere üç alt endeks kullanılmaktadır. Yaşam beklentisi endeksinde; doğuşta yaşam beklentisi, eğitim endeksinde; yetişkin okur-yazarlık oranı ve okullaşma oranı, refah endeksinde ise kişi başına GSYİH değerleri veri olarak kullanılmaktadır. 0-1 arasında değişen değerler alan İGE’ne göre ülkeler gelişmişlik düzeyleri açısından üç kategoriye ayrılmaktadır. İGE değeri 0-0,499 arasındaki ülkeler “Düşük İnsani Gelişmişlik”, 0,500-0,799 arasında yer alan ülkeler “Orta İnsani Gelişmişlik” ve 0,800-1 değerleri arasında yer alan ülkeler “Yüksek İnsani Gelişmişlik” kategorisinde bulunmaktadır. Birleşmiş Milletler Kalkınma Programı (UNDP) tarafından düzenli olarak dünya ülkelerinin tamamına yönelik olarak İGE hesaplanmakta ve elde edilen değerlere göre ülkelerin gelişmişlik düzeyleri İnsani Gelişme Raporları (İGR) aracılığı ile yayınlanmaktadır. OECD ülkelerinin 2006 yılı İGE değerlerine göre insani gelişmişlik düzeylerinin analiz edilmesi amacıyla yapılan bu çalışmada, tarafımızdan yapılan hesaplamalar sonucu oluşturulan endeks değerlerinin UNDP tarafından açıklanan değerlerle uyumlu olduğu görülmüştür. Oluşturulan endeks değerlerine göre; Türkiye dışındaki OECD ülkelerinin tamamı yüksek insani gelişmişlik düzeyine sahip ülkeler kategorisinde yer alırken, Türkiye eğitim endeksi dışındaki diğer endekslere göre orta insani gelişmişlik düzeyine sahip ülkeler kategorisinde yer almaktadırThe Human Development Index (HDI) is one of the most important indicators concerning the the analysis of countries’ development levels. Three sub-indexes, namely Life Expectancy Index, Education Index, and Welfare Index, are used in order to gauge the value of HDI. Life Expectancy at birth figures are used in the Life Expectancy Index; Adult literacy rate and schooling ratio are used in the Education Index whereas GDP per capita figures are used in the Welfare Index. According to the HDI, which is showing values between 0 and 1, countries are sorted into three categories. Countries of HDI figures between 0 and 0,499 are demonstrated as having Low Human Development levels; HDI figures between 0,500 and 0,799 demonstrates countries of Middle Human Development Levels whereas HDI figures between 0,800 and 1 are categorized as countries with High Human Development Levels. The HDI is calculated regularly by the United Nations Development Programme (UNDP) for all countries in the world and countries’ development levels are published by Human Development Reports (HDR) according to the calculated figures. In this work that aims to analyze OECD countries human development levels with respect to HDI values for the year 2006, it was observed that the index values established after the calculations done by us were in line with the values published by the UNDP. According to the index values all of the OECD countries are placed in the category of countries with High Human Development Levels whereas Turkey is placed in the category of countries with Middle Human Development Levels according to all other indexes but education index.

Different intravenous sedation techniques during sinonasal surgery with local anaesthesia

Amaç: Lokal anestezi altında uygulanan sinonazal cerrahide, intravenöz sedasyon için kullanılan dört farklı anestezik medikasyonun hemodinamiye etkileri ve yan etkileri karşılaştırıldı. Gereç ve Yöntem: Septoplasti veya fonksiyonel endoskopik sinüs cerrahisi geçiren seksen hasta, rastgele dört gruba ayrıldı. Birinci gruptaki hastalara midazolam (0,07 mg/kg) ve fentanyl (1 µg/kg/dk), intravenöz (İV), ikinci gruptaki hastalara fentanyl (1 µg/kg), İV ve propofol infüzyonu (2 mg/kg/sa), üçüncü gruptaki hastalara midazolam (0,07 mg/kg), İV ve remifentanil infüzyonu (0.05 µg/kg/dk), dördüncü gruptaki hastalara ise propofol (2 mg/kg/sa) ve remifentanil (0.05 µg/kg/dk) infüzyonu uygulandı. Bütün hastalarda elektrokardiyografi, kan basıncı ve satürasyon şeklinde standart monitörizasyon yapıldı. Sekiz ölçüm periyodunda alınan veriler istatiksel olarak analiz edildi: 1: ameliyat öncesi (bazal), 2: intravenöz medikasyon sonrası, 3: lokal anestezi sonrası, 4: ameliyat başlangıcından hemen sonra, 5, 6, 7: ameliyat süresince ve 8: ameliyat bitiminde. Bulgular: Kalp hızı ve kan basıncı seyrinde gruplar arasında anlamlı fark gözlenmedi. Sedasyon sonrası satürasyon değerleri gruplar arasında farklı bulundu (p0.01). Hemodinamik parametreler, midazolam ve remifentanil alan hasta grubunda stabil seyretti. Propofol ve remifentanil alan hastalarda ameliyatın ikinci yarısında görülen hipoventilasyon dışında yan etki gözlenmedi. Sonuç: Sinonazal cerrahide lokal anestezi ile birlikte uygulanan sedasyon tekniklerinden, midazolam-remifentanil kombinasyonu oldukça stabil hemodinami sağlamaktadır. Yan etkilerinin azlığı bakımından propofol-remifentanil kombinasyonu midazolam-remifentanile alternatif olabilir.Objectives: To compare the haemodynamic and adverse effects of different intravenous sedation techniques during sinonasal surgery with local anaesthesia. Materials and Methods: Eighty patients undergoing septoplasty or functional endoscopic sinus surgery were studied. Patients were randomly assigned into one of four groups (n20/group). Group I received midazolam (0.07 mg/kg) and fentanyl (1 µg/kg), group II received fentanyl (1 µg/kg) and propofol (2 mg/kg/h), group III received midazolam (0.07 mg/kg) and remifentanil (0.05 µg/kg/min), and group IV received propofol (2mg/kg/h) and remifentanil (0.05 µg/kg/min). Cardiovascular monitoring including electrocardiography, mean arterial pressure and oxygen saturation was applied to all patients. The readings; baseline (1), after intravenous medication (2), after local anesthesia (3), at the beginning of the operation (4), during the operation (5, 6, 7) and at the end of the operation (8), were analyzed. Results: There were statistically significant differences among the groups in saturation after sedation (p<0.01). Haemodynamic parameters remained more stable in group-I. In group-IV, no side effect occurred, except a decrease in saturation, at the second part of the operation. Conclusion: The combination of midazolam and remifentanil provided more stable haemodynamic parameters during sinonasal surgery. Propofol and remifentanil may be an alternative technique in respect to less side effects except hypoventilation