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Öğe A case of hyponatremia and pulmonary oedema developed during operative hysteroscopy and treated intensive care unit [Operati·f hi·steroskopi· sirasinda geli·şen ve yogun bakimda tedavi· edi·len hi·ponatremi· ve akci·ger ödemi· olgusu](2013) Sargin A.; Akdemir A.; Günüşen I.; Sertöz N.; Karaman S.Hysteroscopic procedures, due to ease of application properties has been widely used at diagnosis and treatment of gynecological cases. However, it should kept in mind that life-threatening complications such as hyponatremia and pulmonary oedema might occur during the operative hysteroscopic procedure. Such complications are usually treated in a short term period hut unfortunately some cases require mechanical ventilation therapy. In this case report, we aimed at presenting the treatment of a patient under histeroscopic procedure with severe hyponatremia accompanied by the phenomenon of pulmonary oedema requiring mechanical ventilation, and discuss the intensive care treatment approaches and management.Öğe Combined spinal-epidural anesthesia with low dose levobupivacaine in pregnant with cardiac disease: 2 cases (case report) [Kardiyak açidan riskli gebelerde düşük doz levobupivakain ile kombine spinal-epidural anestezi uygulamasi: 2 olgu](2008) Günüşen I.; Karaman S.; Asian D.; Firat V.Cardiac disease is an important cause of maternal mortality and morbidity in pregnancy. Improvements in the obstetrics field have enabled better observation of pregnant patients suffering cardiac diseases resulting in an increase in the number of cases reported. The treatments of these patients constitute a major challenge for anesthesiologists. We aimed to discuss on two patients with cardiac disease, scheduled for caesarean section under combined spinal-epidural anesthesia with low-dose local anesthetic and opioids, instead of general anesthesia.Öğe A comparison of intravenous general anesthesia and paracervical block for in vitro fertilization: Effects on oocytes using the transvaginal technique [İnvitro fertilizasyonda intravenöz genel anestezinin transvaginal ponksiyonla ali{dotless}nan oositler üzerine etkilerinin paraservikal lokal anestezik blokla karşi{dotless}laşti{dotless}ri{dotless}lmasi{dotless}](2011) Bümen S.; Günüşen I.; Firat V.; Karaman S.; Akdogan A.; Tavmergen G¨ker E.N.Aim: To compare the effects of 2 different anesthetic techniques used for oocyte retrieval. Comparison was made based on the number of retrieved and fertilized oocytes, metaphase 2 (M2, mature) oocytes, and transferred embryos, as well as fertilization, pregnancy, and live birth rates. Ultrasound-guided transvaginal oocyte retrieval for in vitro fertilization is one of the most common minor surgical procedures. Despite this, it is stressful and painful for the patient; most patients request sedation and/or pain relief. Propofol, which is frequently used for general anesthesia in such procedures, has been suspected to damage oocytes. Materials and methods: Results from 70 patients without premedication were compared in this randomized prospective study. Patients were divided into 2 groups based on treatment. Those in Group G received intravenous general anesthesia with atropine (10 µg kg-1), remifentanil (1 µg kg-1), and propofol (2.5 mg kg-1), while patients in Group P received a paracervical block with 100 mg of prilocaine (2%) and 0.75 mg kg-1 of intramuscular meperidine. Results: Our results revealed no statistically significant difference between the 2 groups in terms of the fertilization rate. The numbers of retrieved and mature oocytes and transferred embryos and the pregnancy rate were greater in the general anesthesia group, although only the number of transferred embryos showed a statistically significant difference (P = 0.045). Conclusion: According to our data, both anesthesia techniques can be used for oocyte retrieval since there were no differences in fertilization, pregnancy, or live birth rates between the 2 groups. © TÜBİTAK.Öğe Comparison of postoperative analgesic effects of low frequency tens and conventional tens used after abdominal hysterectomy [Abdominal histerektomi operasyonundan sonra düşük frekansli{dotless} tens ile konvansiyonel tens uygulamasi{dotless}ni{dotless}n postoperatif analjezik etkilerinin karşi{dotless}laşti{dotless}ri{dotless}lmasi{dotless}](2011) Çelik Y.; Günüşen I.; Eyigör C.; Karaman S.; Uyar M.; Durmaz B.Aim: Transcutaneous electrical nerve stimulation (TENS) which is used to treat chronic pain syndromes has been reported to be of some utility in the treatment of post-surgical pain. The aim of this prospective, randomized, double-blinded study was to investigate the effects of high or low frequency-TENS on postoperative pain control after abdominal hysterectomy. Material and Methods: Forty patients undergoing abdominal hysterectomy were randomly allocated to receive either low frequency or conventional TENS. Patient-controlled analgesia was applied to all patients with morphine infusions for postoperative analgesia after surgery. Pain scores were assessed before and after each application of TENS. Sedation scores, total morphine consumption, additional analgesic requirement and adverse effects were recorded. Results: Pain score was significantly lower after TENS application in both groups (except at 18th hours). There was a statistically significant intergroup difference only at 30th mins, postoperatively for morphine delivery (p=0,012). Morphine consumption, adverse effects and sedation scores (except 18th hours) were similar in both groups. Conclusion: There was no difference between low and high frequency-TENS for morphine consumption after abdominal hysterectomy. In both groups, pain scores were significantly lower than baseline values after each application of TENS.Öğe Comparison of the maternal and neonatal effects of combined spinal-epidural block and spinal block for cesarean section [Sezaryen operasyonlarinda kombine spinal epidural blok ile spinal blogun maternal ve neonatal etkilerinin karşilaştirilmasi](2011) Uysallar E.; Karaman S.; Günüşen I.; Uyar M.; Firat V.Objectives: Combined spinal-epidural block (CSEB) has gained increasing interest as it combines the reliability of a spinal block (SB) and the flexibility of an epidural block in cesarean section. We investigated the maternal and fetal effect of CSEB against SB in cesarean operation. Methods: Forty healthy, term pregnant women were randomized into two groups. Patients in the CSEB and SB groups were given 1.5 ml and 2.5 ml of 0.5% hyperbaric bupivacaine intrathecally, respectively. If sensorial block did not reach T4 within 10 min, supplemental bupivacaine was injected epidurally 2 ml per unblocked segment in the CSEB group. The quality and side effects of surgical anesthesia, hemodynamic parameters, Apgar scores, neurological and adaptive capacity score (NACS) and postoperative duration of pain were compared between the two groups. Results: The time for the block to reach the T4 level was significantly lower in the SB group (p<0.05). More patients in the SB group achieved complete motor blockade sooner than in the CSEB group (p<0.05). Mean arterial pressure was lower in the SB group (p<0.05). There were no significant differences between the groups with respect to Apgar scores, cord blood gases, NACS, and adverse effects such as nausea and vomiting. Conclusion: Both SB and CSEB provide good surgical analgesia for cesarean section. Maternal hypotension is a risk with both techniques, but it occurs earlier and is greater with SB. There is no difference in neonatal outcome, provided that maternal blood pressure is cautiously monitored and hypotension promptly treated.Öğe Comparison of the preemptive MgSO4 and remifentanil on perioperative hemodynamics and postoperative pain in total abdominal hysterectomy [Total abdominal histerektomi operasyonlarinda preemptif MgSO4 ile remifentanilin hemodinami ve postoperatif agri üzerine etkilerinin karşilaştirilmasi](2005) Günüşen I.; Karaman S.; Firat V.; Uyar M.Aim: Administration of analgesia prior to surgical stimulus has been proposed to inhibit sensitivity to surgery at the spinal level and has been referred to as preemptive analgesia. In our study we compared the effects of MgSO4 and remifentanil on intraoperative analgesie requirements and postoperative pain. Materials and Methods: Forty patients, ASA I-II, between 30-60 years age undergoing total abdominal hysteretomy were randomly assigned to two groups. Prior to induction Group M received 30 mg kg-1 iv MgSO4 and Group R received 1 µg kg iv bolus remifentanil. After same anaesthetic induction, during surgery group M received 10 mg kg -1 min-1 MgSO4 infusion and, group R received 0.25 µg kg-1 min-1 remifentanil infusion. Postoperatively all groups received patient control analgesia (PCA) morphine by a standard protocol. Results: No intraoperative change in haemodynamics was noted in the M group. There was no significant difference in heartrate (HR) between the groups but the remifentanil group was more hypotensive (p<0.05). The intraoperative analgesic requirement was not different between the groups. Postoperative pain scores, morphine consumption and rescue medication requirements were lower in the MgSO4 group while sedation scores and patient satisfaction were higher (p<0.05). Conclusion: We conclude that MgSO4 produces equivalant perioperative analgesia and improved intraoperative haemodynamic stability, when compared with remifentanil.Öğe Effects of two different doses of dexmedetomidine on intraoperative desflurane consumption, hemodynamic parameters and neuromuscular blockade [İki farkli deksmedetomidin dozunun i·ntraoperatif desfluran tüketimi, hemodinamik parametreler ve kas gevşemesi üzerine olan etkileri](2009) Aliyeva A.; Günüşen I.; Karaman S.; Firat V.Purpose: The effects of two different doses of dexmedetomidine, a selective ? 2-receptor agonist, on anesthetic agent consumption and neuromuscular blockade and intraoperative analgesic requirement were aimed to compare with the control group. Material and methods: Sixty patients between 18 and 60 ages were studied. Three groups were made, dexmedetomidine infusion was begun for Group A and Group B, 1 µg kg -1 and 0.5 µg kg -1 respectively and Group C were infused serum physiologic. After the standard anesthesia induction, dexmedetomidine infusion was begun for Group A and Group B, 0.5 µg kg -1h -1 and 0.25 µg kg -1 h -1 respectively and Goup C were infused serum physiologic. During the operation, hemodynamic parameters, neuromuscular function, BIS and total amount of desflurane were recorded. Results: Total desflurane consumptions (Group A: 50.12±15 ml, Group B: 80.26±13.7 ml, Group C:92.19±25.1 ml), additional dose of fentanyl and the onset time of rocuronium in Group A were statistical difference lower than other groups. Conclusion: It was concluded that administration of dexmedetomidine as a bolus of 1µkg -1 and as an infusion dose of 0.5 µkg -1 h -1 decreases the onset time of rocuronium, and decreases desflurane consumption by 45% in accordance with the control group, and reduces intraoperative requirement for additional analgesic dose.Öğe Esmolol, remifentanly and esmolol+remifentanyl combinations effects on hemodynamic changes caused by laryngoscopy and tracheal intubation [Laringoskopi ve trakeal entübasyona bagli hemodinamik degişiklikler üzerine esmolol, remifentanil ve esmolol+remifentanil kombinasyonunun etkileri](2007) Altunişik U.; Karaman S.; Günüşen I.; Firat V.Aim: The efficacy of esmolol, remifentanil and esmolol+remifentanil on changes in heart rate (HR) and arterial blood pressure (ABP) after laryngoscopy and tracheal intubation were compared. Materials and Methods: Sixty patients (ASAI-II) were included in this study. Before induction HR, systolic and diastolic arterial pressure (SAP and DAP), mean arterial pressure (MAP) and Rate-Pressure Product (RPP: HRxSAP) values were measured three times with 1 minute intervals and the mean value of these measurements was accepted as baseline. Patients were divided into three groups, Group ESM (esmolol group) received 2 mg kg-1 esmolol IV, Group REM (remifentanil group) 1 µg kg-1 remifentanil IV, while Group ESM+REM (esmolol+remifentanil group) received the combination of 1 mg kg-1 esmolol + 0.5 µg kg-1 remifentanil IV. Before induction and intubation and through the 1. to 10. minute after intubation HR, SAP, DAP, MAP was recorded with 1 minute intervals and RPP was calculated according to this data. Results: There was no difference between the groups when demographic data HR, SAP, DAP, MAP and RPP values were compared, but in all groups the HR values were significantly higher at the 1. minute after intubation in comparison with preintubation values. In the remifentanil group measurements showed a significant increase in HR at the 1. minute after intubation when compared to baseline and preinduction measurements. RPP was higher at the 1. minute after intubation in all groups when compared with preintubation values, while the SAP, DAP, and MAP values significantly increased only in esmolol and remifentanil groups (p<0.05). Conclusion: We concluded that, esmolol and esmolol+remifentanil were more effective than remifentanil in preventing hemodynamic response to laryngoscopy and intubation.Öğe HELLP syndrome and spinal anesthesia (case report) [HELLP Sendromu ve Spinal Anestezi (Olgu Sunumu)](2006) Karaman S.; Günüşen I.; Firat V.HELLP syndrome is characterized by hemolysis, elevated liver enzymes and thrombocytopenia. It may cause serious maternal and fetal morbidity and mortality. In management, prompt delivery of the patient is very important. This case report discusses a patient in her 35-36th week of pregnancy with elevated liver enzymes, thrombocytopenia, hypertension and a full stomach. An emergency cesarean section was indicated and the procedure was performed with spinal anaesthesia using 10 mg hyperbaric bupivacaine and 0.2 mg morphine sulphate. It was concluded that spinal anesthesia can be performed in patients with thrombocytopenia provided that other coagulation paramaters are normal and there are no signs of bleeding.Öğe Noncardiogenic pulmonary edema, hyponatremia and venous air embolus in operative hysteroscopy: 2 cases [Operatif histeroskopilerde, nonkardiyojenik pulmoner ödem, hiponatremi ve venöz hava embolisi: 2 olgu](2011) Karaman S.; Biricik E.; Günüşen I.; Uyar M.; Firat V.Nowadays, hysteroscopy guided operations are widely used in the diagnosis and treatment of intrauterine pathologies. Although hysteroscopy is a safe and short procedure, particularly operative hysteroscopy brings along many risks that anesthetists should consider about. In this report, we presented two cases in which pulmonary edema, hyponatremia and venous air embolism developed during the operative hysteroscopy, and aimed to draw attention to the management of these complications.
