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    The effect of dehydrobenzperidol on nausea and vomiting in patient controlled analgesia [Hasta kontrollu analjezide dehydrobenzperidol postoperatif bulanti ve kusmaya etkisi]
    (2000) Ongun B.; Agrali S.; Sakarya M.; Gokpinar B.; Ugur G.
    This study aims to reveal the efficacy of droperidol, a neuroleptic drug with anti-emetic properties, in preventing postoperative nausea and vomiting (PONV) due to IV morphine administered during patient controlled analgesia (PCA). Thirty patients of ASA I-II to whom abdominal hysterectomy was applied were randomly allocated into two groups to receive PCA by morphine alone (Group I) or in combination with dehydrobenzperidol (DHBP) (Group II). Group I received a loading dose of 5 mg IV morphine followed by 1 mg IV boluses with a 10 min lockout period while Group II received morphine plus dehydrobenzperidol (0.05 mg/mL) infusion following loading dose. Otherwise the protocol were the same. Pain and sedation scores, mean and cumulative morphine requirements, incidence of side effects, and vital functions were recorded hourly for 24 hours. Morphine requirement did not show difference between groups. Initial and first hour VAS value was higher in Group I. PONV incidence was significantly lower in Group II (p<0.05), 6.7% vs. 28.6%. None of the patients showed side effects such as respiratory depression, significant haemodynamic changes, and extrapyramidal effects. It is concluded that the addition of DHBP to morphine in intravenous PCA lowered the incidence of PONV safely.
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    The effects of branched-chain amino acids on the oxygen consumption in patients with metabolic stress [Metabolik stresli hastalarda dallanmis zincirli aminoasitlerin oksijen tuketimine etkisi]
    (1999) Sakarya M.; Mert S.; Moral A.R.
    In recent years, there has been a much controversy about the feasibility of amino acid solutions with a high content of branched-chain amino acids (BCAA: leucine, isoleucine, valine) in fields of hepatic failure, trauma, obtaining a better nitrogen balance, low morbidity and low mortality. The aim of this study was to establish the effects of BCAA infusions on the oxygen consumption (VO2) in patients with metabolic stress. We studied nine patients who were mechanically ventilated suffering from acute respiratory failure. Muscle relaxants, sedation and volum controlled mechanical ventilatory support were applied to all patients. Daily energy supply was obtained with standard enteral formulas 1 kcal/mL. In addition to daily energy requirement, 0,5 g/kg amino acid solution which contains % 45 BZAA was infused parenterally in 6 hours. Before (I) and after (II) 6 hours infusion VO2 were calculated with thermodilution technique via pulmonary arterial catheter. Wilcoxon was used for statistically comparisons. We conclude that, although the statistical difference was non-significant between two measurements there seems to be a relative increase of VO2 consumption with the use of BCAA and this may be important in the ICU for critically ill patients with poor oxygen supply.
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    The effects of dobutamine on oxygen consumption and energy expenditure in nonseptic and septic patients [Dobutamin'in septik olmayan ve septik hastalarda oksijen ve enerji tuketimi uzerine etkisi]
    (1997) Sakarya M.; Ulukaya E.; Cevik A.; Moral A.R.
    In this study, the effects of dobutamine infusion, given at 3 µg/kg/min and 6 µg/kg/min, on oxygen consumption (VO2) and energy expenditure (EE) were evaluated in ten nonseptic and ten septic patients. Each dose of dobutamine was infused for 30 minutes. All patients were monitorized with both a radial artery and a pulmonary artery catheter. Cardiac output was measured using thermodilution technique. VO2 and EE were calculated before debutamine infusion as control, and at the end of each dose dobutamine infusion. The mean EE of control, after 3 µg/kg/min and 6 µg/kg/min of dobutamine were 1850±108, 2086±157, 2067±100 kcal/day, respectively, in nonseptic patients; 1781±104, 1905±103, 1985±101 kcal/day, respectively, in septic patients. Compared with control measurements, EE increased by 11% in response to maximum dose of dobutamine infusion in two groups. There were no differences between the nonseptic and septic patients. We conclude that the additional energy demands imposed by dobutamine infusion needs to be taken into account to determine the energy requirements of critically ill patients.
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    Nutritional risk of hospitalized patients in Turkey
    (2009) Korfali G.; Gündogdu H.; Aydintug S.; Bahar M.; Besler T.; Moral A.R.; Oguz M.; Sakarya M.; Uyar M.; Kiliçturgay S.
    Background & aims: We conducted a multicentre study to assess nutritional risk at hospital admission, hospital-associated iatrogenic malnutrition and the status of nutritional support in Turkish hospitals. Methods: A database which allowed for online submission of hospital and patient data was developed. A nutritional risk screening system (NRS-2002) was applied to all patients and repeated weekly in patients with hospital stays greater than one week and no invasive procedures. Patient-specific nutritional support was recorded during the study period. Results: Thirty-four hospitals from 19 cities contributed data from 29,139 patients. On admission, 15% of patients had nutritional risk. Nutritional risk was common (52%) in intensive care unit patients and lowest (3.9%) in otorhinolaryngology patients. Only 51.8% of patients with nutritional risk received nutritional support. Nutritional risk was present in 6.25% of patients at the end of the first week and 5.2% at the end of the second week, independent of nutritional support. In patients with nutritional risk on admission who were hospitalized for two weeks and received nutritional support, the NRS-2002 score remained ?3 in 83% of cases. Conclusions: Nutritional risk is common in hospitalized Turkish patients. While patients at nutritional risk often do not receive nutritional support when hospitalized, nutritional risk occurs independent of nutritional support. © 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.
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    Propofol or midazolam infusion for sedation following myocardial revascularization [Miyokard revaskularizasyonu sonrasi propofol ve midazolam ile sedasyon]
    (1999) Sakarya M.; Askar F.; Derbent A.; Ongun B.; Sungurtekin H.
    In cardiac surgery, postoperative sedation is important not only to facilitate mechanical ventilation but also to avoid post-operative hypertension. This study compared the sedative properties of propofol and midazolam following myocardial revascularization. Fourty patients, NYHA classes 2 or 3, scheduled for coronary artery bypass surgery were included in the study. All patients received the same premedication, anaesthesia induction and maintenance. A nitroglycerin infusion 0.5 (g/kg/min was started after cardiopulmonary bypass (CPB) in all patients and continued throughout the study period. At the end of the surgery artificial ventilation was continued and the patient transferred to the ICU. Patients were randomly allocated to one of two groups after recovery from anaesthesia and received either propofol infusion within the range 0.5-2.0mg/kg/h after a loading dose of propofol (1 mg/kg) or midazolam infusion within the range 0.01-0.05 mg/kg/h after a loading dose of midazolam (0.05 mg/kg). Sedative infusion rates were adjusted to maintain a Ramsay Score of between 3 and 4. Sedative infusion was stopped, if systolic blood pressure (SBP) was <110 mmHg. Additional boluses were given if sedation score was less than 3 on the Ramsay Scale. Morphine was given with bolus doses (10 mg) for pain relief. Central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) were kept in normal range. Weaning from the ventilator was achieved using standard criteria. Sedation time, the bolus doses of propofol/midazolam, morphine and hemodynamic data (SBP, DBP, HR, CVP, PCWP) were noted for each patient as was the duration of sedation. At the end of the sedation period recovery times, extubation were recorded. Twenty patients were included in each sedation group and there were no significant differences between the two groups with regard to age, weight, gender, operation time, CPB time and peroperative opiate doses. The mean time from stopping sedation to extubation 51.2±32.6 min for propofol versus 106.5±65.6 min for midazolam. Patients in propofol group required less sedative and morphine sulfate bolus doses. Throughout the duration of the study, all patients were hemodynamically stable except for a moderate but clinically acceptable decrease in SBP, DBP, HR in the propofol group. Results of this study have shown that both propofol and midazolam provide adequate sedation following cardiac surgery. However, propofol sedation resulted in faster weaning from the ventilator.
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    Relationship of oxygen delivery and consumption during short term dobutamine infusion in septic and non-septic patients [Septik ve septik olmayan hastalarda kisa sureli dobutamin uygulamasinda oksijen sunumu - Tuketimi iliskisi]
    (1998) Ulukaya S.; Ulukaya E.; Ayanoglu H.O.; Sakarya M.; Moral A.R.
    In this study it was aimed to compare the increase in oxygen consumption in response to the increase in oxygen delivery after short term infusion of dobutamine in two groups of patients including 10 septic (Group I) and 9 non- septic (Group II) patients in our Reanimation Clinic. Both groups patients are elected from patients who had neuromuscular blockade, sedation and mechanical ventilatory support for acute respiratory failure, the septic group consisted of the patients having the two or more of the sepsis criteria. After maintaining standard monitoring the heart rate, MAP, MPAP, PCWP, CVP, Q measurements and arterial and mixed venous blood gas analysis together with CaO2, CvO2, a-vDO2, DO2, VO2, ERO2 calculations were performed. The measurements before the dobutamine infusion were recorded as the control values and the measurements were repeated after 30 minutes infusion of 3 µg/kg/min dobutamine and again after another 30 minutes infusion of 6 µg/kg/min infusion of dobutamine, in the septic group, the DO2 values increased from baseline values 954±192 mL/min/m2 to 1185±195 and to 1360±199 mL/min/m2 (p<0.01), and VO2 values increased from 246±41 mL/min/m2 to 1185±195 and to 1360±199 mL/min/m2 (p<0.01), and VO2 values increased from 246±41 mL/min/m2 to 1185±195 and to 1360±199 mL/min/m2 (p<0.01), and VO2 values increased from 246±41 mL/min/m2 to 270±45 and to 283±48 mL/min/m2 (p<0.05) respectively. In the septic group, DO2 values, increased from 940±222 mL/min/m2 to 1255±216 mL/min/m2 and to 1361±230 mL/min/m2 (p<0.01) and VO2 values increased from 269±50 mL/min/m2 mL/min/m2 and to 294±50 mL/min/m2 to 302±75 mL/min/m2 mL/min/m2 and to 294±47 mL/min/m2 (p<0.05) respectively. The DO2 increase in both groups were similar after the infusion dose was increased to 6 µg/kg/min, whereas the VO2 values in the non-septic group decreased without statistical significance when compared to the septic group (p>0.05). As a result lineer relation 'pathological oxygen delivery-consumption relationship' in the septic group and biphasix relation 'physiological oxygen delivery-consumption relationship' was found in the septic group.