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Öğe Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam(Wiley-Blackwell, 2014) Kilicaslan, Alper; Gok, Funda; Erol, Atilla; Okesli, Selmin; Sarkilar, Gamze; Otelcioglu, SerefBackgroundIt has been shown that early placement of an intravenous line in children administered sevoflurane anesthesia increased the incidence of laryngospasm and movement. However, the optimal time for safe cannulation after the loss of the eyelash reflex during the administration of sevoflurane and nitrous oxide is not known. AimThe aim of the study was to determine the optimum time for intravenous cannulation after the induction of anesthesia with sevoflurane and nitrous oxide in children premedicated with oral midazolam. MethodWe performed a prospective, observer-blinded, up-down sequential, allocation study, and children, aged 2-6years, ASA physical status I, scheduled for an elective procedure undergoing inhalational induction were included in the study. Anesthesia was induced with sevoflurane and nitrous oxide after premedication with oral midazolam. For the first child, 4min after the loss of the eyelash reflex, the intravenous cannulation was attempted by an experienced anesthesiologist. The time for intravenous cannulation was considered adequate if movement, coughing, or laryngospasm did not occur. The time for cannulation was increased by 15s if the time was inadequate in the previous patient, and conversely, the time for cannulation was decreased by 15s if the time was adequate in the previous patient. The probit test was used in the analysis of up-down sequences. ResultsA total of 32 children were enrolled sequentially during the study period. The adequate time for effective intravenous cannulation after induction with sevoflurane and nitrous oxide in 50% and 95% of patients were 1.29min (95% confidence interval, 0.96-1.54min) and 1.86min (95% confidence interval 1.58-4.35min), respectively. ConclusionWe recommend waiting 2min for attempting intravenous placement following the loss of the eyelash reflex in children sedated with midazolam and receiving an inhalation induction with sevoflurane and nitrous oxide.Öğe The effects of ketamine and lidocaine on free radical production after tourniquet-induced ischemia-reperfusion injury in adults(Turkish Assoc Trauma Emergency Surgery, 2019) Peker, Kevser; Okesli, Selmin; Kiyici, Aysel; Deyisli, CemileBACKGROUND: The primary aim of this study was to compare the effects of a small-dose infusion of 2 antioxidant agents, ketamine and lidocaine, on ischemia-reperfusion injury (IRI) in patients undergoing elective lower limb surgery. Ischemia-modified albumin (IMA), lactate, and blood gas levels were all measured and assessed. METHODS: A total of 100 patients who underwent lower extremity surgery were randomized into 3 groups. After spinal anesthesia, the ketamine group (Group K, n= 33) was given a ketamine infusion, a lidocaine infusion was administered to the lidocaine group (Group L, n= 33), and in the control group (Group C), 0.9% a sodium chloride infusion was performed. Blood samples were obtained for IMA analysis before anesthetic administration (baseline), at 30 minutes of tourniquet inflation (ischemia), and 15 minutes after tourniquet deflation (reperfusion). Arterial blood gas measurements were determined before anesthetic administration and 15 minutes after tourniquet deflation. RESULTS: The lactate and IMA levels at reperfusion were significantly lower in both the ketamine group and the lidocaine group when compared with the control group. CONCLUSION: The administration of both ketamine and lidocaine infusions significantly decreased skeletal muscle IRI-related high lactate and IMA levels. These results suggest the possibility of the clinical application of ketamine or lidocaine infusions in cases of skeletal muscle-related IRI.Öğe Is intra-articular magnesium effective for postoperative analgesia in arthroscopic shoulder surgery?(Pulsus Group Inc, 2015) Saritas, Tuba Berra; Borazan, Hale; Okesli, Selmin; Yel, Mustafa; Otelcioglu, SerefBACKGROUND: Various medications are used intra-articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, a N-methyl-D-aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements. METHODS: A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra-articular injections of either 10 mL magnesium sulphate (100 mg/mL; group M, n=34) or 10 mL of normal saline (group C, n= 33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra-articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient-controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock-out time; for visual analogue scale scores > 5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times). RESULDS: Intra-articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra-articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range. CONCLUSION: Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra-articularly after arthroscopic shoulder surgery, and has no serious side effects.Öğe Oral Magnesium Lozenge Reduces Postoperative Sore Throat A Randomized, Prospective, Placebo-controlled Study(Lippincott Williams & Wilkins, 2012) Borazan, Hale; Kececioglu, Ahmet; Okesli, Selmin; Otelcioglu, SerefBackground: Postoperative sore throat (POST) is an undesirable complaint after orotracheal intubation. Magnesium is a noncompetitive N-methyl-D-aspartate receptor antagonist thought to be involved in the modulation of pain. The present study aimed to investigate the effect of preoperative administration of oral magnesium lozenge on POST. Methods: Seventy patients undergoing orthopedic surgery were randomly allocated into two groups, to either receive placebo (control) or magnesium lozenges (magnesium) to be dissolved by sucking 30 min preoperatively. Patients were assessed for incidence and severity (four-point scale, 0-3) of POST at 0, 2, 4, and 24 h postoperatively. The primary outcome was sore throat at 4 h after surgery. The secondary outcome was the severity of POST at four evaluation time-points postoperatively. Results: The incidence of POST at 4 h was higher in control group than in magnesium group (95% CI: 26%, 14-42%; P = 0.032). The highest incidence of POST occurred at the second hour after surgery, with the rate of 23% in the magnesium group and 57% in the control group (95% CI: 34%, 20-51%; P = 0.007). The severity of POST was significantly lower in the magnesium group at 0 (P = 0.007) and 2 h (P = 0.002). The incidences of POST at 0 and 24 h and severity scores at 4 and 24 h were not significantly different between the groups. Conclusions: The administration of magnesium lozenge 30 min preoperatively is effective to reduce both incidence and severity of POST in the immediate postoperative period.