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Bu çalışmada, köpeklerde göz kırpma refleksinin anestezi derinliği ile ilişkisive göz kırpma refleksinin anestezi derinliğini belirlemedeki etkisine ek olarak bundanelde edilebilecek parametrelerin değerlendirilmesi amaçlandı. Çalışma materyaliniMAKÜ Veteriner Fakültesi Cerrahi Kliniğine çeşitli operatif amaçlar için getirilen 11'idişi, 5'i erkek, beden ağırlıkları 13-30 kg (ort, 21,31±1,41kg) arasında değişen 20 adetköpek oluşturdu. Tüm köpeklere anestezi indiksiyonu amacıyla 4 mg/kg dozundapropofol uygulandı. Bunu takiben anestezi idamesi sevofluran ile sağlandı. Köpekleriçin derin anesteziyi sağlayan end tidal MAK değeri olan 2,9 MAK değerinde anestezisabit tutuldu. Operasyon bitimini takiben 2,9 end tidal MAK değerinden başlanarakazalan her 0,1'lik MAK değeri için supraorbital sinire elektriksel uyarı verilerek heriki orbikularis okuliden göz kırpma parametreleri kaydedildi. Elde edilen verilerdenR2c parametresinin latans ve süresi ile diferansiyel latans hariç diğer tüm latans,amplitüd ve süre değerleri ile MAK arasında anlamlı bir ilişki bulundu. Göz kırpmaparametrelerinin MAK'a bağlı elde edilme başarı oranları ortaya konuldu. Bazıliteratürlerde R2c değeri yüzlekleşen anestezi için bir kriter olarak kabul edilmiştir.Operasyon boyunca anestezi sırasında yüzlek anesteziyi göstermede kriter olarakkabul edilen R2c değeri yüzeysel anesteziyi gösterecek şekilde eldeedilemedi. AncakR2c değeri bir kere elde edildikten sonra daha düşük MAK değerlerinde tekrar gözkırpma refleksi için verilen uyarı hastalar tarafından tolere edilemedi. Bu yüzden tekraruyarı verilmedi. R2c değeri için ortalama end tidal MAK değeri 0,88 olarak elde edildi.R2c değerinin anestezi sırasında yüzlek anesteziyi göstermede bir kriter olamayacağıdüşünüldü. The, aim of this study was to evaluate the relationship between the blink reflexand the depth of anesthesia in dogs and the effect of the blink reflex on determiningthe depth of anesthesia and to evaluate the parameters that can be obtained from it.Thestudy material consisted of sixteen dogs (11 female, 5 male), body weight between 13-30 kg (mean, 21,31 ± 1,41 kg) were brought to the Surgical Clinic of Burdur MehmetAkif Ersoy University (MAKÜ), the Faculty of Veterinary Medicine for variousoperations. Propofol was used all dogs 4 mg/kg for anesthesia induction. Subsequently,anesthesia was maintained with sevoflurane. Anesthesia was kept constant at 2,9MAC, which is the end tidal MAC value that provides deep anesthesia for dogs.Following the end of the operation, starting from 2,9 end tidal MAC, electricalstimulation was given to the supraorbital nerve for each declining 0,1 MAC valueandblink parameters were recorded from both orbicularis oculi. A significant relationshipwas found between the all latency, amplitude, time values and MAC excluding latencyand duration of R2c parameter with differential latency. The success rates of the blinkparameters related to MAC were determined. In some literature, R2c value has beenaccepted as a criterion for surface anesthesia. During the operation, R2c value, whichwas accepted as the criterion for showing superficial anesthesia during anesthesia,could not be obtained to indicate superficial anesthesia. However, once the R2c valuewas obtained, the stimulus given for the blink reflex at lower MAC values could notbe tolerated by the patients. Therefore stimulus weren't given again. The mean endTidal MAC value for the R2c value vas 0,88. It was thought that R2c value could not be a criterion to Show superficial anesthesia during anesthesia. 105

SÜLÜNLERDE İZOFLURAN VE SEVOFLURAN ANESTEZİSİNİNETKİLERİNİN ARAŞTIRILMASIAmaç: Bu çalışmada sülünlerde (Phasianus colchicus) izofluran (İSO) ve sevofluran(SEVO) anesteziklerinin fizyolojik ve biyokimyasal parametreler üzerine etkilerininaraştırılması amaçlanmıştır.Materyal ve Metot: Çalışma materyalini 32 adet ergin sülün (16 dişi ve 16 erkek)oluşturmuştur. Sülünler rastgele İSO (n=8 dişi + 8 erkek) ve SEVO (n=8 dişi + 8 erkek)olmak üzere 2 anestezi grubuna ayrılmıştır. %100 oksijen ve anestezik maddenin maskeyolu ile verilmesiyle indüksiyonu sağlanmış ve entübe edilerek anestezi cihazınabağlanmışlardır. Biyokimyasal değerleri tespit etmek için preanestezi ve postanestezidöneminde kan örnekleri alınmıştır. Fizyolojik değerler ve anestezi derinlik kriterleriölçümleri ise preanestezi, 0.dk, 15.dk, 30.dk, 45.dk, 60. dk. ve uyanma zamanlarındaalınmıştır.Bulgular: İSO ve SEVO grubunda sırasıyla minimum anestezik konsantrasyonu(MAC) değeri ortalama % 0,88 ve % 0,35 olarak tespit edilmiştir. İzofluran vesevofluran anestezilerinin etkileri değerlendirildiğinde pedal refleks, çene refleksi vepalpebral refleksin derin anestezi kriterleri olarak kullanılabileceği kanısına varılmıştır.Hct değerlendirmelerinde her iki grupta ve cinsiyette istatistiksel bir farkbulunamamıştır. İzofluran grubunda erkek sülünlerde kreatin (KREA) ve laktatdehidrojenaz (LDH) değerlerinde, dişilerde alkalin fosfataz (ALP) değerlerinde azalmaolduğu belirlenmiştir. Sevofluran grubunda erkek sülünlerde kreatin (KREA) değerindeartış, kolesterol (KOL) değerinde azalma, dişilerde total protein (TP) değerinde azalmaolduğu belirlenmiştir.Sonuç: Sonuç olarak sülünlerde inhalasyon anestezisinde izofluran ve sevofluranın herikisinin de güvenle kullanılabileceği kanısına varılmıştır.Anahtar Kelimeler: Fizyolojik parametreler; İzofluran; Kan parametreleri; Sevofluran;Sülün (Phasianus colchicus)Burcu SARAÇOĞLU, Yüksek Lisans TeziOndokuz Mayıs Üniversitesi – Samsun, Mayıs - 2018 ABSTRACTINVESTIGATION OF EFFECTS OF ISOFLURANE AND SEVOFLURANEANESTHESIA IN PHEASANTSObjective: In this study, it was aimed to investigate the effects of isoflurane (ISO) andsevoflurane (SEVO) anesthetics on the physiological and biochemical parameters of thepheasants (Phasianus colchicus).Material and Method: The study material consisted of 32 adult (16 female and 16male) pheasants. Pheasants were divided into 2 anesthesia groups as ISO (n = 8 female+ 8 male) and SEVO (n = 8 female + 8 male).100% oxygen and anesthetic materialwere given by mask for induction and after intubation, they were connected to theanesthesia device. Blood samples were taken during preanesthesia and postanesthesia todetermine biochemical values. The measure of physiological values and depth ofanesthesia criteria were recorded at preanesthesia, 0 th min., 15 th min., 30 th min., 45 th min.,60 th min. and at the time of recovery.Results: In the ISO and SEVO groups, the mean value of the minimum anestheticconcentration (MAC) was determined as 0.88% and 0.35%, respectively. When theeffects of isoflurane and sevoflurane anesthesia were evaluated, it was concluded thatpedal reflex, jaw reflex and palpebral reflex could be used as deep anesthesia criteria.There was no statistical difference in Hct evaluations in both groups and gender. In theisoflurane group, creatinine (CRE) and lactate dehydrogenase (LDH) values in malesand alkaline phosphatase (ALP) values in females were found to decrease. Increase increatinine (CRE) and decrease in cholesterol (CHO) in male pheasants, and a decreasein the total protein (TP) value in females were determined in the group of sevoflurane.Conclusion: As a result of these studies, it was concluded that both isoflurane andsevoflurane could be safely used in pheasants in an inhalation anesthesia.Key words:Physiological parameters; Isoflurane; Blood parameters; Sevoflurane;Pheasant (Phasianus colchicus)Burcu SARAÇOĞLU, Master ThesisOndokuz Mayis University – Samsun, May - 2018 105

Bu çalışmada, sevofluran genel anestezisine alınan köpeklerde propofol ve tiyopental indüksiyonunun hematolojik, biyokimyasal ve kardiyovasküler değişikliklerin araştırılması ve klinik kullanılabilirliğinin belirlenmesi amaçlandı. Çalışma materyalini MAKÜ Veteriner Fakültesi Cerrahi Kliniğine çeşitli operasyonlar için getirilen 14'ü erkek, 6'sı dişi, beden ağırlıkları 6-33 kg (ort, 22,35±9,43 kg) arasında değişen 20 adet köpek oluşturdu ve köpekler rastgele iki gruba (propofol grubu n=10, tiyopental grubu n=10) ayrıldı. Her iki gruptaki köpeklere preanestezik olarak 1 mg/kg morfin uygulamasını takiben 0,3 mg /kg dozunda midazolam uygulandı. Preanestezi sonrası ilk gruba 4 mg/kg dozunda propofol; ikinci gruba ise 11 mg/kg dozunda tiyopental sodyum uygulanarak indüksiyon sağlandı. Çalışmada tüm köpeklerin anestezi öncesinde ve ventilasyon başlangıcından itibaren altmış dakika boyunca kardiyovasküler, hematolojik ve biyokimyasal parametreler kaydedildi. Çalışmaya dahil edilen olguların anestezi öncesi ve intraoperatif dönemde beşer dakika aralıklarla kaydedilen ortalama nabız değerlerinde; propofol grubunda 30'uncu dakikadan, tiyopental grubunda ise ventilasyon başlangıcından itibaren istatistiki olarak anlamlı bir düşüş belirlendi ve bu her iki gurup arasında 50. dakikadan itibaren istatistiki açıdan anlamlı bulundu. Çalışmadaki olguların ortalama RBC, HGB ve HCT değerlerinin hem propofol hem de tiyopental grubunda, ventilasyon başlangıcından itibaren azalmaya başladığı ve bunun 15'inci dakikadan itibaren istatistiki açıdan anlamlı düzeyde olduğu belirlenirken tüm bu değerlerin her iki grupta da 45'inci dakikada istatistiki açıdan anlamlı olmayan düzeyde arttığı görüldü. Üre değerinin her iki grupta da intraoperatif dönem boyunca istatistiki açıdan anlamlı olmayan düzeyde arttığı saptandı. Tiyopental grubundaki olgularda üre değerinin ventilasyon başlangıcından itibaren referans aralığın (8-28 mg/dl) üzerinde olduğu görüldü. ALT değerlerinin propofol grubundaki olgularda ventilasyon başlangıcında yükseldiği ardından anestezi sonuna kadar azaldığı, tiyopental grubundaki olgularda ise intraoperatif dönem boyunca azaldığı, bu azalmanın her iki grupta da istatistiki açıdan anlamlı düzeyde olmadığı tespit edildi. Yapılan çalışmadan elde edilen veriler ışığında; bilinen kardiyovasküler ve böbrek hastalığı olan köpeklerin indüksiyonunda tiyopental sodyumun, şiddetli karaciğer hastalığı olanlarda propofolün, anemisi olan hastalarda ise her iki ilacın kontrollü kullanılması gerektiği sonucuna varıldı. This study was aimed at determining the clinical usability of propofol and thiopental for anaesthesia induction and investigating any haematological, biochemical and cardiovascular alterations caused by these induction agents in dogs under sevoflurane anaesthesia. Twenty dogs weighing 6-33 kg (on average 22.35±9.43 kg), 14 of which were male and 6 were female, and all which were referred to the Surgery Clinic of Burdur Mehmet Akif Ersoy University (MAKÜ), Faculty of Veterinary Medicine, constituted the study material. The dogs were randomly assigned to two groups, one which received propofol induction (n=10), and the other thiopental induction (n=10). Both groups were administered firstly with 1 mg/kg bw of morphine and next with 0.3 mg/kg bw of midazolam as preanesthetics. Subsequently, the first group received 4 mg/kg bw of propofol and the second group received 11 mg/kg bw of thiopental sodium for the induction of anaesthesia. In this study, the cardiovascular, haematological and biochemical parameters of each dog were recorded during preanaesthesia and for a 60-minute period as from the start of ventilation. According to the mean pulse rates of each animal recorded at 5-min intervals during preanaesthesia and the intraoperative period, a statistically significant decrease was detected in the propofol group as of 30 min and in the thiopental group as of the start of ventilation. The mean pulse rates recorded for the two groups showed significant differences as of 50 min. The mean RBC, HGB and HCT values of both the propofol group and the thiopental group showed a progressive decrease as from the start of ventilation. This decrease gained statistical significance as of 15 min and converted to a statistically insignificant increase as of 45 min in both groups. The urea levels of the two groups displayed an insignificant increase throughout the intraoperative period. It was observed that in the thiopental group, the urea levels exceeded the limit of the reference range (8-28 mg/dl) as of the start of ventilation. While the ALT values first increased at the beginning of ventilation and later decreased until the end of anaesthesia in the propofol group, they showed a progressive decrease throughout the intraoperative period in the thiopental group. The decrease observed in both groups was statistically insignificant. In view of the data obtained in this study, it is suggested that precaution should be taken in the use of thiopental sodium for anaesthesia induction in dogs with cardiovascular and renal disease, and in the use of propofol for induction in dogs with severe hepatic disease, with precaution requirements applying to the use of both induction agents in anaemic patients. 55

Objective: This study was designed to compare the effects of remifentanil on anesthesia depth, sevoflurane consumption, hemodynamic parameters on children administered sevoflurane for general anesthesia. Method: 60 children aged 3-10 years were included and allocated to 2 groups. The anesthesia was induced with sevoflurane in nitrousoxide/oxygen in all children. Anesthesia was maintained with sevoflurane (Minimum alveolar concentration (MAC): % 0,5-2) in group I. In group II, 0,5 microgram/kilogram remifentanil was given for one minute, anesthesia was maintained with sevoflurane (MAC: % 0,5-2), 0,25 µg kg-1 h-1 remifentanil infusion. Sevoflurane concentration was titrated to be +/-20% of normal value of systolic, diastolic blood pressure and heart rate. Remifentanil infusion rate was kept constant in group II. Intraoperative bispectral index (BIS) values, heart rate, systolic, diastolic blood pressure, oxygen saturation, end tidal sevoflurane concentration, somatic reflexes (tears, sweating, cough, strain) were recorded every 15 minutes. Results: In all measurement, heart rates were lower in group II than group I (p

Genel anestezi, intravenöz olarak uygulanan sedatif hipnotikler sonrasında idame için taşıyıcı medikal gaz içinde inhalasyon anesteziklerinin uygulanmasıyla sağlanır. Taşıyıcı gazın miktarı anestezi hızını, derinliğini, inhale edilen gaz ve buharların tüketimini belirler. Düşük akımlı anestezi, yeniden soluma sistemi kullanılarak karbondioksit (CO2) absorbsiyonundan sonra ekshale edilen gaz karışımının en az %50'sinin akciğerlere geri dönmesiyle sonuçlanan bir tekniktir. Minimal akımlı anestezi ise bir çeşit düşük akım tekniği olup taze gaz akımının 0,5 mL/dk'ya düşürüldüğü anestezi yöntemidir. Minimal akımlı anestezinin klinik, ekolojik ve ekonomik açıdan üstünlükleri bulunmaktadır. Güncel genel anestezi pratiğinde yaygın olarak kullanılan sevofluran ve desfluranın düşük kan/gaz çözünürlüğüne sahip olmaları ve modern anestezi cihazlarının teknik üstünlükleri, bu ajanların düşük ve minimal akımlı anestezi için ideal ve güvenli inhalasyon anestezikleri olarak seçilmelerini sağlamıştır. Çalışmamızda minimal akımlı sevofluran ve desfluran anestezilerinin hemodinamik parametreler, vücut sıcaklığı, anestezik tüketimi ve maliyet açısından karşılaştırılması amaçlandı.Çalışmamıza etik kurul onayı alındıktan sonra genel anestezi altında 60 dakikadan uzun sürmesi beklenen elektif cerrahi geçirecek 18 yaş ve üzeri, ASA I-II fiziksel statüye sahip 120 hasta dahil edildi. Minimal akım kullanma imkanı veren Dräger Perseus® A500 anestezi iş istasyonu kullanıldı. Hastalar randomize olarak sevofluran (Grup S) ve desfluran (Grup D) gruplarına ayrıldı. Operasyon odasına alınan hastaların yaş, cinsiyet, vücut ağırlığı, boy, vücut yüzey alanı gibi demografik bilgileri kaydedildi. İndüksiyon öncesi elektrokardiyogram (EKG), non-invaziv kan basıncı, pulse oksimetre, indüksiyon sonrası nazofarengeal vücut sıcaklığı, endtidal karbondioksit basıncı (EtCO2) ve train-of-four (TOF) monitorizasyonu yapıldı. Ameliyathane oda sıcaklığı sabit tutuldu. Bazal vital ölçümler kaydedildi. Tüm olgulara 6 L/dk'dan %100 oksijen (O2) ile üç dakika süreyle pre-oksijenizasyon yapıldı. Kırk mg prilokain, 2,5 mg/kg propofol, 1 µg/kg fentanil ve 0,6 mg/kg roküronyum bromür sonrası endotrakeal entübasyon yapıldı. Entübasyon sonrası fraksiyone inspiratuar oksijen konsantrasyonu (FiO2) %40'a, taze gaz akımı 4 L/dk'ya indirildi ve hastanın grubuna göre minimum alveoler konsantrasyon (MAK) 1,5 olacak şekilde sevofluran veya desfluran başlandı. Taşıyıcı gaz olarak medikal hava kullanıldı. Olgular volüm kontrollü modda, tidal hacim 6-8 mL/kg, solunum frekansı 12/dakika, ekspirasyon sonu pozitif basınç (PEEP) 5 cmH2O olacak şekilde ventile edildi. EtCO2 değeri 30-40 mmHg olarak hedeflendi. Tüm olgularda FiO2, fraksiyone inspiratuar karbondioksit konsantrasyonu (FiCO2), fraksiyone inspiratuar ajan konsantrasyonu (Fiajan), fraksiyone ekspiratuar ajan konsantrasyonu (Feajan) izlendi. İki grupta da MAK değeri 0,9'a ulaştığında taze gaz akımı 0,5 L/dk olarak düşürüldü ve FiO2 %68'e çıkarıldı. Bu MAK değeri vakanın sonuna kadar korundu. Kalp hızı, sistolik arteriyel basınç (SAB), diyastolik arteriyel basınç (DAB), ortalama arter basıncı (OAB) ve periferik oksijen saturasyonu (SpO2) indüksiyon sonrası 1., 5., 10., 15., 30. ve sonrasında 30 dakikada bir; nazofarengeal vücut sıcaklığı, Fiajan, Feajan, FiO2, FiCO2, MAK değerleri, ekspiryum dakika volümü (MVe) ve EtCO2 indüksiyon sonrası 5., 10., 15., 30. ve sonrasında 30 dakikada bir kayıt edildi. Cerrahi işlem sonlanınca vaporizatör kapatıldı ve taze gaz akımı artırıldı (4 L/dk, FiO2 %100). Manuel solutma ile hastanın spontan solunuma geçmesi sağlandı, kas gevşetici antagonize edildi. Vaporizatör kapatıldıktan sonraki 3., 6. dakikalarda ve sonrasında dakikada bir hastalara göz açma komutu verildi. TOF oranı %100 olduğunda ekstübasyon gerçekleştirildi. Ekstübasyona kadar geçen süre ve göz açma süresi kayıt edildi. Biro'nun formülünün ve Dräger Perseus® A500 anestezi iş istasyonunun tüketim hesapları karşılaştırıldı.Grup S ve Grup D'de hastaların demografik verileri ve hemodinamik parametreleri benzerdi. MAK'ın 0,9'a ulaşma, ekstübasyon ve göz açma sürelerinde; anestezik, O2 ve hava tüketimlerinde, Biro'nun formülünün ve Dräger Perseus® A500 anestezi iş istasyonunun tüketim hesaplarında her iki grupta anlamlı farklılık saptandı. Diğer verilerde iki grup arasında istatistiksel fark bulunmadı. Çalışmamızda vaka başına sevofluran tüketimi 23,6 ± 10,9 mL, desfluran tüketimi 31,6 ± 12,0 mL olarak bulundu. Biro'nun formülüne göre sevofluran tüketimi 11,5 ± 3,8 mL, desfluran tüketimi 21,6 ± 8,1 mL olarak hesaplandı. Sevofluran grubunda oksijen tüketimi 115,2 ± 34,0 L, hava tüketimi 49,8 ± 19,5 L, MAK'ın 0,9'a ulaşma süresi 7,3 ± 3,2 dk, ekstübasyon süresi 7,1 ± 2,5 dk, göz açma süresi 10,7 ± 2,7 dk iken desfluran grubunda oksijen tüketimi 95,7 ± 19,6 L, hava tüketimi 32,5 ± 11,8 L, MAK'ın 0,9'a ulaşma süresi 4,2 ± 1,5 dk, ekstübasyon süresi 6,1 ± 1,8 dk, göz açma süresi 7,9 ± 2,2 dk olarak bulundu.Çalışmamızda minimal akımlı desfluran uygulaması ile sevoflurana göre daha hızlı hedef MAK değerine ulaşıldığı, ekstübasyon ve göz açma sürelerinin daha kısa olduğu, anestezik, O2 ve hava tüketimlerinin daha az olduğu görüldü. Bu bulgularla desfluran ile daha hızlı uyku ve uyanıklığa geçiş olduğunu ve bu hızlı geçişin de anestezik tüketimini azalttığını söyleyebiliriz.Sonuç olarak; minimal akımlı desfluran anestezisinin, minimal akımlı sevofluran anestezisine göre daha olumlu sonuçları olduğunu ve bu sonuçların daha kapsamlı çalışmalarla desteklenmesi gerektiği kanaatindeyiz. General anesthesia is achieved by administration of inhalation anesthetics in the carrier medical gas after intravenous sedative hypnotics. The amount of carrier gas determines the rate of anesthesia, its depth, and the consumption of inhaled gases and vapors. Low flow anesthesia is a technique that results in return of at least 50% of the exhaled gas after carbondioxide (CO2) absorption using the re-breathing system. Minimal flow anesthesia is a kind of low flow anesthesia technique in which fresh gas flow is reduced to 0.5 mL/min. Minimal flow anesthesia has clinical, ecological and economical advantages. The low blood-gas solubility of sevoflurane and desflurane, which are commonly used in current general anesthesia practice, and the technical superiority of modern anesthesia devices ensure that these agents are selected as suitable and safe inhalation anesthetics for low and minimal flow anesthesia. In this study, we aimed to compare the minimal flow sevoflurane and desflurane anesthesia in terms of hemodynamic parameters, body temperature, anesthetic gas consumption and cost.After the ethics committee approval, 120 patients with ASA I-II physical status over 18 years of age who underwent elective surgery for longer than 60 minute after general anesthesia were randomized into two groups: sevoflurane (Group S) or desflurane (Group D). The Dräger Perseus® A500 workstation that allows minimal flow was used. Patient characteristics as age, gender, body weight, height, body surface area were recorded. Before induction electrocardiogram, non-invasive blood pressure, pulse oximetry were monitored. Following induction nasopharyngeal body temperature, endtidal carbondioxide pressure (EtCO2) and train-of-four (TOF) monitoring were performed. In all cases, operating room temperature was kept constant. Initial vital measurements were recorded. Pre-oxygenation was performed for 3 minutes with 6 L/min to 100% oxygen in all cases. Endotracheal intubation was performed after administration of 40 mg prilocain, 2.5 mg/kg propofol, 1 µg/kg fentanyl and 0.6 mg/kg rocuronium bromide. Fractional inspirium oxygen concentration (FiO2), was reduced to 40% and fresh gas flow was 4 L/min after intubation and sevoflurane or desflurane was started as 1.5 minimal alveolar concentration (MAC) according to the patient's group. Medical air was used as carrier gas. The cases were ventilated in volume controlled mode with 6-8 mL/kg tidal volume, 12 breaths/min and 5 cmH2O positive end-expiratory pressure (PEEP). EtCO2 was maintained 30-40 mmHg. In all cases FiO2, fractional inspirium carbondioxide pressure (FiCO2), fractional inspirium agent concentration (Fiagent), fractional expirium agent concentration (Feagent) were recorded. In both groups, when the MAC value reached 0.9, fresh gas flow was reduced to 0.5 L/min and FiO2 was increased to 68%. This MAC value was maintained until the end of the case. Hearth rate, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and peripheral oxygen saturation (SpO2) were recorded on the 1st, 5th, 10th, 15th and 30th and then every 30 minutes; nasopharyngeal body temperature, Fiagent, Feagent, FiO2, FiCO2, MAC values, expirium minute ventilation (MVe) and EtCO2 were recorded on the 5th, 10th, 15th, 30th and then every 30 minutes after the induction. At the end of the surgery, the vaporizer was switched off and the fresh gas flow was increased (4 L/min, FiO2 100%). The patient was allowed to breath spontaneously with manual ventilation and muscle relaxant was antagonized. Eye opening command was given at the 3rd, 6th and then every minute. When the TOF ratio was 100%, extubation was carried out. The time to extubation and the eye opening time were recorded.There were no differences in patient characteristics and initial hemodynamic parameters of Group S and Group D. There were statistically significant differences between the times to reach 0.9 MAC, extubation and eye opening, anesthetic, O2 and air consumption, measurement of inhalation agent consumption with Biro's formula and Dräger Perseus® A500 algorithm in both groups. There was no significant difference between the two groups concerning other data. Sevoflurane consumption per operation was 23.6 ± 10.9 mL, and desflurane consumption was 31.6 ± 12.0 mL. Mean value for sevoflurane consumption was 11.5 ± 3.8 mL, desflurane consumption was 21.6 ± 8.1 mL by calculated Biro's formula. For Group S, oxygen consumption was 115.2 ± 34.0 L, air consumption was 49.8 ± 19.5 L, time to reach 0.9 MAC was 7.3 ± 3.2 min, extubation was 7.1 ± 2,5 min and eye opening was 10.7 ± 2.7 min. For Group D, oxygen consumption was 95.7 ± 19.6 L, air consumption was 32.5 ± 11.8 L, time to reach 0.9 MAC was 4.2 ± 1.5 min, extubation was 6.1 ± 1.8 min and eye opening was 7.9 ± 2.2 min.With minimal gas flow; the times to reach target MAC, time to extubation and eye opening were significantly faster for desflurane as compared to sevoflurane and anesthetic, oxygen and air consumption in desflurane anesthesia were less than sevoflurane. With these findings, we can say that desflurane has a faster anesthetic induction and recovery times with lower anesthetic consumption.We concluded that minimal flow desflurane anesthesia has more favorable results than minimal flow sevoflurane anesthesia; however, these results should be supported by further studies. 66

Bu çalışmada veteriner hekimlikte sıkça kullanılan propofol-izofluran ve propofol-sevofluran anestezisinin ortopedik cerrahi hasta grubunda bazı hematolojik, biyokimyasal ve fizyolojik parametreler üzerine etkilerinin karşılaştırılması amaçlanmıştır.Çalışma materyalini çeşitli amaçlarla anesteziye alınması gereken değişik ırk ve cinsiyetten 30 köpek oluşturdu. Köpekler her grupta 15 hasta olacak şekilde rastgele 2 gruba bölünerek farklı anestezi protokolleri uygulandı. Preanestezik dönem, anestezinin 15, 30, 45 ve 60. dakikaları ile anesteziden 60 dakika sonra kan alınarak tam kan sayımı gerçekleştirildi. Serum ALT, AST, üre, kreatinin değerleri, preanestezi, anestezinin 30. dakikasında ve anesteziden 60 dakika sonra ölçüldü. Anestezi öncesi değerlendirilen kardiyopulmoner parametreler perianestezik, 15, 30, 45, 60. dakikada ve hasta uyandıktan 60 dakika sonra da kaydedildi. Anestezi süresince hastalar monitörize edildi. Her iki gruptaki hastalara propofol ile anestezi indüksiyonu sağlandıktan sonra 1. grubun anestezisine izofluran, 2. grubun anestezisine sevofluran ile devam edildi.Her iki anestezi grubunda vücut sıcaklığı fizyolojik değerlerin altına düşmüş, solunum sayısı da fizyolojik sınırlara düşmüştür. Her iki anestezik ajanın kullanım esnasında hematokrit düzeyi fizyolojik sınırların altına düştüğü saptansa da istatistiksel olarak anlamlı değildi. Her iki anestezik ajanın hematolojik ve biyokimyasal değerleri olumsuz yönde etkilemediği tespit edilmiştir.Anahtar kelimeler: Propofol, İzofluran, Sevofluran, Ortopedik cerrahi, Köpek In this study, we aimed to compare the effects of propofol-isoflurane and propofol-sevoflurane anesthesia on hematological, biochemical and physiological parameters in orthopedic surgery patients group which are frequently used in veterinary medicine.The study material consisted of 30 dogs from different breeds and sexes for which anesthesia should be taken for various purposes. Dogs were randomly divided into 2 groups as 15 patients in each group, and different anesthetic protocols were applied. Blood samples were taken at the 15, 30, 45 and 60th minutes of the anesthesia and 60 minutes after the anesthesia for the preanesthetic period. Serum ALT, AST, urea, creatinine values, preanesthesia, anesthesia was measured at 30 minutes and the anesthesia was measured at 60 minutes. Cardiopulmonary parameters assessed before anesthesia were recorded at the perianesthetic, 15, 30, 45, 60th minute and 60 minutes after the patient was awake. Patients were monitored during anesthesia. After induction of anesthesia with propofol in both groups was achieved, group 1 continued with isoflurane anesthesia and group 2 anesthesia with sevoflurane.In both anesthesia groups, body temperature fell below physiological values, reducing the number of breaths to physiological limits. The detection of hematocrit levels below the physiological limits during the use of both anesthetic agents was not statistically significant either. It has been determined that hematological and biochemical values of both anesthetic agents are not adversely affectedKey words: Propofol, Isofuran, Sevoflurane, Orthopedic surgery, Dog 93

WOS: 000406284600018 Purpose: This study aimed to evaluate the effect of ultrasound-guided rectus sheath block by using two different volume on consumption of peroperative anesthetic and postoperative analgesic agents undergoing major abdominal surgery in children. Material and Methods: American Society of Anesthesiologists (ASA) I-II, 40 patients between 1-16 years and scheduled for major abdominal surgery were included in this study. After induction of general anesthesia, patients were randomly divided into two groups. Ultrasound-guided rectus sheath block was performed with 0.1 ml/kg 0.25% levobupivacaine (total volume of 0.1 ml/kg to be diluted with saline) in Group I (n=20) and 0.1 ml/kg 0.25% levobupivakain (total volume of 0.4 ml/kg to be diluted with saline) in Group II (n=20). Hemodynamic data and sevoflurane consumption during the surgery, pain scores, the sedation levels and additional analgesia requirement after the surgery were recorded. Results: Inspired sevoflurane concentration and consumed sevoflurane amount were similar in both groups. The total sevoflurane consumption was 106.85 +/- 28.6 ml in Group I and 91.50 +/- 36.6 ml in Group II. There were no statistically significant differences between postoperative pain levels, sedation scores and additional analgesic consumption of the groups. Conclusion: Ultrasound-guided rectus sheath block provide an effective and safe analgesia in children undergoing major abdominal surgery but increased local anesthetic volume does not reduce intraoperative sevoflurane consumption and additional analgesic requirements.

Giriş: Tiroid operasyonlarında genellikle oturur pozisyon tercih edilmekte ve baş ekstansiyona getirilmektedir. Bu tür pozisyon değişiklikleri serebral dolaşımı olumsuz etkileyebilir. Çalışmamızda serebral fonksiyonun NIRS monitörizasyonu ile daha iyi korunabileceğini göz önünde bulundurarak; yarı oturur pozisyonda tiroid cerrahisi yapılan hastalarda serebral oksijenizasyonu monitörizasyonu ile iki farklı anestezik gazın (desfluran ve sevofluran) serebral oksijen saturasyonuna etkileri arasındaki olası farklılıkları saptamayı amaçladık. Metod: Bu çalışma Yüzüncü Yıl Üniversitesi Etik Komitesi onayı alındıktan sonra prospektif olarak gerçekleştirildi. ASA fiziksel durumu I-II-III olan, 18-65 yaş arasındaki, elektif tiroid cerrahisi planlanan 60 hasta randomize olarak 2 eşit gruba ayrıldı. Tüm hastalarda standart monitörizasyonu takiben serebral oksijen satürasyonu monitörizasyonu uygulandı. Anestezi indüksiyonu 2 µg/kg fentanil, 2,5 mg/kg propofol ve 0,5 mg/kg rokuronyum ile yapıldı. Ayrıca ek analjezik ihtiyacı için 50 μg fentanil ve ek kas gevşetici ihtiyacı olduğunda 0.2 mg/kg roküronyum yapıldı. Tüm hastalar % 40 O2 ve % 60 hava ile ventile edildi. Hastalar, anestezi idamesinde kullanılan volatil anestezik maddenin türüne göre Grup S (sevofluran) ve diğeri Grup D (desfluran) olarak iki gruba ayrıldı. Grup D'de % 7 anestezik ajan konsantrasyonunda desfluran ve Grup S'de % 2 anestezik ajan konsantrasyonunda sevofluran kullanıldı. Hastalar entübe edildikten sonra 45 derece yarı oturur pozisyon verildi. Vital değerler ve bilateral frontal serebral hemisferler için oksijen saturasyon seviyeleri; anestezi indüksiyonu öncesi-sonrası, entübasyon sonrası, yarı oturur pozisyon verilmesinin ardından, ani değişiklikler olduğunda ve her 5 dakikada bir kaydedildi. Bulgular: Çalışmaya dahil edilen 60 hastanın yaş, boy, vücut ağırlığı, ASA risk sınıflaması, cerrahi süresi gibi demografik özellikleri değerlendirildiğinde iki grup arasında istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Grup D ve Grup S'de periferik O2 saturasyonu, nabız, sistolik kan basıncı, diastolik kan basıncı, ortalama kan basıncı ve end-tidal CO2 değerleri istatistiksel yönden benzerdi. Her iki grubun serebral oksijenizasyonu etkileyebilecek laboratuar ve hemodinamik verileri istatistiksel yönden benzerdi (p>0.05). Çalışmamızda Grup D'de %18; Grup S'de ise %26 olguda rSO2 de bazale göre %10 luk düşüşler saptadık. %20'lik düşüş oranı; Grup S'deki olgular için %13, Grup D'deki olgular için ise %10 olarak bulundu. Olguların hiçbirinde bazal değer olarak kaydedilen rSO2 değeri %55'in altında değildi. Hiçbir olguda nörolojik bir bozuklukla karşılaşılmadı. Sağ ve sol serebral hemisfer rejyonal oksijen saturasyonu (rcSO2R) açısından gruplar karşılaştırıldığında iki grup arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). Sonuç: Yarı oturur pozisyonda tiroid cerrahisi yapılan hastalarda desfluran veya sevofluranın serebral oksijen satürasyonu üzerine olan etkilerinin benzer olduğunu saptadık. Anahtar kelimeler: Tiroidektomi, genel anestezi, desfluran, sevofluran, serebral oksijen saturasyonu Introduction: In a well-applied anaesthesia, expectations are stable vital findings of the patient, fast anesthesia recovery after the procedure and rapid return to normal activities after the recovery. In thyroid operations, usually half-sitting position is preferred with extension of the head. It is thought that such position changes may negatively affect cerebral circulation. In this study, considering that cerebral function can be better protected by NIRS monitoring; we monitorized cerebral oxygenation in patients who underwent thyroidectomy in half sitting position. We aimed to determine possible differences of the effects of two different gases (desflurane and sevoflurane) to cerebral oxygenation. Method: This study was approved by Yüzüncü Yıl University Ethics Committee. 60 patients undergoing elective thyroid surgery, aged between 18-65 years, with ASA physical status I-II-III, were randomly divided into 2 equal groups. For all patients, after standart monitorization of vital parameters and serebral oxygen saturation monitorization; anesthesia was induced with fentanil, propofol and rocuronium. An additional dose of 50 μg fentanyl + 0. 2 mg / kg rocuronium was administered every 45 minutes. According to the type of volatile anesthetic agent used, one of two randomly generated groups was named Group S (sevoflurane) and the other was named Group D (desflurane). All patients were ventilated with 40% O2 and 60% medical air. For maintenance of anesthesia; in Group D, desflurane was used in 8% anesthetic agent concentration and in Group S, sevoflurane was used in 2% concentration. After the patients were intubated, all of them were given a 45 degree semi-sitting position. Vital parameters and oxygen saturation levels for bilateral frontal cerebral hemispheres were recorded; before-after the induction of anesthesia, after the intubation, after giving semi-sitting position, when sudden changes occurred and with 5 minutes intervals throughout the study period. Values measured before induction were accepted as baseline values.Findings: There were no statistically significant differences between the two groups (p> 0.05) when the demographic characteristics of 60 patients included in the study were evaluated such as age, height, body weight, ASA risk classification, and surgical time. 90% of the cases included in the study were women; 10% were male. Group D and Group S; peripheral O2 saturation, heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, and end-tidal CO2 values were statistically similar to each other. The laboratory and haemodynamic values that could affect cerebral oxygenation in both groups (Group D and Group S) were statistically similar (p> 0.05). In our study, we found a decrease of 10% in baseline value in rSO2 at 18% in Group D. In group S, we found a decrease of 10% compared to the baseline value of 26% in rSO2. 20% decrease rate; 13% in group S and 10% in group D. rso2 value recorded as baseline values was not below 55% in any of the cases. When the groups were compared in terms of right and left cerebral hemisphere regional oxygen saturation (rcSO2R), there was no statistically significant difference between two groups (p> 0,05). Result: In patients undergoing thyroid surgery in the semi-sitting position we found that similar to the effects of desflurane or sevoflurane on cerebral oxygen saturation.Keywords: Thyroidectomy, general anesthesia, cerebral oxygen saturation, desflurane, sevoflurane 65

WOS: 000382992900005 PubMed ID: 27366563 Objective: We compared the effects of the laryngeal mask airway (LMA), face mask and Cobra perilaryngeal airway (PLA) in the airway management of spontaneously breathing paediatric patients undergoing elective inguinal surgery. Methods: In this study, 90 cases of 1-14-year-old children undergoing elective inguinal surgery were scheduled. The patients were randomly divided into three groups. Anaesthesia was provided with sevoflurane and 50%-50% nitrous oxide and oxygen. After providing an adequate depth of anaesthesia, supraglottic airway devices were inserted in the group I and II patients. The duration and number of insertion, haemodynamic parameters, plateau and peak inspiratory pressure and positive end-expiratory pressure of the patients were recorded preoperatively, after induction and at 5, 10, 15 and 30 min peroperatively. Results: There were no statistical differences between the groups in terms of haemodynamic parameters (p>0.05). In group II, instrumentation success was higher and instrumentation time was shorter than group II. The positive end-expiratory pressure and plateau and peak inspiratory pressure values were statistically lower in group II (p

Background/aim: Premature infants experience more respiratory problems after surgical procedures. We aimed to compare general anesthesia with sedation regarding the need for postoperative mechanical ventilation in infants undergoing retinopathy of prematurity (ROP) surgery. Materials and methods: Sixty patients who underwent laser surgery for ROP were included in this study. This study was performed between October 2010 and December 2012. The sedation group (Group S, n = 30) received 1 mg/kg ketamine and 1 mg/kg propofol as a bolus for induction. The patients then received an infusion of 100-150 μg kg-1 min-1 propofol and 0.25 mg kg-1 h-1 ketamine for maintenance. In the general anesthesia group (Group G, n = 30), anesthesia was induced using 8% sevoflurane by inhalation with 50% nitrous oxide in oxygen. Anesthesia was maintained with sevoflurane (2%) and 50% nitrous oxide in oxygen. Results: There was no difference in gestational age, birth weight, current age, or current body weight between the two groups. Preoperative medical histories of the groups were similar. Two patients in Group S and 11 patients in Group G required postoperative mechanical ventilation (P = 0.010). Blood pressures and heart rates were similar. Conclusion: In premature infants, sedoanalgesia administration reduced the need for postoperative mechanical ventilation after surgery for ROP.

Epidermolysis Bullosa (EB) is characterized by the presence of extremely fragile skin and painful blister formations in the skin. We present the anesthetic management of 15-years-old, twin sisters with EB during the syndactyly operation. Premedication was done with 0.5 mg/kg nasal midazolam. Anesthesia induction was performed with sevoflurane without touching the facial masks to the skin. After intravenous 2 mgkg-1 ketamine and 50 μg fentanyl, anesthesia was maintained by intravenous 1 mg/kg/hr ketamine and 0.1 μg/kg/min remifentanil. We injected 2 mg intravenous morfin for postoperative pain control. Ketamine with remifentanil seems to be effective, simple, and safe for airway management and practical way to provide general anesthesia and analgesia of EB., Epidermolizis bülloza (EB) aşırı hassas cildin oluşu ve ciltte ağrılı sıvı kabarcıkları oluşumuyla karakterizedir. Epidermolizis bülloza\'lı 15 yaşında ikiz kız kardeşlerin sindaktili operasyonu sırasındaki anestetik yaklaşımımızı sunuyoruz. Premedikasyon 0.5 mg kg-1 nasal midazolam ile yapıldı. Yüz maskesi cilde temas ettirilmeden anestezi indüksiyonu sevofluran ile yapıldı. İntravenöz 2 mgkg-1 ketamine and 50 μg fentanyl veridikten sonra, intravenöz 1 mgkg-1st-1 ketamine and 0.1 μg/kg/dk remifentanil ile anestezi idamesi yapıldı. Postoperatif ağrı kontrolü için 2 mg intravenöz morfin uygulandı. Remifentanil ile ketamin EB\' nın genel anestezi ve analjezi uygulaması için pratik bir yol ve hava yolu yönetiminde etkili, basit ve güvenli olarak gözükmektedir.

Medical Technologies National Conference (TIPTEKNO) -- OCT 15-18, 2015 -- -- Bodrum, TURKEY, WOS: 000380505200036, The main subject in this study is to monitor the changes of EEG power spectrum during sevoflurane general anesthesia and to determine the variables which show meaningful changes for anesthetic depth. Sevoflurane has been suggested as a suitable agent for anesthetic induction. The data base was constructed of the records from a total of 25 patients. During the operation blood pressure, heart rate and sevoflurane agent ratio were recorded. Additionally, EEG recordings are taken continuously during the operation. The power spectral density values corresponding 1-50 Hz frequency interval of the selected EEG slices which has 10 seconds of time interval is used. Investigated EEG parameters show correlations with anesthetic depth in sevoflurane anesthesia. This study confirms EEG power spectrum as potantially useful measures of anesthetic depth in sevoflurane anesthesia. After the induction of sevoflurane, power spectrum of EEG is changed sharply. Total power and low frequency powers are increased sharply. But the beta and gamma band frequencies are decreased totally.

WOS: 000323610400030 Aim: Recently studies showed that volatile anesthetics affect the ciliary beat frequency in vitro. We know that impairment of ciliary beat frequency is related to a risk of pulmonary complications with general anesthesia. Other studies have also shown that exposure to a volatile anesthetic can increase the permeability of the alveolar-capillary barrier. The present study aimed to determine the effects of desflurane and sevoflurane anesthesia on the technetium-labeled diethylene triamine penta-acetic acid (Tc-99m DTPA) clearance rate of the alveolar epithelium. Materials and methods: A total of 40 patients who underwent elective tympanoplasty with general anesthesia were included in this study. Patients having any systemic disease or infection, or with any property that affected lung functions, were excluded from the study. Patients were randomized into 2 groups (20 patients in each) as receiving sevoflurane and desflurane. A Tc-99m DTPA aerosol inhalation lung imaging method was used to assess lung functions. Results: Demographic properties were similar in both groups. There were no significant differences between basal and postoperative lung clearance of inhaled Tc-99m DTPA in either group. Conclusion: We propose that neither sevoflurane nor desflurane induces pulmonary alveolar capillary injury in the acute period of general anesthesia based on Tc-99m DTPA scan results.

Background/aim: There are limited data in the literature investigating the effects of anesthetic agents on cardiac output used in the chest-knee position. Te aim of this study is to compare the effects of inhalation and total intravenous anesthesia on cardiac output in patients undergoing lumbar discectomy in the chest-knee position. Materials and methods: Forty patients undergoing discectomy in the chest-knee position were allocated to 2 groups. The first group (GrS, n = 20) received sevofurane after thiopental induction, while the second group (GrP, n = 20) received propofol induction and infusion. Heart rate (HR), mean arterial pressure (MAP), peripheral oxygen saturation, cardiac output (CO), and cardiac index (CI) were recorded. Results: Groups were comparable in terms of HR and MAP. The differences related to anesthetic technique and position were statistically significant within each group. Cardiac output and CI were similar between the groups. Cardiac output and CI of GrP were found to be decreased in the chest-knee position and significantly elevated in the supine position after surgery (P < 0.05). There were significant decreases in the mean CO and CI values recorded after the chest-knee position in GrP. Conclusion: Sevofurane is found to be superior when compared to propofol in patients undergoing surgery in the chest-knee position in terms of perioperative hemodynamic stability. Therefore, sevofurane may be the anesthetic of choice, especially in patients operated on in the chest-knee position with suspected hemodynamic instability. © TÜBİTAK.

Amaç: Pasif sigara içiciliği özellikle çocuk hastalarda pulmoner işlevlerde oluşturduğu olumsuz etki ile anestezi ve cerrahi sırasında sorunlara neden olabilir Bu çalışmanın amacı pasif içici olan ve genel anestezi planlanan çocuklarda COHb PaO2 ve PaCO2 değerleri ile cerrahi sonrası solunumsal yan etkileri değerlendirmekti. Gereç ve Yöntem: Bir veya iki ebeveyni sigara içen pasif sigara içicisi olan karın veya ürolojik cerrahi planlanan 100 çocuk ve hiçbir ebeveyni sigara içmeyen 50 çocuk çalışmaya alındı Hastaların ebeveynlerinin sigara alışkanlıkları cerrahi öncesi verilen bir anket formu ile değerlendiridi Çocukların anestezi sırasında COHb PaO2 ve PaCO2 değerleri entübasyon sonrasında kan gazı alınarak değerlendirildi Cerrahi sonrası yan etkiler ise uyanma odasında gözlendi Çalışma için etik kurul onayı alındı.Bulgular: En düşük COHb değerleri hiçbir ebeveyni sigara içmeyen grupta Grup H saptandı 1 134 plusmn;0 491 Karboksihemoglobin değerleri bir ebeveyni sigara içen Grup E1 grupta 1 306 plusmn;0 452 iken iki ebeveyni sigara içen Grup E2 grupta 1 396 plusmn;0 491 olarak saptandı ve Grup H ile diğer iki grup arasında istatiksel olarak anlamlı fark olduğu gözlendi p=0 011 En düşük PCO2 değeri Grup H rsquo;da saptandı 33 234 plusmn;4 33 mmHg ve değer anlamlı olarak diğer iki gruptan daha düşük bulundu p=0 007 Gruplar arası PaO2 değerleri ve yan etkiler açısından gruplar arasında fark bulunmadı En sık saptanan yan etkiler bronşiyal hipersekresyon öksürük desaturasyondu Pasif içici çocuklarda daha yüksek COHb ve PaCO2 değerleri ve astım oranlarına rağmen cerrahi sonrası yan etki görülme sıklığı açısından sigara içen gruplarda içmeyen gruba oranla belirgin bir farklılık gözlenmemiştir.Çıkarımlar: Pasif sigara içicisi olan çocuklar ameliyat öncesi dönemde beraberinde varolan diğer risk etmenleri de gözönüne alınarak cerrahi sonrası yan etkilerden kaçınmak için dikkatli değerlendirilmelidirler., Malign hyperthermia is a rare anesthesia related disorder which may be fatal Here we present a newborn who developed malign hyperthermia after general anesthesia and recovered with dantrolene treatment Anesthesia with sevoflurane was performed in the patient planning examination of the upper airways under general anesthesia One hour after anesthesia the patient developed hyperthermia tachycardia tachipnea and muscle rigidity and a diagnosis of malignant hyperthermia was made with clinical and laboratory findings The findings improved dramatically with dantrolene treatment Turk Arch Ped 2012; 47: 210 2

Amaç:Çalışmamızın amacı, pediyatrik yaş grubunda yapılan adenoidektomi ve tonsillektomi operasyonlarında hastanın entübasyonundan sonra veya anesteziden uyanmadan önce titre edilen dozlarda oral tramadol uygulamasının postoperatif analjeziye etkilerini belirlemektir.Materyal Metod:Elektif olarak adenoidektomi ve tonsillektomi operasyonu uygulanacak ASA I-II sınıfı 3-16 yaş grubu 90 hasta çalışmaya dahil edildi. Hastalar randomize olarak üç eşit gruba (n=30) ayrıldı ve her üç gruptaki hastalara rutin monitörizasyon uygulandı. Anestezi indüksiyonu propofol 2-2.5 mg/kg, roküronyum bromid 0.6 mg/kg ile sağlandı. Endotrakeal entübasyon uygulandıktan sonra anestezi idamesi sevofluran ( % 2-2.5) ve N2O/O2 ( oksijen oranı %50) ile sürdürüldü. Grup 1'de operasyon bitiminden sonra (postoperatif), Grup 2 `de entübasyondan sonra (preemptif) oral yoldan damla şeklinde uygulanmak üzere 1 mg/kg tramadol Grup 3`de ise entübasyondan sonra kontrol grubuna eşit volümde serum fizyolojik oral olarak uygulandı. Tramadol dozu insülin enjektörüne konularak nazofarenkse doğru ilerletilerek adenoid dokusuna uygulandı. Operasyondan sonra hastaların ağrı ve derlenmesi görsel ağrı skalası veya VRS ile değerlendirildi. VRS skoru ilk 4 saatte her saat başı, takip eden süreçte 4 saatte bir bakıldı ve hastanın ağrısı 11 derecede (0= yok veya 10= en şiddetli ağrı) değerlendirildiBulgular:Pediatrik adenoidektomi ve tonsillektomi operasyonu yapılan hastalarda kontrol grubu, preemptif ve postoperatif tramadol uygulanan gruplarla karşılaştırıldığında 15, 30, 45 ve 60. dakika ajitasyon skorlarında anlamlı artış ve 0, 10 ve 20. dakika Modifiye Aldrete Skorlarında anlamlı azalma saptandı. Kontrol grubu başlangıç ajitasyon skoru diğerlerine göre anlamlı olarak düşüktü.Sonuç:Adenoidektomi bölgesine preemptif veya postoperatif oral tramadol damla uygulaması sevofluran ile oluşan ajitasyonu azaltmakta ve postoperatif analjezi sağlamaktadır. Uygulamalar arasında fark bulunmamıştır. Uygulamanın basit ve non-invazif olması nedeni ile avantaj sağladığı düşünülmektedir.Anahtar kelimeler: Genel anestezi, sevoflurane, ajitasyon, tramadol. Background:The postoperative analgesic efficacy of tramadol infiltration to the surgical area has been demonstrated in tonsillectomy. The present study aimed to investigate nasopharyngeal tramadol instillation for the possible influence on sevoflurane-induced agitation in pediatric patients undergoing adenoidectomy, tonsillectomy with or without tube placement.Materials and methods:After obtaining approval from Local Ethics Committe and written informed consents from parents, ninety ASA class I-II pediatric patients included to the study. Induction of anesthesia was achieved with propofol 2-2.5 mg/kg and rocuronium bromide. Sevoflurane 2-2.5% in N2O-O2 mixture (InsO2: 50%) was given for the maintenance. Pateints were randomized into three groups and insulin injector was attached to the vasocan without introducer and advanced to the nasopharynx through the oral cavity. Saline controls was injected to the Group III (n=30), tramadol 1 mg/kg was given10 min before adenoidectomy in Group I (n=30) after bleeding control in Group II (n=30) respectively. Pateints were evaluated for postoperative pain, agitation and for modified Aldrete scores in the recovery.Results:Agitation scores were significantly higher in control group at 15, 30, 45, and 60. min periods when compared to pre-emptive and postoperative tramadol treatment groups. Modified Aldrete scores were significantly lower in the control group during 0, 10, and 20 min.s. The first agitation score was also significantly decreased in the control group.Conclusion:Pre-emptive or postoperative tramadol ointment to the adenoidectomy area decreased sevoflurane-induced agitation. No difference was found between pre orviiipostoperative administration. The technique has advantages with easy and non-invasive administration.Key words: General anesthesia, sevoflurane, agitation, tramadol. 53

Modern anestezide, havayolunun kontrol altına alınmasında alternatif bir yöntem olarak LMA kullanımı sık başvurulan bir yöntem olmuştur.LMA'nın yerleştirilmesi esnasında görülen yan etkilerin azaltılması, yerleştirme işlevinin kolaylaştırılması için indüksiyonda kas gevşetici kullanımı önerilen bir uygulama olmuştur.Bu çalışma Dicle Üniversitesi Tıp Fakültesi Etik kurulunun izni ve hastaların onayı alındıktan sonra solunum, kardiyovasküler sistem ve kas hastalığı olmayan ASA I-II, grubu yaşları 2-14 arasında 90 hastada gerçekleştirildi. Hastalara premedikasyon uygulamadan ameliyathaneye alındı, ıv damar yolu açıldı, non invazıv monitorızasyon yapıldı. Hastalar rastgele üç gruba ayrıldı. İndüksiyonda bütün gruplara Fentanyl 1,5mcg/Kg, Sevoraine 5MAC verildi. Grup-I'e süksinilkolin 0.5mg/Kg, grup-II'ye 0.25mg/Kg, grup-III'e kas gevşetici yerine 10cc izotonik uygulandı. Sevoflurane ile indüksiyona başlandıktan kirpik refleksi kayboldugu ana kadar beklenip kas gevşetici yapıldı. 90 sn sonra LMA yerleştirildi ve yerleştirilirken oluşan istenmeyen etkiler, çıkarıldığında oluşan etkiler ve 24 saat sonra oluşan istenmeyen etkiler, hemodinamık parametreler(sistolik diastolik tansiyon, nabız) , O2 saturasyonu kaydedildi.Bu sonuçlar ışığında düşük doz süksinilkolin kullanımının bir avantajı görülmemiş, düşük doz süksinilkolin kullanımının diğer indüksiyon yöntemlerinden belirgin üstünlüğü bulunmamıştır. Bununla birlikte süksinil kolin kullanıldığında hastalarda daha rahat bir ağız açıklığı sağlandığı için LMA daha yumuşak ve kolay yerleştirilmiştir.Anahtar Kelimeler: Laringeal Maske Airway, Süksinil kolin, Sevofluran, Fentanil In modern anesthesia, LMA using has become more frequent method for airway management as an alternative tecnique.Using a neuromuscular agent while anesthesic induction is advised for easy LMA insertion and decreasing the side effects.With the permission of patients and the ethics committee of Dicle University Medical Faculty, 90 patients of The American Society of Anaestheologist (ASA) physical status I and II, aged between 2-14 years, without any respiratory, muscular and cardiovascular diseases were enrolled in this study. All the patients had no premedication before the operations. Intravenous catheter application and non-invasive monitorization practiced in the operation room. The patients were allocated randomly to three groups. Fentanyl 1,5mcg/kg, Sevoraine 5% were used for induction in all groups. Group I received succinycholine IV 0.5 mg/kg, Group II received succinycholine IV 0.25 mg/kg, and Gruop III received IV 10 cc saline as neuromuscular agent. Induction started with sevoflurane, and neuromuscular agents were used after eyelash reflex had been lost. LMA was inserted 90 seconds later. For all groups, non-invasive blood pressure, heart rate, oxygen saturation (SpO2), and side effects were recorded before and after LMA inserting, and 24 hours later.As a result, low dose succinycholine for induction, had no more advantanges over the placebo. In addition, succinycholine supplied more smooth jaw opening in the patients. And with this benefit, LMA inserting was easier and smooth in succinycholine received patients.Key Words: LMA, Anesthesia, Sevoflurane, Fentanyl, Succynilecholine. 68

In our research we aimed to evaluate effects of sevoflurane and desflurane on respiratory mechanics in smokers and nonsmokers. 100 patients who were with an age between 30 and 55 years, in ASA I-II risk group and who does not have any pulmonary diseases were participated. With using Sevoflurane and desflurane randomly in smokers and nonsmokers patient groups, 4 patient groups that each has 25 patients were constituted. After a standart anesthetic induction, desflurane of %6 and sevoflurane of %2 in O2/dry air of %50 applied for maintenance. Dynamic compliance, airway resistance and peak airway pressure of patients were recorded after induction (ind.), in the 5th (ent.5) and 25th (ent.25) after intubation. Demographic characteristics between patient groups did not differ significantly. In nonsmokers in desflurane group, airway resistance values in ent.25 (6.36±1.35) were not different than baseline value, whereas airway resistance in ent.5 (7.36±1.18.) were greater than ind. period (6.56±1.08; p

Sunulan araştırma ile İsoflurane ve Sevoflurane anestezik ajanların immun sistem üzerine olan etkilerinin belirlenerek post operatif dönemin komplikasyonsuz geçmesi için alınabilecek önlemlerin belirlenmesi amaçlanmıştır. Çalışmada 48 tavşan isofluran ve sevofluran olmak üzere iki, bu iki gurubunda anestezi, anestezi/antibiyotik, anestezi/operasyon, anestezi/antibiyotik/operasyon olmak üzere 4 alt guruptaki kombinasyonları denenerek immun sistem üzerine olan etkileri IgG, IgM ve ANAE enzimi bazında değerlendirilmiştir. Sonuç olarak Sevoflurane'ın klinikte kullanımı sırasında avantajlarının daha fazla olmasına rağmen immun sistem üzerine İsoflurane' a göre daha fazla etki ettiği belirlenmiştir., The aim of this study was to determine precautions in order to have uncomplicated post operative time following İsoflurane and Sevoflurane anesthesia affecting immunologic system. Total of 48 rabbits were used in this study as in İsoflurane and Sevoflurane groups. These two groups were divided to 4 sub groups including anesthesia, anesthesia/antibiotic, anesthesia/surgery and anesthesia/antibiotic and surgery. IgG, IgM and ANAE enzymes were evaluated as to determine the differences among groups. As a result, although the use of sevofluran is more advantages clinically, it is more adverse reactions on immunological system compared to isoflurane .

Aim: Numerous studies have suggested that chronic exposure to trace levels of anesthetic gas is harmful to operating room personel. In this study, we aimed to the effects of subanesthetic doses of sevoflurane and desflurane on anxiety and hepatic and renal toxicities according to biochemical and histopathological changes in rats. Material and Methods: Total 24 rats were included study and three groups were formed as sevoflurane (% 0.1), desflurane (% 0.04) and control (3 L min -1 O 2). During four months, every day between 09.00-13.00 hours in the morning were inhaled with anesthetic agent determined concentrations. Anxiety were examined with Plus Maze Test; pre and post study urea, BUN, creatinine and GGT were examined in blood supplies. At the end of the study, rats were sacrificed for examined of kidney and liver histopathologically. Results: In the sevoflurane and desflurane groups increased the time spent within the closed pathways without motion. In the sevoflurane group; GGT, urea and BUN levels were elevated significantly. In the sevoflurane and desflurane groups hepatic congestion were examined significantly increased more than control group, focal necrosis increased in the sevoflurane group more than others. In the sevofluran group; focal lymphocytic infiltration and flatting in the tubuler epithelium were examined significantly higher than other groups. Conclusion: Our results were examined, subanesthetic doses of sevoflurane and desflurane were used increased to anxiety, caused of renal and hepatic damage at subclinic levels in rats.

Introduction: The aim of the present study was to asses the effects of sevoflurane and desflurane as inhalational anaesthetics on heart rate variability, dysrhythmias, QT interval and QT dispersion in patients who will undergo laporoscopic cholecystectomy under general anaesthesia. Material and Methods: 34 patients who will undergo elective laparoscopic cholecystectomy are enrolled in the study. The patients were monitored with Holter device 15 minutes before the anaesthesia induction till 30 minutes in recovery room. Anaesthesia was induced using 4-7 mg kg-1 thiopental sodium, l ?g kg -1 fentanyl and 1 mg kg-1 vecuronium for muscle relaxation. Cases were randomized into 2 groups; Group 1 Sevoflurane, Croup 2 Desflurane. End tidal CO2, O2, N2O were monitorized and ventilation were maintained to Keep EtCO2 between 30-40 mmHg. Minimum, maximum, mean heart rates and heart rate variability parameters included low frequency (LF), high frequency (HF) values which are heart rate variability Parameters, LF/HF ratio, Global Sympathetic Index (GSI), R-R intervals were measured in preoperative, intraoperative periods and 2 nd, 10th and 30th minutes after extubation. Atrial and ventricular dysrhythmias (AES, VES) were determined. QT interval was corrected using Bazett's formula (QTc=QT?RR). QT dispersion was calculated by finding shortest and longest QT interval. Results: Assessing data from Holter Monitor maximum heart rates values were significantly higher in Desflurane group (p=0.049). LF/HF ratio, GSI values were higher in Desflurane group in perioperative period except in induction-extubation events. Maximum R-R intervals in Sovoflurane group in perioperative period were significantly higher. In desflurane group QT intervals were significantly longer and QT dispersion was significantly more frequent. Positive correlation between sympathetic tonus increase and YES was recognized in both groups. Conclusion: In this study sympathetic activation was frequently seen in desflurane group, Severe dysrhythmias did not occur in both groups. Although both desflurane and sevoflurane increased the rate of QT, the increased of QTc and QTd in desflurane anesthesia were significantly higher than sevoflurane anesthesia.

The aim of this study was to compare the effects of sevoflurane and desflurane on intraocular pressure, hemodynamic parameters, and recovery characteristics in young and elderly patients undergoing cataract surgery. Following Ethics Committee approval and informed patient consent, we divided eighty patients into two groups: young patients (aged 20-45) and elderly patients (aged 65-80). Then each group was randomly divided into two subgroups, each consisting of 20 patients. The subgroups were given either sevoflurane 1-2 % or desflurane 3-6 % with N2O 66 % in O2. Emergence and recovery characteristics, hemodynamic effects, intraocular pressure changes were evaluated. Heart rates were higher in young sevoflurane group than in the other groups during the study period. There were no significant differences in intraocular pressure values. Orientation time was shorter in the young desflurane group than in the other groups; the difference between young desflurane and elderly sevoflurane groups was significant. The time required to achieve a score of 9 on the PAR scoring system was longer in group YS than in the other groups, and shorter in group GD than in groups GS and YD (p

In this study, the effects of sevoflurane and halothane on induction and emergence and were compared. The study enrolled 60 ASA I-II pediatric patients aged between 0-12 years. They received no premedication and were randomized into two groups, one of which received sevoflurane anesthesia (S) and the other halothane anesthesia (H). Each of these volatile anesthetics were adminisrated in 33% oxygen and 67% nitrous-oxide mixture, in increasing doses. When the eye-lash reflex disappeared, the volatile anesthetic concentration was kept constant for four and a half minutes to complete the induction of anesthesia, until the patients were intubated. Following intubation, the volatile anesthetic dose was reduced to 1-1.5 MAC for maintenance. At the end of the surgical procedure, all volatile anesthetics were stopped and 100% oxygen was administrated. During induction, the time between the beginning of the administration of the volatile anesthetic to the patient and the loss of the eye-lash reflex was recorded. During recovery, the time between the beginning of application of 100% oxygen and the first swallowing reflex, the first leg-pulling, the extubation time and the time of crying were noted. There were statistically significant difference the first leg-pulling times between the two groups. Laryngospasm was observed in two patients in Group H, vomiting was observed in one patient in Group H and 3 patients in Group S. The utilisation of sevoflurane in the pediatric patiens may be safer than halothane in terms of having shorter recovery time and no laryngospasm during the induction.

The aim of the current study was to compare the effects of desflurane and sevoflurane on haemodynamic variables, APGAR, neuro adaptive capacity scores (NACS) and umblical vein blood gas values during cesarean section. Following Ethies Committee approval and informed patient consent, 60 ASA I or II mothers, scheduled for elective Cesarean section undergoing general anaesthesia, were enrolled to the study. Patients were randomly divided into two groups. Anaesthesia was induced in all patients by intravenous propofol 2 mg kg -1 and maintained with 1% sevoflurane in a mixture of 50% N 2O in oxygen in group 1 and 3% desflurane in a mixture of 50% N 2O in oxygen in group II. Systolic blood pressures, diastolic blood pressures, heart rate and peripheral oxygen saturation were recorded before anaesthesia induction and at 1, 15 and 30 minute after endotracheal intubation. After delivery, umblical blood samples were taken for determination of blood gas analysis. New-borns' performance were assessed using APGAR and NACS. Heart rate was found significantly higher in group II at first minute than in group I (p