ÖZETAmaç: Bu prospektif randomize çalışmanın amacı sevofluran ve isofluranın koroner baypas cerrahisi sırasında miyokart üzerindeki koruyucu etkilerini karşılaştırmaktır. Yöntemler: Etomidat (0.3 mg /kg ) ile genel anestezi indüksiyonunu takiben 0.1 mg/kg pankuronyum ve 1 mikrogr/kg remifentanil bolus olarak verildi. Anestezi idamesi Grup 1'deki hastalarda (n=20) %2-4 değerinde sevofluran, Grup 2'deki hastalarda (n=20) %1-2 değerinde isofluranla sağlandı. Anestezi indüksiyonundan önce, aortik klemp kaldırıldıktan sonra ve postoperatif periyotta arteriyel kan örnekleri alındı. Bu örneklerde Troponin T, kreatinin kinaz ve kreatinin kinaz MB değerleri ölçüldü. İstatistiksel analizler -iki-yönlü ANOVA ve Mann-Whitney testleri ile yapıldı. Bulgular: Kalp hızı sevofluran grubunda pompa periyodunda, pompadan çıkış sonrası 10. ve 20. dakikalarda anlamlı yüksek bulunmuştur. CKMB düzeyi postoperatif 24. saatte sevofluran grubunda isofluran grubuna göre anlamlı düşüktür. Troponin T kros-klemp kaldırıldıktan sonra (1.015 (0.935-1.850) ng/ml, 1.469 (1.290-1.645) ng/ml, p<0.001) ve postoperatif 24.saatte (5.345±0.654 ng/ml, 8.715±1.020 ng/ml, p<0.001) sevofluran grubunda isofluran grubu ile karşılaştırıldığında anlamlı düşüktür. Sonuç: Miyokardiyal hasarlanma işaretleyicileri olan troponin T ve CKMB düzeylerinin daha düşük düzeylerde saptanması ile sevofluranın isoflurana göre miyokardiyal korumayı daha iyi sağlamakta olduğu kanısındayız. (Anadolu Kardiyol Derg 2011; 11: 257-62) Anahtar kelimeler: Sevofluran, isofluran, miyokardiyal koruma, koroner baypas cerrahisi ABSTRACT Objective: The aim of this prospective randomized study was to compare the myocardial protective effects of sevoflurane and isoflurane during coronary bypass surgery. Methods: After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg and remifentanil 1 mcg/kg was administered. For the maintenance of anesthesia, patients received either sevoflurane (n=20) at 2-4% or isoflurane (n=20) at 1-2%. Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative period. Troponin-T, creatine kinase (CK), and creatine kinase-MB (CKMB) values were measured in all obtained samples. Statistical analysis was performed using two-way ANOVA analysis and Mann-Whitney test. Results: Heart rate was significantly higher in the sevoflurane group during the aortic side-clamp period, at the 10 th minute and 20 th minute after cardiopulmonary bypass (CPB) ending. The CK-MB values at 24 th postoperative hour in the sevoflurane group were found to be significantly lower from the isoflurane group. The troponin-T values following the removal of the cross-clamp (1.015 (0.935-1.850) ng/ml vs 1.469 (1.290-1.645) ng/ml, p<0.001) and those at the 24 th postoperative hour (5.345±0.654 ng/ml vs 8.715±1.020 ng/ml, p<0.001) were significantly lower in the sevoflurane group when compared to those in the isoflurane group. Conclusion: Sevoflurane provides a better myocardial protection than isof...

CCI-CCR-tramadol treatment is highly effective in the symptomatic treatment of neuropathic pain. CCR-curcumin is associated with less degeneration and high levels of regeneration in the nerve tissue.

No abstract

SummaryObjectives: Preventive analgesia has been defined as reduction in noxious stimuli during preoperative, intraoperative, and postoperative periods. The aim of the present study was to prevent central sensitization by administering ketamine infusion throughout the surgical procedure. In addition, possible preventive effects of dexketoprofen when administered before and after incision were evaluated. Methods: Fifty patients were included. Group I was administered 50 mg intravenous dexketoprofen prior to surgical incision, and Group II received the same amount 10 minutes after the incision had been made. Following induction of general anesthesia, all patients received a bolus of 0.50 mg/kg ketamine in 0.07 mg/kg/h intravenous infusion. Results: When postoperative visual analog scale values were compared, values for Group I after 1 and 4 hours were significantly lower than those of Group II. In addition, morphine consumption at 4, 8, 12, and 24 hours was significantly lower in Group I. Conclusion: Combined with the prevention of central sensitization with ketamine, administration of dexketoprofen prior to incision led to a lower rate of morphine consumption and more effective analgesia than post-incision administration.

Amaç: Multimodal analjezi postoperatif ağrının tedavisinde tercih edilen bir metodtur, analjezik ilaçların aditif etkisi yan etkilerden kaçınmaya olanak sağlar. Bu çalışmada postoperatif ağrıda deksketoprofen ve parasetamol kombinasyonunun etkilerinin karşılaştı-rılması amaçlandı.Yöntemler: Non-malin jinekolojik laparatomi geçirecek 96 hasta çalışmaya dahil edildi. Hastalar randomize 3 gruba ayrıldı. Grup D'ye operasyon bitiminden 15 dakika önce, postoperatif 8. ve 16. saatlerde 50 mg intravenöz deksktoprofen verildi. Grup P'ye 1 gr intravenöz parasetamol, Grup DP'ye 500 mgr parasetamol + 25 mgr deksketoprofen intravenöz olarak aynı zamanlarda verildi. Tüm hastalara postoperatif morfin infüzyonu uygulandı. Postoperatif 24. saatin sonunda total morfin tüketimi, visual analog skala, hasta memnuniyeti ve yan etkiler değerlendirildi. Bulgular:Grup DP'deki 24.saatteki vizüel analog skala diğer gruplara göre düşük bulundu, ve bu düşüklük Grup D ile karşı-laştırıldığında istatiksel yönden anlamlı idi. Her 3 grup arasında morfin tüketimi açısından fark bulunmadı. En az sayıda yan etki Grup DP idi.Sonuç: Jinekolojik abdominal cerrahide deksketoprofen ve parasetamol birlikteliğinin morfinle kullanımı iyi analjezi ve daha az yan etki sağlamaktadır.Anahtar Kelimeler: Postoperatif ağrı, deksketoprofen, parasetamol, multimodal analjezi Objective: Multimodal analgesic methods are preferred for the treatment of postoperative pain; as a result, the additive effects of analgesics are provided while probable side effects are avoided. The current study aimed to compare the effects of the combination of dexketoprofen and paracetamol with regard to postoperative pain therapy. Methods:Ninety-six patients who underwent non-malignant gynaecological laparotomy operations were included in this study. Patients were randomized into 3 groups. Group D received 50 mg intravenous dexketoprofen 15 minutes before the end of the operation and 8 and 16 hours after the operation. Group P received 1 g intravenous paracetamol and Group DP received the combination of 500 mg paracetamol and 25 mg dexketoprofen at the same time intervals. All patients received morphine infusion after operation. Total morphine consumption at 24 hours, visual analog scale, patient satisfaction and side effects were investigated. Results:Comparison of the visual analog scale scores revealed that the Group DP presented lower scores at 24th hours compared to the other groups; and the difference between Group DP and Group D was statistically significant. Total morphine consumption was not significantly different between the three groups. The minimum number of side effects was observed in the Group DP. Conclusion:Co-administration of paracetamol, dexketoprofen and morphine provided good analgesia and fewer side effects in gynaecological abdominal surgery.