Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Addition of Low-Dose Ketamine to Midazolam-Fentanyl-Propofol-Based Sedation for Colonoscopy: A Randomized, Double-Blind, Controlled Trial(2015) Tuncali, Bahattin; Pekcan, Yonca Ozvardar; Celebi, Arzu; Zeyneloglu, Pinar; 0000-0002-7898-2943; 0000-0002-0991-7435; 0000-0003-2312-9942; 25801162; AAJ-7840-2021; AAD-5696-2021; C-3736-2018Study Objective: To evaluate the effects of low-dose ketamine on midazolam-fentanyl-propofol-based sedation for outpatient colonoscopy. Design: Prospective, randomized, double-blinded, placebo-controlled trial. Setting: Gastroenterology unit at a practice and clinical research center. Subjects: Ninety-seven healthy American Society of Anesthesiology physical status 1 volunteers. Interventions: Subjects were randomized to receive midazolam (0.02 mg/kg), fentanyl (1 mu g/kg), and ketamine (0.3 mg/kg) and midazolam (0.02 mg/kg), fentanyl (1 mu g/kg), and placebo (0.9% sodium chloride) in group K and group C, respectively. In both groups, incremental doses of propofol were used to maintain a Ramsay sedation score of 3 to 4. Measurements: Values of heart rate, blood pressure, oxygen saturation, and respiratory rate were measured. Procedure times, recovery times, drug doses used, complications associated with the sedation, and physician and patient satisfaction were also recorded. Main Results: In group K, mean amount of propofol used and mean induction time (P < .001), the need for the use of jaw thrust maneuver and mask ventilation, and the incidence of disruptive movements were significantly lower (P < .05) and gastroenterologist satisfaction at the beginning of the procedure was significantly superior (P < .05). Mean systolic blood pressures at 4, 6, 8, and 10 minutes (P < .01); diastolic blood pressures at 4, 6, and 8 minutes (P < .05); respiratory rates at 4, 6, 8, 10, 15, 20, and 25 minutes (P < .01); and oxygen saturation at 6, 8, 10, 15, and 20 minutes (P < .05) were significantly lower in group C. Patient satisfaction scores, recovery times, and discharge times were similar. No patient in either group experienced unpleasant dreams or hallucination in the postanesthesia care unit and on the first postoperative day. Conclusions: Addition of low-dose ketamine to midazolam-fentanyl-propofol-based sedation for outpatient colonoscopy resulted in more rapid and better quality of sedation, less propofol consumption, more stable heinodynamic status, and less adverse effects with similar recovery times in adult patients. (C) 2015 Elsevier Inc. All rights reserved.Item Effects of Music on Sedation Depth and Sedative Use During Pediatric Dental Procedures(2016) Ozkalayci, Ozlem; Araz, Coskun; Cehreli, Sevi Burcak; Tirali, Resmiye Ebru; Kayhan, Zeynep; 0000-0002-4927-6660; 0000-0001-6487-3984; 0000-0003-0579-1115; 27687464; AAJ-4576-2021; AAD-6138-2021; HZK-4947-2023; AAD-2907-2020; AAJ-4623-2021Study objective: The study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients. Design: Prospective, randomized, and controlled study. Setting: Tertiary, university hospital. Patients: In total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment. Interventions: Patients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi's The Four Seasons violin concertos by sound isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required. Measurements and main results: Bispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients' heart rates, oxygen saturations, and Observer's Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004). Conclusions: Listening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients. (C) 2016 Elsevier Inc. All rights reserved.Item Congenital insensitivity to pain: How should anesthesia be managed?(2017) Ozmete, Ozlem; Sener, Mesut; Bali, Cagla; Caliskan, Esra; Aribogan, Anis; 0000-0003-2615-1918; 0000-0001-6497-0610; 0000-0002-4419-5693; 0000-0001-5845-699X; 29168371; AAI-7779-2021; AAI-8790-2021; S-8336-2019; AAI-7866-2021Congenital insensitivity to pain syndrome is a rare, sensorial and autonomic neuropathy characterized by unexplained fever, insensitivity to pain and anhidrosis. Patients may require anesthesia even for minor surgical procedures due to mental retardation and trauma arising from self-mutilating behavior. A child diagnosed with congenital insensitivity to pain syndrome was scheduled for gastric endoscopy under sedation due to suspected ingestion of a household cleaning disinfectant. Deep sedation was achieved, and spontaneous respiration was maintained. We did not encounter any complications. There is limited data regarding the safe anesthesia management in these patients because of the rarity of the disease. Therefore, we think that more clinical experience, case reports and studies are needed to establish the appropriate anesthesia management.Item Ambulatory colonoscopy under sedoanalgesia in adult patients with and without irritable bowel syndrome: A prospective, cross-sectional, and double-blind comparison(2018) Tuncali, Bahattin; Araz, Coskun; Celebi, Arzu; 29755018Background/Aims: it is unclear whether patients with irritable bowel syndrome (IBS) require a high dose of sedatives during colonoscopy. In this study, we investigated the pre-procedural anxiety levels, sedative consumption, procedure times, complications, and patient's satisfaction between patients with IBS and controls for ambulatory colonoscopy under sedation. Materials and Methods: Rome III criteria were used in the diagnosis of IBS. Anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BA/). Patients received a fixed dose of midazolam (0.02 mg/kg), fentanyl (1 mu g/kg), ketamine (0.3 mg/kg), and incremental doses of propofol under sedation protocol. Demographic data, heart rate, blood pressure, and oxygen saturation were measured. Procedure times, recovery and discharge times, drug doses used, complications associated with the sedation, and patient's satisfaction scores were also recorded. Results: The mean Trait (p=0.015), State (p=0.029), Beck anxiety scores (p=0.018), the incidence of disruptive movements (p=0.044), and the amount of propofol (p=0.024) used were significantly higher in patients with IBS. There was a decline in mean systolic blood pressure at the 6th minute in patients with IBS (p=0.026). No association was found between the sedative requirement and the anxiety scores. Conclusion: Patients with IBS who underwent elective colonoscopy procedures expressed higher pre-procedural anxiety scores, required more propofol consumption, and experienced more disruptive movements compared with controls. On the contrary, the increased propofol consumption was not associated with the increased pre-procedural anxiety scores.Item Ketamine dosing for sedation during repeated radiotherapy sessions in children(2018) Yalcin Cok, Oya; Evren Eker, Hatice; Aribogan, Anis; 30119163Background/aim: We report the analysis of ketamine doses needed and the recovery tones in pediatric oncology patients undergoing repeated radiotherapy sessions. Materials and methods: In a single-blind prospective study design, thirty-three pediatric patients undergoing radiotherapy due to oncologic disorders received 2 mg/kg ketamine and 10 mu g/kg atropine intravenously and the rescue drug to be administered was ketamine at 0.5 mg/kg when the sedation level was inadequate. Total ketamine consumption, additional doses, and recovery time were recorded. Results: Data of 635 consecutive radiotherapy sessions were evaluated. There was no significant alteration in total ketamine consumption required to complete the radiotherapy periods during consecutive procedures (P > 0.05). However, the recovery times started to decrease by the fourth session (P = 0.02) and continued to decrease onwards during the whole study period (P = 0.001). The mean of the first recovery time was 13.68 +/- 3.99 min, whereas the mean of the last recovery time was 7.66 +/- 6.35 min. Conclusion: A requirement for an incremental increase in ketamine dose after subsequent administrations was not detected, despite a significant decrease in recovery times being anticipated when ketamine is used repeatedly for sedative purposes in consecutive radiotherapy sessions.