Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri

Yıl: 2013 Cilt: 2 Sayı: 3 Sayfa Aralığı: 194 - 203 Metin Dili: Türkçe
hred

Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri

Öz:
Amaç: Bu çalışmanın amacı, kronik hipertansif olgulardaperioperatif deksmedetomidin kullanımının hemodinamikdeğişiklikler ve cerrahi stres yanıtın endokrin parametrelerüzerindeki etkilerini araştırmaktır.Yöntem : Elektif batın ve pelvis operasyonu geçirecek 42 kronikhipertansif olgu rastgele iki gruba ayrıldı. Her iki grupta anestezindüksiyonunda tiyopental, vekuronyum ve fentanil, idamesindesevofluran (%1,5 - %2,5) ile N2O/O2 (%65 -%35) kullanıldı. GrupD (Grup Deksmedetomidin) olgularına (n=21) indüksiyondan 10dk. önce 1μg /kg deksmedetomidin yükleme dozu 10 dakikaiçerisinde verildi ve 0,5 μg /kg/saat dozunda infüzyonaoperasyon sonuna kadar devam edildi. Kontrol grubu olgularına(Grup K, n=21 ) aynı protokol ile izotonik sıvı verildi. Hastalarınortalama arteriyel kan basıncı (OAB), bazal değerin %20sindendaha fazla arttığında her iki gruba da ek fentanil verildi.Hipertansiyon fentanil ile kontrol edilemediğinde, hastalaranitrogliserin infüze edildi. Hemodinamik parametreler [sistolikarter kan basıncı (SAB), diyastolik arter kan basıncı (DAB), OABend-tidal karbondioksit (ETCO2), kalp hızı (KAH), SpO2], ekfentanil ile nitrogliserin dozları kaydedildi. Her hastada, serumglukoz, insülin, Growth Hormon, ACTH, prolaktin, kortizoseviyeleri, operasyon sabahı (t0), cerrahi insizyondan 10 dk.sonra (t1), post op. 24. saat (t2), ve 48. saat (t3) venöz kanörneği alınarak karşılaştırıldı.Bulgular: SAB, DAB, OAB, KAH değerleri operasyon esnasındaGrup Dde Grup Kdan daha düşük bulundu (p<0,05). Grup Kda14 hasta, grup Dde 7 hastaya ek fentanil verildi (p<0,05). GrupKya verilen ortalama ek fentanil dozu 73,80 ± 68,22 μg iken,Grup Dye verilen ek fentanil dozu ise 35,71 ± 61,52 μg şeklindeoldu. Her iki grup arasında stres hormon seviyeleri, bazadeğerlerine göre artış gösterdi. Her iki grup arasında, serumglukoz, insülin, Growth Hormonu, ACTH ve prolaktin seviyelerarasında istatiksel olarak anlamlı bir fark bulunmazken, GrupDde serum kortizol seviyeleri Grup Kya göre daha düşük tespitedildi (p<0,05).Sonuç : Kronik hipertansif olgularda perioperatifdeksmedetomidin infüzyonu cerrahi travmaya yanıtbaskılayabilir ve hemodinamik değişiklileri stabilize edebili r.
Anahtar Kelime:

Konular:
Fen > Tıp > Cerrahi

The effect of perioperative use of dexmedetomidine on hemodynamic parameters and surgical stress response in chronic hypertensive patients

Öz:
Objective : The aim of this study was to observe the effects ofperioperative use of dexmedetomidine on hemodynamicchanges and endocrine parameter which can be affected bysurgical stres.Method : Forty two chronic hypertensive patient undergoingabdominal or pelvic surgery, we allocated randomly into twogroups. Anesthesia was applied with thiopental, vecuronium,fentanyl, and was maintained with sevoflurane (1.5% -2.5%)within N2O/O2 (65%-35%) in both groups. In Group D (n: 21)loading dose of dexmedetomidine (1 µg /kg within 10 min) wasgiven to the patients 10 min before induction, and infusion withthe dose of 0,5 mcg/kg/h) was started together with anestheticinduction until the end of operation. In control group (group K,n: 21) saline was given with the similar protocol as applied tothe patient of group D. Additional fentanyl was given to patientswhen mean arterial blood pressure (MAP) has been increasedmore than 20% of baseline, and nitroglyserine was infused ifhypertension can not be controlled with fentanyl alone.Hemodynamic parameters [systolic arterial blood pressure(SAP), diastolic arterial bood pressure (DAP), MAP, end -tidalcarbon dioxide, heart rate (HR), and pulse oxymetry] andadditionally used fentanyl and nitrogliceryne were recorded.Venous blood samples were obtained from all patients formeasurement of serum glucose, insulin, growth hormone,Adrenocorticotropin hormone (ACTH), prolactin, cortisol levelsat eight o clock on the day of operation (t0, baseline), 10 min.after surgical incision (t1), postoperative 24th (t2) and 48thhours (t3) and were compared.Results : SAP, DAP, MAP, and HR values were significantly lowerin Group D than in Group K (p<0.05) during the operation.Additional fentanyl was given to 14 patients in Group K, and to 7patients in Group D (p<005). The mean dose of additionally usedfentanyl was 73,80± 68,22 µg in group K while it was35,71±61,52 µg in grup D (p<0.05). All stres hormone, valueswere found to be increased in both groups compared to theirbaseline values. There was no statistically significant differencein serum glucose, insulin, growth hormone, ACTH and prolactinlevels between two groups while serum cortisol levels weresignificantly lower in group D than in Group K in measurementsof t1 (p<0.05).Conclusion : We conclude that perioperative infusion ofdexmedetomidine may supress the response to surgical trauma,and may stabilize the hemodynamic changes in chronichypertensive patients.
Anahtar Kelime:

Konular:
Fen > Tıp > Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003; 362: 1921-8.
  • 2. Sepsis, abnormal metabolik control and multiple organ failure syndrome. In Siegel JH(ed): Trauma: Emergency Surgery and Critical Care, new York, Churchill Livingstone. 1987: 411.
  • 3. Phlippa Newfield. Handbook of Neuroanesthesia 3nd ed.Lippincott Williams &Wilkins 2003; 116 –118.
  • 4. Derbyshire DR, Smith G. Sympathoadrenal responses to anaesthesia and surgery. Br. J. Anaesth. , 1984. 56: 725-739.
  • 5. Hall GM, The anaesthetic modification of the endocrine and metabolic response to surgery. Annls of the Royal College of Surgeons of England. 1985. 67: 25-29.
  • 6. Kehlet H, Stres Free Anaesthesia and Surgery. Acta anaesth. Scand., 1979. 23: 503 -504.
  • 7. Jay Epstein MD, The stress response of citical illness. Critical Care Clinics 1999: 15: 17 -39
  • 8. Barash PG, Cullen BF, Stoelting RK, Clinical Anesthesia,epidural and spinal anesthesia, chapter 25, Lippincott Williams& Wilkins, USA 2006: 710 -711.
  • 9. Phlippa Newfield. Handbook of Neuroanesthesia 3nd ed. Lippincott Williams & Wilkins 2003; 116 –118.
  • 10. Coloma M, Chiu JW, White PF. The Use of Esmolol as an Alternative to Remifentanil During Desflurane Anesthesia for Fast-Track Outpatient Gynecologic Laparoscopic Surgery. Anesth Analg 2001; 92(2): 352-7.
  • 11. Morgan GE, Mikhail MS. Anesthesia for patients with cardiovascular disease In. Morgan GE, Mikhail MS, Clinical Anesthesiology 3rd ed, Stampford, Lange Medical Books. 2002;386 -432.
  • 12. Prys -Roberts C. Isolated systolic hypertension on the anaesthetist? Anaesthesia 2001;56:505 -10.
  • 13. Miller RD, Cucchiara RF, Miller ED, et al. Anesthesia, 6th ed., Churchill Livingstone, Philadelphia 2005; 664 -665.
  • 14. Charles W. The Metabolic Response To Stress: An Overvievv and Update Anesthesiology 1990; 73:308 -27.
  • 15. Philip BK, Scuderi PE, Chung F, Conahan TJ, Maurer W, Angel JJ et al, Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. The Remifentanil/Alfentanil Outpatient TIVA Group. Anesth Analg 1997; 84: 515 - 521.
  • 16. Schricker T, Carli F, Schreiber M, et al. Propofol/sufentanil anesthesia suppresses the metabolic and endocrine response during, not after, lower abdominal surgery. Anesth Analg 2000; 90:450 - 455.
  • 17. Durmus M, But AK, Erdem TB, Ozpolat Z, Ersoy MO. The effects of magnesium sulphate on sevoflurane minimum alveolar concentrations and haemodynamic responses. Eur J Anaesthesiol. 2006; 23: 54-59
  • 18. El-Tahan MR, Warda OM, Diab DG A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section.J Anesth. 2009;23(2):215 -21.
  • 19. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87:62 -72.
  • 20. Dahl JB, Møiniche S. Pre -emptive analgesia. Br Med Bull 2004;71:13 -27.
  • 21. Miller D, Martineau R, Wynands JE, Hill J. Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian multicentretrial. Can J Anaesth 1991; 38:849-58.
  • 22. Farber NE, Samso E, Staunton M, Schwabe D, Schmeling WT. Dexmedetomidine modulates cardiovascular responses to stimulation of central nervous system pressor sites. Anesth Analg 1999;88:617 -24.
  • 23. Khan ZP, Ferguson CN, Jones RM. Alpha -2 and imidazoline receptor agonists. Anaesthesia 1999;54:146 -65.
  • 24. Scheinin H, Jaakola ML, Sjovall S, Melkkila TM, Kaukinen, Turunen, Kanto:İntramuscular dexmedetomidine as premedication for general anesthesia. Anesthesiology 1993; 78: 1065 -1075
  • 25. Martina A, Lehtinen M, Erkola O, Kallio A, Korttila K : The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and ısoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesıology 1991; 74: 997-1002.
  • 26. Coloma M, Chiu JW, White PF. The Use of Esmolol as an Alternative to Remifentanil During Desflurane Anesthesia for Fast-Track Outpatient Gynecologic Laparoscopic Surgery. Anesth Analg 2001; 92(2): 352 -7.
  • 27. Vigorito C, et al. Hemodynamic effects of magnesium sulfate on the normal human heart. Am J Cardiol 1991; 67: 1435 -1437
  • 28. Mangoo DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiak surgery. Mult,center study of perioperative ischemia research group. N Engl. J Med. 1996; 335 1713 -1720
  • 29. Toraman F, Öztiryaki H, Karabulut H, ve ark. Koroner baypas cerrahisi sonrası hipertansiyon kontrolünde diltiazem, nitrogliserin ve sodyum nitroprussidin karşılaştırılması. Türk Kardiyoloji Derneği Arşivi 2002;30(9):530 -533)
  • 30. Kallio A, Sheinin M, Koulu M, Pankilainen R, Ruskaaha H, Viinamaki O, et al. Effectsof dexmedetomidine, a selective α2 adrenoceptor agonist, on hemodynamic control mechanism. Clin Pharmacol Ther 1989; 46:33 -42.
  • 31. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000;85:109 -17.
  • 32. Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87:62 -72.
  • 33. Kay NH, Allen MC, Bullingham RES, Baldwin D. Influence of meptazinol on metabolic and hormonal responses following major surgery. Anesthesia 1985; 40: 223-228.
  • 34. Taylor NM. Fentanyl and the interleukin 6 responses to surgery. Anaesthesia, 1997; 52: 112 -5.
  • 35. Stone DJ, Gal JT. Airway management In: Miller RD, Anesthesia 5th ed, Philadelphia, Churchill Livingstone 2000;1414 -51.
  • 36. Tobias JD. Controlled hypotension in children: A critical review of available agents. Pediatric Drugs 2002; 47:439 -53.
  • 37. Coursin DB, Coursin DB, Maccioli GA. Dexmedetomidine. Curr Opin Crit Care 2001; 7:221-6.
APA KOÇOĞLU H, KARAASLAN K, ÇOLAK C, SARPKAYA A, BUĞDAYCI G, BAYIR H (2013). Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri. Abant Tıp Dergisi, 2(3), 194 - 203.
Chicago KOÇOĞLU HASAN,KARAASLAN Kazım,ÇOLAK Cemil,SARPKAYA Ali,BUĞDAYCI Güler,BAYIR Hakan Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri. Abant Tıp Dergisi 2, no.3 (2013): 194 - 203.
MLA KOÇOĞLU HASAN,KARAASLAN Kazım,ÇOLAK Cemil,SARPKAYA Ali,BUĞDAYCI Güler,BAYIR Hakan Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri. Abant Tıp Dergisi, vol.2, no.3, 2013, ss.194 - 203.
AMA KOÇOĞLU H,KARAASLAN K,ÇOLAK C,SARPKAYA A,BUĞDAYCI G,BAYIR H Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri. Abant Tıp Dergisi. 2013; 2(3): 194 - 203.
Vancouver KOÇOĞLU H,KARAASLAN K,ÇOLAK C,SARPKAYA A,BUĞDAYCI G,BAYIR H Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri. Abant Tıp Dergisi. 2013; 2(3): 194 - 203.
IEEE KOÇOĞLU H,KARAASLAN K,ÇOLAK C,SARPKAYA A,BUĞDAYCI G,BAYIR H "Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri." Abant Tıp Dergisi, 2, ss.194 - 203, 2013.