Koroner arter cerrahisinde desfluran-fentanil ve midozolam-fentanil anestezisinin hemodinamik, hepato-renal ve postoperatif etkileri
Küçük Resim Yok
Tarih
2014
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Türk Anestezi ve Reanimasyon Dergisi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Öz: Bu çalışmada koroner arter cerrahisinde desfluran-fentanil ve midazolam-fentanil anestezisinin hemodinamik, hepato-renal ve postoperatif etkilerini karşılaştırmayı amaçladık. Elektif koroner arter bypass greftlemesi planlanan, ejeksiyon fraksiyonu % 45'in üzerinde 60 olgu çalışmaya alındı. Olgular, rastgele desfluran (Grup D, n=30) ve midozolam (Grup M, n=30) olmak üzere iki gruba ayrıldı. Anestezi indüksiyonu; Grup D'de 0.2 mg kg-1 etomidat ve 5 µg kg-1 fentanil, Grup M'de 0.1-0.3 mg kg-1 midazolam ve 5 µg kg-1 fentanil ile, anestezi idamesi ise hemodinamik duruma göre Grup D'de % 2-6 desfluran ve 15-25 µg kg-1 fentanil, Grup M'de 0.1-0.5 mg kg-1 sa-1 midazolam ve 15-25 µg kg-1 fentanil ile sağlandı. İndüksiyondan önce (t0), indüksiyondan (t1) ve entübasyondan sonra (t2), insizyon sonrası (t3) ve sternotomi sonrası (t4), kardiyopulmoner bypass öncesi (t5), protamin sonrası (t6) ve cerrahi sonunda (t7); kalp hızı, ortalama arter basıncı, santral venöz basınç, ortalama pulmoner arter basıncı, pulmoner ka piller oklüzyon basıncı, kardiyak indeks, sistemik vasküler rezistans indeksi, pulmoner vasküler rezistans indeksi, sol ventrikül stroke work indeksi ve sağ ventrikül stroke work indeksi ölçümleri yapıldı. Total bilirübin, aspartat aminotransferaz, alanin aminotransferaz, g-glutamil transpeptidaz, laktat dehidrogenaz, alkalen fosfataz, kreatinin ve kan üre nitrojeni değerleri için indüksiyondan hemen önce, postoperatif 1, 4 ve 14. günlerde 3-5 mL kan alındı. Sonuç olarak, koroner arter cerrahisinde iki grupta da intraoperatif hemodinamik yanıt birbirine benzer bulunurken, yine her iki grupta postoperatif dönemde karaciğer ve böbrek fonksiyonlarında geçici bozulmalar saptandı. Desfluran-fentanil grubunda ekstübasyon ve YBÜ'de kalış süreleri daha kısa tespit edildi.
Abstract: In this study, we aimed to compare the hemodynamic, hepatorenal and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anaesthesia during coronary artery bypass surgery. Sixty patients undergoing elective coronary artery bypass surgery with ejection fraction of more than 45 % were included in the study. Patients were randomly divided into two groups as desflurane (Group D, n=30) and midazolam (Group M, n=30). Anaesthesia was induced with etomidate, 0.2 mg kg-1 and fentanyl, 5 µg kg-1 in Group D and with midazolam, 0.1-0.3 mg kg-1 and fentanyl, 5 µg kg-1 in Group M. For the maintenance of anaesthesia; desflurane, 2-6 % and fentanyl, 15-25 µg kg-1 were given in group D and infusion of midazolam at a rate of 0.1-0.5 mg kg-1 hr-1 and fentanyl at a rate of 15-25 µg kg-1 were used in group M. Heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resi stance index, left ventricle stroke work index and right ventricle stroke work index were measured before induction (t0), after induction (t1), after intubation (t2), after incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine administration (t6) and at the end of the surgery (t7). Blood samples were taken to measure total bilirubine, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkalane phosphatase, creatinine and blood urea nitrogen just before induction and at the 1st 4th and 14th days of postoperative period. In conclusion; intraoperative hemodynamic responses were similar in both of the groups and transient hepatic and renal dysfunction were observed in the postoperative period in both groups. The extubation and ICU discharge time were found to be shorter in the desflurane-fentanyl group.
Abstract: In this study, we aimed to compare the hemodynamic, hepatorenal and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anaesthesia during coronary artery bypass surgery. Sixty patients undergoing elective coronary artery bypass surgery with ejection fraction of more than 45 % were included in the study. Patients were randomly divided into two groups as desflurane (Group D, n=30) and midazolam (Group M, n=30). Anaesthesia was induced with etomidate, 0.2 mg kg-1 and fentanyl, 5 µg kg-1 in Group D and with midazolam, 0.1-0.3 mg kg-1 and fentanyl, 5 µg kg-1 in Group M. For the maintenance of anaesthesia; desflurane, 2-6 % and fentanyl, 15-25 µg kg-1 were given in group D and infusion of midazolam at a rate of 0.1-0.5 mg kg-1 hr-1 and fentanyl at a rate of 15-25 µg kg-1 were used in group M. Heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resi stance index, left ventricle stroke work index and right ventricle stroke work index were measured before induction (t0), after induction (t1), after intubation (t2), after incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine administration (t6) and at the end of the surgery (t7). Blood samples were taken to measure total bilirubine, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkalane phosphatase, creatinine and blood urea nitrogen just before induction and at the 1st 4th and 14th days of postoperative period. In conclusion; intraoperative hemodynamic responses were similar in both of the groups and transient hepatic and renal dysfunction were observed in the postoperative period in both groups. The extubation and ICU discharge time were found to be shorter in the desflurane-fentanyl group.
Açıklama
Yıl: 2004Cilt: 32Sayı: 2ISSN: 1304-0871 / 1305-614XSayfa Aralığı: 120 - 129Metin Dili:Türkçe
Anahtar Kelimeler
Kaynak
Türk Anestezi ve Reanimasyon Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
32
Sayı
2
Künye
BUT A. K,DURMUŞ M,TOPRAK H. İ,ÖZTÜRK E,DEMİRBİLEK S,ERSOY M. Ö (2004). Koroner arter cerrahisinde desfluran-fentanil ve midozolam-fentanil anestezisinin hemodinamik, hepato-renal ve postoperatif etkileri. Türk Anestezi ve Reanimasyon Dergisi, 32(2), 120 - 129.
