Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri
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2013
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info:eu-repo/semantics/openAccess
Özet
Öz: Amaç: Bu çalışmanın amacı, kronik hipertansif olgularda perioperatif deksmedetomidin kullanımının hemodinamik değişiklikler ve cerrahi stres yanıtın endokrin parametreler üzerindeki etkilerini araştırmaktır. Yöntem : Elektif batın ve pelvis operasyonu geçirecek 42 kronik hipertansif olgu rastgele iki gruba ayrıldı. Her iki grupta anestez indüksiyonunda tiyopental, vekuronyum ve fentanil, idamesinde sevofluran (%1,5 - %2,5) ile N2O/O2 (%65 -%35) kullanıldı. Grup D (Grup Deksmedetomidin) olgularına (n=21) indüksiyondan 10 dk. önce 1?g /kg deksmedetomidin yükleme dozu 10 dakika içerisinde verildi ve 0,5 ?g /kg/saat dozunda infüzyona operasyon sonuna kadar devam edildi. Kontrol grubu olgularına (Grup K, n=21 ) aynı protokol ile izotonik sıvı verildi. Hastaların ortalama arteriyel kan basıncı (OAB), bazal değerin %20sinden daha fazla arttığında her iki gruba da ek fentanil verildi. Hipertansiyon fentanil ile kontrol edilemediğinde, hastalara nitrogliserin infüze edildi. Hemodinamik parametreler [sistolik arter kan basıncı (SAB), diyastolik arter kan basıncı (DAB), OAB end-tidal karbondioksit (ETCO2), kalp hızı (KAH), SpO2], ek fentanil ile nitrogliserin dozları kaydedildi. Her hastada, serum glukoz, insülin, Growth Hormon, ACTH, prolaktin, kortizo seviyeleri, operasyon sabahı (t0), cerrahi insizyondan 10 dk. sonra (t1), post op. 24. saat (t2), ve 48. saat (t3) venöz kan örneği alınarak karşılaştırıldı. Bulgular: SAB, DAB, OAB, KAH değerleri operasyon esnasında Grup Dde Grup Kdan daha düşük bulundu (p<0,05). Grup Kda 14 hasta, grup Dde 7 hastaya ek fentanil verildi (p<0,05). Grup Kya verilen ortalama ek fentanil dozu 73,80 ± 68,22 ?g iken, Grup Dye verilen ek fentanil dozu ise 35,71 ± 61,52 ?g şeklinde oldu. Her iki grup arasında stres hormon seviyeleri, baza değerlerine göre artış gösterdi. Her iki grup arasında, serum glukoz, insülin, Growth Hormonu, ACTH ve prolaktin seviyeler arasında istatiksel olarak anlamlı bir fark bulunmazken, Grup Dde serum kortizol seviyeleri Grup Kya göre daha düşük tespit edildi (p<0,05). Sonuç : Kronik hipertansif olgularda perioperatif deksmedetomidin infüzyonu cerrahi travmaya yanıt baskılayabilir ve hemodinamik değişiklileri stabilize edebili r.
Abstract: Objective : The aim of this study was to observe the effects of perioperative use of dexmedetomidine on hemodynamic changes and endocrine parameter which can be affected by surgical stres. Method : Forty two chronic hypertensive patient undergoing abdominal or pelvic surgery, we allocated randomly into two groups. 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) was given to the patients 10 min before induction, and infusion with the dose of 0,5 mcg/kg/h) was started together with anesthetic induction until the end of operation. In control group (group K, n: 21) saline was given with the similar protocol as applied to the patient of group D. Additional fentanyl was given to patients when mean arterial blood pressure (MAP) has been increased more than 20% of baseline, and nitroglyserine was infused if hypertension can not be controlled with fentanyl alone. Hemodynamic parameters [systolic arterial blood pressure (SAP), diastolic arterial bood pressure (DAP), MAP, end -tidal carbon dioxide, heart rate (HR), and pulse oxymetry] and additionally used fentanyl and nitrogliceryne were recorded. Venous blood samples were obtained from all patients for measurement of serum glucose, insulin, growth hormone, Adrenocorticotropin hormone (ACTH), prolactin, cortisol levels at eight o clock on the day of operation (t0, baseline), 10 min. after surgical incision (t1), postoperative 24th (t2) and 48th hours (t3) and were compared. Results : SAP, DAP, MAP, and HR values were significantly lower in Group D than in Group K (p<0.05) during the operation. Additional fentanyl was given to 14 patients in Group K, and to 7 patients in Group D (p<005). The mean dose of additionally used fentanyl was 73,80± 68,22 µg in group K while it was 35,71±61,52 µg in grup D (p<0.05). All stres hormone, values were found to be increased in both groups compared to their baseline values. There was no statistically significant difference in serum glucose, insulin, growth hormone, ACTH and prolactin levels between two groups while serum cortisol levels were significantly lower in group D than in Group K in measurements of t1 (p<0.05). Conclusion : We conclude that perioperative infusion of dexmedetomidine may supress the response to surgical trauma, and may stabilize the hemodynamic changes in chronic hypertensive patients.
Abstract: Objective : The aim of this study was to observe the effects of perioperative use of dexmedetomidine on hemodynamic changes and endocrine parameter which can be affected by surgical stres. Method : Forty two chronic hypertensive patient undergoing abdominal or pelvic surgery, we allocated randomly into two groups. 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) was given to the patients 10 min before induction, and infusion with the dose of 0,5 mcg/kg/h) was started together with anesthetic induction until the end of operation. In control group (group K, n: 21) saline was given with the similar protocol as applied to the patient of group D. Additional fentanyl was given to patients when mean arterial blood pressure (MAP) has been increased more than 20% of baseline, and nitroglyserine was infused if hypertension can not be controlled with fentanyl alone. Hemodynamic parameters [systolic arterial blood pressure (SAP), diastolic arterial bood pressure (DAP), MAP, end -tidal carbon dioxide, heart rate (HR), and pulse oxymetry] and additionally used fentanyl and nitrogliceryne were recorded. Venous blood samples were obtained from all patients for measurement of serum glucose, insulin, growth hormone, Adrenocorticotropin hormone (ACTH), prolactin, cortisol levels at eight o clock on the day of operation (t0, baseline), 10 min. after surgical incision (t1), postoperative 24th (t2) and 48th hours (t3) and were compared. Results : SAP, DAP, MAP, and HR values were significantly lower in Group D than in Group K (p<0.05) during the operation. Additional fentanyl was given to 14 patients in Group K, and to 7 patients in Group D (p<005). The mean dose of additionally used fentanyl was 73,80± 68,22 µg in group K while it was 35,71±61,52 µg in grup D (p<0.05). All stres hormone, values were found to be increased in both groups compared to their baseline values. There was no statistically significant difference in serum glucose, insulin, growth hormone, ACTH and prolactin levels between two groups while serum cortisol levels were significantly lower in group D than in Group K in measurements of t1 (p<0.05). Conclusion : We conclude that perioperative infusion of dexmedetomidine may supress the response to surgical trauma, and may stabilize the hemodynamic changes in chronic hypertensive patients.
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Abant Tıp Dergisi
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Scopus Q Değeri
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2
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3
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SARPKAYA A,KARAASLAN K,KOÇOĞLU H,BUĞDAYCI G,BAYIR H,ÇOLAK C (2013). Kronik hipertansif olgularda, perioperatif deksmedeto midin kullanımının stres yanıt ve Hemodinami üzerine etkileri. Abant Tıp Dergisi, 2(3), 194 - 203.
