Sistolik ve ortalama kan basıncına göre uygulanan hipotansif anestezi tekniklerinin beyin perfüzyonu, kan oksidan-antioksidan seviyelerileri ve HIF-1a seviyeleri üzerindeki etkilerinin karşılaştırılması

Year 2024, Volume: 49 Issue: 4, 996 - 1005, 30.12.2024

Ayşe Şencan , Hayrettin Daşkaya , Harun Uysal , Muhittin Çalım , Kazım Karaaslan , İsmail Sümer

https://doi.org/10.17826/cumj.1519841

Abstract

Amaç: Bu çalışmanın amacı, kontrollü hipotansiyon sırasında arteriyel kan basıncının ayarlanmasında referans parametre olarak sistolik kan basıncı (SKB) veya ortalama kan basıncının (OKB) kullanılması durumunda doku ve beyin perfüzyonundaki değişiklikleri değerlendirmektir.
Gereç ve Yöntem: Kontrollü hipotansiyon uygulanacak planlı rinoplasti ya da çene cerrrahisi yapılacak hastalar çalışmaya dahil edildi. Hastalar, Grup 1 (sistolik kan basıncı grubu) ve Grup 2 (ortalama kan basıncı grubu) olarak kategorize edildi. Anestezi indüksiyonundan ve uyandırmadan önce kandaki toplam oksidan durumu (TOS), toplam antioksidan durumu (TAS), oksidatif stres indeksi (OSI) ve hipoksi inducible factör (HIF-1a) seviyeleri ölçüldü. Perioperatif beyin perfüzyonu monitörizasyonu near infraraed spectroscopy (NIRS) kullanılarak gerçekleştirildi.
Bulgular: İki grup arasında oksidatif stres göstergesi olarak kullanılan TAS, TOS, OSI, ve HIF-1α değerlerinde preoperatif ve postoperatif anlamlı bir fark bulunmadı. İki grup arasında RsO2 değerlerinde anlamlı fark bulunmadı. Grup 2'de cerrahi memnuniyet skorları anlamlı olarak daha yüksek, kanama skorları ise anlamlı olarak daha düşüktü.
Sonuç: OKB hedefli kontrollü hipotansiyonun, serebral oksijenasyon ve oksidatif stres açısından bir dezavantaj yaratmadan daha yüksek cerrahi memnuniyet ve daha düşük kanama skorları sağladığını göstermektedir.

Keywords

Hipotansif anestezi, hipoksi, hipoksi indüklenebilir faktör, yakın kızılötesi spektroskopisi

Ethical Statement

14.11.2018 tarihli Bezmialem Vakıf Üniversitesi Klinil Araştırmalar Etik Kurulu'ndan onay alınarak yapılmştır.

Supporting Institution

Bezmialem Vakıf Üniversitesi Bilimsel Araştırmalar Projeler Koordinasyon Birimi (BAP)

Project Number

3.2019/16

Thanks

Destek ve yardımlarını esirgemeyen tüm hocalarıma bilhassa Sn Doç. Dr Hayrettin Daşkaya'ya teşekkür ederim.

Comparison of the effects of hypotensive anesthesia techniques based on systolic and mean arterial pressure on cerebral perfusion, blood oxidant-antioxidant levels and HIF-1a levels

Abstract

Purpose: This study aims to compare and evaluate changes in tissue and cerebral perfusion when systolic blood pressure (SBP) or mean arterial pressure (MAP) is used as the reference parameter to achieve controlled hypotension.
Materials and Methods: Patients scheduled for planned rhinoplasty or jaw surgery requiring controlled hypotension were included in the study. The patients were categorized into two groups: Group 1 (systolic blood pressure group) and Group 2 (mean arterial pressure group). Before anesthesia induction and emergence, levels of total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and hypoxia-inducible factor (HIF-1α) in the blood were measured. Perioperative cerebral perfusion monitoring was performed using near-infrared spectroscopy (NIRS).
Results: There was no significant difference between the two groups in preoperative and postoperative levels of TAS, TOS, OSI, and HIF-1α, which are used as indicators of oxidative stress. Similarly, there was no significant difference in RsO2 values between the groups. Surgical satisfaction scores were significantly higher in Group 2, while bleeding scores were significantly lower.
Conclusion: MAP-targeted controlled hypotension provides higher surgical satisfaction and lower bleeding scores without causing disadvantages in terms of cerebral oxygenation or oxidative stress.

Keywords

Hypotensive anesthesia, Hypoxia, Hypoxia inducible factör, Near infrared spectroscopy, Tissue perfusion

Project Number

3.2019/16

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