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Spinal anestezi uygulanan hastalarda propofol ve deksmedetomidinin hemodinamik parametreler ile serum IL-6 düzeylerine etkilerinin karşılaştırılması Türkçe

Year 2011, Volume: 8 Issue: 3, 100 - 107, 01.12.2011

Abstract

Amaç: Bu çalışmada, spinal anestezide propofol ve deksmedetomidinin intravenöz infüzyonlarının hemodinamik parametrelere ve IL-6 düzeylerine etkileri araştırıldı. Materyal ve metod: Çalışmaya 90 hasta dâhil edildi ve 3 eşit gruba ayrıldı. Tüm gruplara 15 mg bupivakain ile spinal anestezi uygulandı. Operasyon süresince Grup P'ye n=30 1 mg/kg/sa propofol infüzyonu, grup D'ye n=30 0,2 μg/kg/sa deksmedetomidin infüzyonu, Grup S'ye n=30 serum fizyolojik infüzyonu yapıldı. Grupların demografik özellikleri, motor blok ve cerrahi süreleri kaydedildi. Hastaların intraoperatif ve postoperatif hemodinamik parametreleri monitorize edildi, Ramsay sedasyon skorları, operasyon sonrası yan etkiler ve ilk analjezik verilme zamanı ile 24 saat içindeki toplam analjezik tüketim miktarları incelendi. Preoperatif ve postoperatif 4. saat sonundaki IL-6 seviyeleri araştırıldı. Bulgular: Propofol grubunda motor blok süresi daha uzun bulundu. İntraoperatif dönemde deksmedetomidin grubunda kalp atım hızı anlamlı azalırken; propofol grubunda ortalama kan basıncı ve oksijen satürasyonu anlamlı derecede azaldı. Postoperatif dönemde ise deksmedetomidin kalp atım hızını ve ortalama kan basıncını anlamlı şekilde azalttığı tespit edildi. Hem intraoperatif hem postoperatif dönemde sedasyon skorlarının, propofol grubunda deksmedetomidin grubuna göre anlamlı yüksek olduğu görüldü. Tüm gruplarda operasyondan preoperatif ve postoperatif 4. saatte IL-6 değerleri karşılaştırılmasında anlamlı fark saptanmadı. Sonuç: Sonuç olarak spinal anestezi boyunca iv. infüzyon olarak kullanılan propofol ve deksmedetomidinin benzer hemodinamik özelliklere sahip olduğu ve kontrol grubuna kıyasla blok sürelerini artırdığını ancak erken dönemde IL–6 açısından kontrol grubuna ve birbirlerine üstünlüklerinin olmadığı sonucuna varıldı. Anahtar Kelimeler: Spinal anestezi, sedasyon, propofol, deksmedetomidin, interlökin 6

References

  • ) Callesen T. Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull. 2003: 50; 18
  • ) Erdine S: Sinir Blokları. 1. Baskı. Emre Matbaacılık. İstanbul, 1993, s: 9- 10, 49- 80, 155
  • ) Kayhan Z: Klinik Anestezi 2. Baskı. Logos Yayıncılık, İstanbul, 1997
  • ) Elcicek K, Tekin M, Katı İ. The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia. J Anesth 2010; : 544–8
  • ) Küçükbayram H. Ürolojik girişimlerde spinal anestezi uygulamasında midazolam, propofol ve tiyopentalin sedasyon ve hemodinamik yönden etkilerinin karşılaştırılması. Uzmanlık tezi. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi. İstanbul. 2005.
  • ) Takemoto Y. Dose effects of propofol on hemodynamic and cytokine responses to endotoxemia in rats. J Anesth 2005; 19: 40–4.
  • ) Song XM, Wang YL, Li JG, et al. Effects of propofol on pro-inflammatory cytokines and nuclear factor kappaB during polymicrobial sepsis in rats. Mol Biol Rep. 2009; 36: 2345-51.
  • ) Corcoran TB, Engel A, Sakamoto H, et al,The effects of propofol on lipid peroxidation and inflammatory response in elective coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2004; : 592-604.
  • ) Taniguchi T, Kidani Y, Kanakura H, Takemoto Y, Yamamoto K. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in rats. Crit Care Med : 32: 1322-6.
  • ) Nishina K, Akamutsu H, Mikawa K, et al. The effects of clonidine dexmedetomidine on human neutrophil functions. Anesth Analg 1999; 88: 452-8
  • ) Can M, Gul S, Bektas S, Hanci V, Acikgoz S. Effects of dexmedetomidine or methylprednisolone on inflammatory responses in spinal cord injury. Acta Anaesthesiol Scand 2009; 53: 1068–72
  • ) Kishikawa H, Kobayashi K, Takemori K, Okabe T, I t o K , S a k a m a t o A . T h e e ff e c t s o f dexmedetomidine on human neutrophil apoptosis. Biomed Res 2008; 29: 189–94.
  • ) Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and cardiovascular, endocrine and inflammatory responses in postoperative patients needing sedation in the intensive care unit. Br J Anaesth 2001; 86: 650–6.
  • ) Qiao H, Sanders RD, Ma D, Wu X, Maze M. Sedation improves early outcome in severely septic Sprague Dawley rats. Crit Care. 2009; 13: 1-8.
  • ) Kaya FM, Yavascaoglu B, Turker G et al. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. J Can Anesth ; 57: 39–45 ) McVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children. J Clin Anest 2010; 22: 538-45
  • ) Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al- Barazangi BA, Massad IM, Al-Ghanem SM. Intravenous dexmedetomidine prolongs Bupivacaine spinal analgesia. M.E.J. Anesth 2009; 20: 225-31
  • ) Yaddanapudi S, Batra YK, Balagopal A, Nagdeve NG. Sedation in patients above 60 years of age undergoing urological surgery under spinal anesthesia: comparison of propofol and midazolam infusions. J. Postgrad Med 2007; 53: 171-5

Comparison of the effect of propofol and dexmedetomidine on hemodynamic parameters and serum IL-6 levels in patients with spinal anesthesia

Year 2011, Volume: 8 Issue: 3, 100 - 107, 01.12.2011

Abstract

Background: In this study, the effects of iv infusion of propofol and dexmedetomidine on hemodynamics and serum IL-6 levels in spinal anesthesia were evaulated. Methods: Ninety patients were enrolled to the study and divided to 3 equal groups. patients. Spinal anesthesia with 15 mg was applied to all groups. Group P n=30 received 1 mg/kg/h propofol infusion, Group D n=30 received 0.2 μg/kg/h dexmedetomidine infusion, Group S n=30 received serum saline infusion during operation. Demographic parameters, motor block and operation times were recorded. Patients' intraoperative and postoperative hemodynamic parameters were monitorised; Ramsay sedation scale, postoperative side effects, first analgesic time and 24th hour total analgesic consumption were recorded. IL-6 levels in preoperative and postoperative 4th hour were evaulated. Results: Motor block time were longer in propofol group. In intraoperative period heart rate were significantly decreased in dexmedetomidine group and mean blood pressure and oxygen saturation significantly decreased in propofol group. In postoperative period heart rate and mean blood pressure were significantly decreased in dexmedetomidine group. Intraoperative and postoperative sedation scores were staistically higher in propofol group. There were no statistically significant differences between groups in serum IL-6 levels in preoperative and postoperative 4th hour. Conclusions: In conclusion, iv infusions of propofol and dexmedetomidine in spinal anesthesia have found to be similiar effects on hemodynamics and prolonged block time. However, there was no superiority on control group and between each other in early postoperative period among IL-6 levels

References

  • ) Callesen T. Inguinal hernia repair: anaesthesia, pain and convalescence. Dan Med Bull. 2003: 50; 18
  • ) Erdine S: Sinir Blokları. 1. Baskı. Emre Matbaacılık. İstanbul, 1993, s: 9- 10, 49- 80, 155
  • ) Kayhan Z: Klinik Anestezi 2. Baskı. Logos Yayıncılık, İstanbul, 1997
  • ) Elcicek K, Tekin M, Katı İ. The effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia. J Anesth 2010; : 544–8
  • ) Küçükbayram H. Ürolojik girişimlerde spinal anestezi uygulamasında midazolam, propofol ve tiyopentalin sedasyon ve hemodinamik yönden etkilerinin karşılaştırılması. Uzmanlık tezi. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi. İstanbul. 2005.
  • ) Takemoto Y. Dose effects of propofol on hemodynamic and cytokine responses to endotoxemia in rats. J Anesth 2005; 19: 40–4.
  • ) Song XM, Wang YL, Li JG, et al. Effects of propofol on pro-inflammatory cytokines and nuclear factor kappaB during polymicrobial sepsis in rats. Mol Biol Rep. 2009; 36: 2345-51.
  • ) Corcoran TB, Engel A, Sakamoto H, et al,The effects of propofol on lipid peroxidation and inflammatory response in elective coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2004; : 592-604.
  • ) Taniguchi T, Kidani Y, Kanakura H, Takemoto Y, Yamamoto K. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in rats. Crit Care Med : 32: 1322-6.
  • ) Nishina K, Akamutsu H, Mikawa K, et al. The effects of clonidine dexmedetomidine on human neutrophil functions. Anesth Analg 1999; 88: 452-8
  • ) Can M, Gul S, Bektas S, Hanci V, Acikgoz S. Effects of dexmedetomidine or methylprednisolone on inflammatory responses in spinal cord injury. Acta Anaesthesiol Scand 2009; 53: 1068–72
  • ) Kishikawa H, Kobayashi K, Takemori K, Okabe T, I t o K , S a k a m a t o A . T h e e ff e c t s o f dexmedetomidine on human neutrophil apoptosis. Biomed Res 2008; 29: 189–94.
  • ) Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and cardiovascular, endocrine and inflammatory responses in postoperative patients needing sedation in the intensive care unit. Br J Anaesth 2001; 86: 650–6.
  • ) Qiao H, Sanders RD, Ma D, Wu X, Maze M. Sedation improves early outcome in severely septic Sprague Dawley rats. Crit Care. 2009; 13: 1-8.
  • ) Kaya FM, Yavascaoglu B, Turker G et al. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. J Can Anesth ; 57: 39–45 ) McVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children. J Clin Anest 2010; 22: 538-45
  • ) Al-Mustafa MM, Badran IZ, Abu-Ali HM, Al- Barazangi BA, Massad IM, Al-Ghanem SM. Intravenous dexmedetomidine prolongs Bupivacaine spinal analgesia. M.E.J. Anesth 2009; 20: 225-31
  • ) Yaddanapudi S, Batra YK, Balagopal A, Nagdeve NG. Sedation in patients above 60 years of age undergoing urological surgery under spinal anesthesia: comparison of propofol and midazolam infusions. J. Postgrad Med 2007; 53: 171-5
There are 17 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Orhan Beyazoğlu This is me

Şaban Yalçın This is me

Harun Aydoğan This is me

Mahmut Alp Karahan This is me

Evren Büyükfırat This is me

Tekin Bilgiç This is me

Fadile Zeyrek This is me

Publication Date December 1, 2011
Published in Issue Year 2011 Volume: 8 Issue: 3

Cite

Vancouver Beyazoğlu O, Yalçın Ş, Aydoğan H, Karahan MA, Büyükfırat E, Bilgiç T, Zeyrek F. Spinal anestezi uygulanan hastalarda propofol ve deksmedetomidinin hemodinamik parametreler ile serum IL-6 düzeylerine etkilerinin karşılaştırılması Türkçe. Harran Üniversitesi Tıp Fakültesi Dergisi. 2011;8(3):100-7.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty