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KALP DIŞI AMELİYAT UYGULANAN ÇOCUKLARDA GENEL ANESTEZİDE KULLANILAN İLAÇLARIN KALP ARİTMOJENLİĞİNE ETKİLERİ

Year 2017, Volume: 8 Issue: 30, 27 - 34, 01.06.2017
https://doi.org/10.17944/mkutfd.323341

Abstract

Amaç:Çalışmamızda kalp dışı ameliyatlarda
genel anestezide kullanılan ilaçların kalp ritmine etkisini değerlendirmeyi
planladık. Bu amaçla atriyal aritmilerin göstergesi olan P dalga
dispersiyonunu, ventriküleraritmojenliği belirleyen QT dispersiyonunu ölçerek
anestezik ilaçların kalp ritmi üzerine etkilerini araştırdık.     



Gereç ve Yöntem:Çalışmamıza Dr. Sami Ulus Kadın
Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi’nde
2013-2014 yılları arasında Çocuk Cerrahisi servisinde kalp dışı ameliyatlarda
genel anestezi uygulanan 0-18 yaş arası 71 gönüllü hasta alındı. Kalp hastalığı
olan, QT uzamasına neden olabilecek ilaç kulanım öyküsü olan hastalar çalışma
dışı bırakıldı. Genel anestezi  sırasında
kullanılan anestezik ilaçlar  propofol, fentanil
ve  sevofluran idi. Bazı hastalara
roküronyum, neostigmin, ondansetron, atropin uygulandı. EKG kayıtları
ameliyattan 30 dk öncesinde ve ameliyattan 60 dk sonra elde edildi. P dalgası,
QT intervali ve QTc  12 derivasyondaki
minimum ve maksimum süreleri ile 
dispersiyonları hesaplandı.



Bulgular: Tüm olguların Pmin ve PR intervali
ameliyat sonrasında daha yüksek bulundu. PDD ve QTc dispersiyonu ameliyat
sonrası daha düşük idi. Roküronyum almayan hastaların Pmin ve PR intervali
değerlerinde ameliyat sonrasında artış olduğu gözlendi. Roküronyum almayan
hastaların P dalga dispersiyonunda ameliyat sonrasında azalma saptandı.
Roküronyum alan ve almayan hastaların ameliyat sonrasında EKG’lerin
değerlendirilmesinde herhangi bir fark gözlenmedi.



Sonuç:Çalışmamızda propofol, sevofluran ve
fentanilin çocuklarda rutin anestezide kullanılmasında herhangi bir sakınca
olmadığını tespit ettik. Kas gevşetici olarak kullanılan roküronyum alan ve
almayan grup arasında bir farklılık saptamadık. Bu nedenle roküronyum çocuk
hastalarda genel anestezide güvenle kullanılabileceğini saptadık.

References

  • 1. Staikou C, Stamelos M, Stavroulaki E. Impact of anaestheticdrugsandadjuvants on ECG markers of torsadogenicity. British Journal of Anaesthesia 2014: 112 (2): 217-30
  • 2. Ugur B, Yuksel H, Odabasi AR, Ogurlu M, Onbasili A, Aydin ON. Effects of intravenouslidocaine on QTdand HRV changes due to tracheal intubation during sevoflurane induction. IntHeartJ.2006;47:597-606.
  • 3. Owczuk R, Wujtewicz MA, Sawicka W, Polak-Krzeminska A, Suszynska-Mosiewicz A, Raczynska K,et al. Effect of anaestheticagents on p-wavedispersion on theelectrocardiogram: comparison of propofolanddesflurane. ClinExpPharmacolPhysiol2008;35:1071-6.
  • 4. Hanci V, Aydin M, Yurtlu BS, Ayoğlu H, Okyay RD, Taş E,et al. AnesthesiaInductionWithSevofluraneandPropofol: Evaluation of P-waveDispersion, QT andCorrected QT Intervals.Kaohsiung J MedSci. 2010 Sep;26(9):470-7.
  • 5. Hancı V, Yurtlu S, Karabağ T, Okyay D, Hakimoğlu S, Kayhan G. Effects of esmolol, lidocaineandfentanyl on P wavedispersion, QT, QTcintervalsandhemodynamicresponsestoendotrachealintubationduringpropofolinduction: a comparativestudy. RevBrasAnestesiol. 2013;63(3):235-244
  • 6. Pljevic D, Smalcelj A, Durakovic Z, Goldner V. QT dispersion, Daily variations, QT interval adaptation and late potentials as risk markersforventriculartachycardia. EurHeart J 1997; 16: 1343-1349.
  • 7. Buja G, Mioreeli M, Turrini P, Melacini P, Nava A. Comparison of QT dipersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993; 72: 973-976.
  • 8. Tutar HE, Ocal B, Imamoglu A, Atalay S. Dispersion of QT andQTcinterval in healthychildren, andeffects of sinüs arrhythmia on QT dispersion. Heart 1998; 80: 77-79.
  • 9. Gurkan Y, Canatay H, Agacdiken A, Ural E, Toker K. Effects of halothaneandsevoflurane on QT dispersion in paediatricpatients. PaediatrAnaesth 2003; 13: 223-227.
  • 10. Aypar E, Karagoz AH, Ozer S, Celiker A, Ocal T. Theeffects of sevofluraneanddesfluraneanesthesia on QTcintervalandcardiacrhythm in children. PaediatrAnaesth 2007; 17: 563-7
  • 11. Hume-Smith HV, Sanatani S, Lim J, Chau A, Whyte SD.Theeffect of propofolconcentration on dispersion of myocardialrepolarization in children. AnesthAnalg 2008;107: 806-10.
  • 12. Uyarel H, Kasikcioglu H, Dayi SU, Tartan Z, Karabulut A, Uzunlar B, et al. Anxietyand P wavedispersion in a healthyyoungpopulation. Cardiology 2005; 104: 162-8.
  • 13. Yavuzkir M, Atmaca M, Dagli N, Balin M, Karaca I, Mermi O,et al. P-wavedispersion in panicdisorder. Psychosom. Med. 2007; 69: 344-7.
  • 14. Kosar F, Aksoy Y, Ari F, Keskin L, Sahin I. P-wavedurationanddispersion in obesesubjects. Ann. NoninvasiveElectrocardiol. 2008;13: 3-7.
  • 15. Alphin RS, Martens JR, Dennis DM. Frequency-dependenteffects of propofol on atrioventricularnodalconduction in guineapigisolatedheart. Mechanismandpotentialantidysrhythmicproperties. Anesthesiology 1995; 83: 382-94
  • 16. Nagashima Y, Furukawa Y, Hirose M, Chiba S. Cardiaceffects of propofol and its interaction with autonomic nervous system in isolated, cross-circulated canine atria. J. Anaesth. 1999; 13: 34-9.
  • 17. Yamada M, Hatakeyama N, Shibuya N, Momose Y, Yamazaki M.Mechanism of QT intervalprolongationinducedbysevoflurane in guinea-pigventricularmyocyte. Masui 2003;52: 482-8.
  • 18. Blair JR, Pruett JK, IntronaRP,AdamsRJ, Balser JS. Cardiacelectrophysiologiceffects of fentanylandsufentanil in canine cardiacPurkinjefibers. Anesthesiology 1989; 71: 565-70
  • 19. Kleinsasser A, Kuenszberg E, Loeckinger A, Keller C, Hoermann C, Lindner KH, et al. Sevoflurane, but not propofol, significantlyprolongsthe Q-T interval. AnesthAnalg 2000; 90: 25-7
  • 20. Kleinsasser A, Loeckinger A, Lindner KH, Keller C, Boehler M, Puehringer F. Reversingsevoflurane-associatedQTcprolongationbychangingtopropofol. Anaesthesia 2001; 56: 248-50
  • 21. Han DW, Park K, Jang SB, Kern SE. Modelingtheeffect of sevoflurane on corrected QT prolongation: a pharmacodynamicanalysis. Anesthesiology 2010; 113: 806-11
  • 22. Loeckinger A, Kleinsasser A, Maier S, Furtner B, Keller C, Kuehbacher et al. Sustainedprolongation of the QTc interval after anesthesia with sevoflurane in infants during the first 6 months of life. Anesthesiology 2003; 9: 639-642. 23. Maier S, Kleinsasser A, Keller C, Kühbacher G, Löckinger A. QT prolongationundersevoflurane in infants. PaediatrAnaesth 2002; 12: 826. 24. Kweon TD, Nam SB, Chang CH, Kim MS, Lee JS, Shin CS,et al. Theeffect of bolusadministration of remifentanil on QTcintervalduringinduction of sevofluraneanaesthesia. Anaesthesia 2008; 63: 347-51
  • 25. Johnston AJ, Hall JM, Levy DM. Anaesthesiawithremifentanilandrocuroniumforcaesareansection in a patientwithlong-QT syndromeand an automaticimplantablecardioverterdefibrillator. Int J ObstetAnesth 2000; 9: 133-6
  • 26. Benedict CR, Arbogast R, Martin L, Patton L, Morrill B, Hahne W. Single-blindstudy of theeffects of intravenousdolasetronmesylateversusondansetron on electrocardiographicparameters. J CardiovascPharmacol. 1996;28(1):53-9.
Year 2017, Volume: 8 Issue: 30, 27 - 34, 01.06.2017
https://doi.org/10.17944/mkutfd.323341

Abstract

References

  • 1. Staikou C, Stamelos M, Stavroulaki E. Impact of anaestheticdrugsandadjuvants on ECG markers of torsadogenicity. British Journal of Anaesthesia 2014: 112 (2): 217-30
  • 2. Ugur B, Yuksel H, Odabasi AR, Ogurlu M, Onbasili A, Aydin ON. Effects of intravenouslidocaine on QTdand HRV changes due to tracheal intubation during sevoflurane induction. IntHeartJ.2006;47:597-606.
  • 3. Owczuk R, Wujtewicz MA, Sawicka W, Polak-Krzeminska A, Suszynska-Mosiewicz A, Raczynska K,et al. Effect of anaestheticagents on p-wavedispersion on theelectrocardiogram: comparison of propofolanddesflurane. ClinExpPharmacolPhysiol2008;35:1071-6.
  • 4. Hanci V, Aydin M, Yurtlu BS, Ayoğlu H, Okyay RD, Taş E,et al. AnesthesiaInductionWithSevofluraneandPropofol: Evaluation of P-waveDispersion, QT andCorrected QT Intervals.Kaohsiung J MedSci. 2010 Sep;26(9):470-7.
  • 5. Hancı V, Yurtlu S, Karabağ T, Okyay D, Hakimoğlu S, Kayhan G. Effects of esmolol, lidocaineandfentanyl on P wavedispersion, QT, QTcintervalsandhemodynamicresponsestoendotrachealintubationduringpropofolinduction: a comparativestudy. RevBrasAnestesiol. 2013;63(3):235-244
  • 6. Pljevic D, Smalcelj A, Durakovic Z, Goldner V. QT dispersion, Daily variations, QT interval adaptation and late potentials as risk markersforventriculartachycardia. EurHeart J 1997; 16: 1343-1349.
  • 7. Buja G, Mioreeli M, Turrini P, Melacini P, Nava A. Comparison of QT dipersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993; 72: 973-976.
  • 8. Tutar HE, Ocal B, Imamoglu A, Atalay S. Dispersion of QT andQTcinterval in healthychildren, andeffects of sinüs arrhythmia on QT dispersion. Heart 1998; 80: 77-79.
  • 9. Gurkan Y, Canatay H, Agacdiken A, Ural E, Toker K. Effects of halothaneandsevoflurane on QT dispersion in paediatricpatients. PaediatrAnaesth 2003; 13: 223-227.
  • 10. Aypar E, Karagoz AH, Ozer S, Celiker A, Ocal T. Theeffects of sevofluraneanddesfluraneanesthesia on QTcintervalandcardiacrhythm in children. PaediatrAnaesth 2007; 17: 563-7
  • 11. Hume-Smith HV, Sanatani S, Lim J, Chau A, Whyte SD.Theeffect of propofolconcentration on dispersion of myocardialrepolarization in children. AnesthAnalg 2008;107: 806-10.
  • 12. Uyarel H, Kasikcioglu H, Dayi SU, Tartan Z, Karabulut A, Uzunlar B, et al. Anxietyand P wavedispersion in a healthyyoungpopulation. Cardiology 2005; 104: 162-8.
  • 13. Yavuzkir M, Atmaca M, Dagli N, Balin M, Karaca I, Mermi O,et al. P-wavedispersion in panicdisorder. Psychosom. Med. 2007; 69: 344-7.
  • 14. Kosar F, Aksoy Y, Ari F, Keskin L, Sahin I. P-wavedurationanddispersion in obesesubjects. Ann. NoninvasiveElectrocardiol. 2008;13: 3-7.
  • 15. Alphin RS, Martens JR, Dennis DM. Frequency-dependenteffects of propofol on atrioventricularnodalconduction in guineapigisolatedheart. Mechanismandpotentialantidysrhythmicproperties. Anesthesiology 1995; 83: 382-94
  • 16. Nagashima Y, Furukawa Y, Hirose M, Chiba S. Cardiaceffects of propofol and its interaction with autonomic nervous system in isolated, cross-circulated canine atria. J. Anaesth. 1999; 13: 34-9.
  • 17. Yamada M, Hatakeyama N, Shibuya N, Momose Y, Yamazaki M.Mechanism of QT intervalprolongationinducedbysevoflurane in guinea-pigventricularmyocyte. Masui 2003;52: 482-8.
  • 18. Blair JR, Pruett JK, IntronaRP,AdamsRJ, Balser JS. Cardiacelectrophysiologiceffects of fentanylandsufentanil in canine cardiacPurkinjefibers. Anesthesiology 1989; 71: 565-70
  • 19. Kleinsasser A, Kuenszberg E, Loeckinger A, Keller C, Hoermann C, Lindner KH, et al. Sevoflurane, but not propofol, significantlyprolongsthe Q-T interval. AnesthAnalg 2000; 90: 25-7
  • 20. Kleinsasser A, Loeckinger A, Lindner KH, Keller C, Boehler M, Puehringer F. Reversingsevoflurane-associatedQTcprolongationbychangingtopropofol. Anaesthesia 2001; 56: 248-50
  • 21. Han DW, Park K, Jang SB, Kern SE. Modelingtheeffect of sevoflurane on corrected QT prolongation: a pharmacodynamicanalysis. Anesthesiology 2010; 113: 806-11
  • 22. Loeckinger A, Kleinsasser A, Maier S, Furtner B, Keller C, Kuehbacher et al. Sustainedprolongation of the QTc interval after anesthesia with sevoflurane in infants during the first 6 months of life. Anesthesiology 2003; 9: 639-642. 23. Maier S, Kleinsasser A, Keller C, Kühbacher G, Löckinger A. QT prolongationundersevoflurane in infants. PaediatrAnaesth 2002; 12: 826. 24. Kweon TD, Nam SB, Chang CH, Kim MS, Lee JS, Shin CS,et al. Theeffect of bolusadministration of remifentanil on QTcintervalduringinduction of sevofluraneanaesthesia. Anaesthesia 2008; 63: 347-51
  • 25. Johnston AJ, Hall JM, Levy DM. Anaesthesiawithremifentanilandrocuroniumforcaesareansection in a patientwithlong-QT syndromeand an automaticimplantablecardioverterdefibrillator. Int J ObstetAnesth 2000; 9: 133-6
  • 26. Benedict CR, Arbogast R, Martin L, Patton L, Morrill B, Hahne W. Single-blindstudy of theeffects of intravenousdolasetronmesylateversusondansetron on electrocardiographicparameters. J CardiovascPharmacol. 1996;28(1):53-9.
There are 24 citations in total.

Details

Subjects Health Care Administration
Journal Section Original Articles
Authors

Tamer Yoldaş This is me

Publication Date June 1, 2017
Submission Date December 11, 2016
Acceptance Date April 20, 2017
Published in Issue Year 2017 Volume: 8 Issue: 30

Cite

Vancouver Yoldaş T. KALP DIŞI AMELİYAT UYGULANAN ÇOCUKLARDA GENEL ANESTEZİDE KULLANILAN İLAÇLARIN KALP ARİTMOJENLİĞİNE ETKİLERİ. mkutfd. 2017;8(30):27-34.