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Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması

Year 2008, Volume: 25 Issue: 2, 57 - 66, 29.12.2009

Abstract

Bu çalışmada desfluran ve sevofluranın solunum mekaniklerine etkilerini, sigara içen ve içmeyen hasta gruplarında değerlendirmeyi amaçladık.
Çalışmamıza 30-55 yaş arası, ASA I-II, akciğer hastalığı olmayan 100 hasta alındı. Sigara içen ve içmeyen gruplarda hastaların yarısında desfluran diğer yarısında sevofluran kullanılarak 25’er kişilik 4 grup oluşturuldu. Standart indüksiyon sonrası idamede O2/kuru hava karışımı içinde %6 desfluran veya %2 sevofluran uygulandı. Hastaların dinamik kompliyans (DK), hava yolu direnci (HYD cmH2O/L/sn) ve tepe hava yolu basıncı değerleri indüksiyon sonrası, entübasyondan sonraki 5., 25. dakikalar ve cerrahi sonunda kaydedildi.
Gruplar arasında demografik ve hemodinamik parametreler yönünden fark bulunmadı. Desfluran grubunda sigara içmeyenlerde entübasyon sonrası 5. dk da HYD (7.36±1.18.) indüksiyon dönemine (6.56±1.08) göre yüksekken (p<0.01), 25.dk değeri (6.36±1.35) başlangıç değerinden farksızdı. Sigara içenlerdeyse 5. dakika ve 25. dakika değerleri başlangıca göre yüksekti (sırasıyla p<0.001, p<0.01). Sigara içmeyenlerde HYD 5 ve 25. dakikalarda içenlere göre düşüktü (p<0.001). Sevofluran grubunda sigara içen ve içmeyenlerde 5. ve 25. dakikalarda HYD indüksiyon öncesine göre düşüktü (p<0.001). Sigara içen ve içmeyen grup arasında fark yoktu. Sevofluran ve desfluran grupları karşılaştırmasında; bazal değerler hariç tüm ölçüm dönemlerinde, desfluran grubunda HYD daha yüksekti. Kompliyans ve tepe basıncı değişimleri HYD’deki değişimlerle uyumluydu.
Literatürde iki ajanın karşılaştırılmış üç çalışmanın ikisinde sevofluranın yanıtları baskılamada üstün olduğu, birinde fark olmadığı bildirilmiştir. Sigara içiminin etkisi araştırılmamıştır. Çalışmamızda sadece iki inhalasyon ajanını karşılaştırdığımızda, entübasyona bronkokonstrüktör yanıtlar desfluran grubunda daha şiddetliydi. Sevofluran grubunda sigara içen ve içmeyenler arasında fark bulunmazken, desfluran grubunda sigara içenlerdeki yanıtlar daha fazla idi. Sonuçta, sigara içen ve bronşiyal hiperaktivitesi olan hastalarda sevofluranın desflurana tercih edilebileceği kanısına varıldı.



The Comparison of Effects of Sevoflurane and Desflurane on Respiratory Mechanics in Smokers and Nonsmokers
In our research we aimed to evaluate effects of sevoflurane and desflurane on respiratory mechanics in smokers and nonsmokers.
100 patients who were with an age between 30 and 55 years, in ASA I-II risk group and who does not have any pulmonary diseases were participated. With using Sevoflurane and desflurane randomly in smokers and nonsmokers patient groups, 4 patient groups that each has 25 patients were constituted. After a standart anesthetic induction, desflurane of %6 and sevoflurane of %2 in O2/dry air of %50 applied for maintenance. Dynamic compliance, airway resistance and peak airway pressure of patients were recorded after induction (ind.), in the 5th (ent.5) and 25th (ent.25) after intubation.
Demographic characteristics between patient groups did not differ significantly. In nonsmokers in desflurane group, airway resistance values in ent.25 (6.36±1.35) were not different than baseline value, whereas airway resistance in ent.5 (7.36±1.18.) were greater than ind. period (6.56±1.08; p<0.01). In smokers, either 5th or 25th minute values were greater than baseline value (p<0.001, p<0.01, respectively). Airway resistance (in ent.5 and ent.25) of smokers in desflurane group were greater than nonsmokers (p<0.001). In the sevoflurane group the airway resistance values at the 5th. and 25th. minutes were either in the smokers or nonsmokers lower than the baseline values (p<0.001). Values between smokers and nonsmokers did not differ from each other. Airway resistance in desflurane group were greater and compliance in desflurane group were lower than in sevoflurane group in all measurement periods except for baseline values. The changes in Dynamic compliance and peak airway pressure were compatible with the changes in the airway resistance. We found three articles who have comparised these two agents, and in two of them it is reported that sevoflurane is better than desflurane in supressing the airway responses, in the other one it was not found any difference. The effects of smoking is not studied.
We found that bronchoconstriction responses to intubation in desflurane group were more severe than the responses in sevoflurane group. The responses in smokers did not differ from nonsmokers in sevoflurane group, whereas these responses in smokers were greater than in nonsmokers in desflurane group. In conclusion we decided that; in patients, who are smokers or have an increrased bronchial hiperactivity, it would a better choise to use sevoflurane than desflurane.

References

  • Rooke GA, Choi J-H, Bishop MJ. The effect of isoflurane, halothane, sevoflurane and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiology 1997; 86: 1294–1299.
  • Goff MJ, Arain SH, Ficke DJ, et al. Absence of bronchodilation during desflurane anaesthesia: a comparison to sevoflurane and thiopental. Anesthesiology 2000; 93: 404–408.
  • TerRiet MF, De Souza GJ, Jacobs JS. Which is the pungent: Isoflurane, sevoflurane or desflurane? Br J Anaesth 2000; 85: 305–307.
  • McKay RE, Bostrom A, Balea MC, et al. Airway responses during desflurane versus sevoflurane administration via a laryngeal mask airway in smokers. Anesth Analg 2006; 103: 1147–1154.
  • Eshima R, Maurer A, Lin B, et al. A comparison of airway responses during desflurane and sevoflurane administration via a laryngeal mask airway for maintenance of anesthesia. Anesth Analg 2003; 96: 701–705.
  • Mahmoud NA, Rose DJA, Laurence AS. Desflurane or sevoflurane for gynaecological day-case anaesthesia with spontaneous respiration? Anaesthesia 2001; 56: 171–174.
  • Ebert TJ, Muzi M: Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers: A comparison with isoflurane. Anesthesiology 1993; 79: 444–453.
  • Dikmen Y, Eminoglu E, Salihoglu Z, et al. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 2003; 58: 745–748.
  • Sıvacı R, Orman A, Yılmazer M, et al. The effect of low- flow sevoflurane and desflurane on pulmonary mechanics during laparoscopic surgery. Journal of Laparoendoscopıc Advanced Surgical Techniques. 2005; 15: 125–129.
  • Volta CA, Alvisi V, Petrini S, et al. The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstructive pulmonary disease. Anesth Analg 2005; 100: 348–353.
  • Myles PS. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery; smokers versus non-smokers. Anesthesiology 2002; 97: 842–847.
  • Dennis A, Curan J, Sherriff J, et al. Effects of passive and active smoking on induction of anaesthesia. Br J Anaesth 1994; 73: 450–452.
  • Doi M, Ikeda K: Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane, enflurane, isoflurane and sevoflurane. Can J Anaesth 1993; 40: 122–126.
  • Tanaka S, Tsuchida H, Nakabayashi K, et al: The effects of sevoflurane, isoflurane, halothane and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans. Anesth Analg 1996; 82: 821–826.
  • Ebert TJ, Muzi M, Lopatka JW: Neurocirculatory responses to sevoflurane in humans: A comparison to desflurane. Anesthesiology 1995; 83: 88–95.
  • Moore Ma, Weiskopf RB, Eger EI II, et al. Rapid 1% increases of end-tidal desflurane concentration to greater than 5% transiently increase heart rate and blood pressure in humans. Anesthesiology 1994; 81: 94–98.
  • Klock PA, Czeslick EG, Klafta JM, et al. The effect of sevoflurane and desflurane on upper airway reactivity. Anesthesiology 2001; 94: 963–967.
  • Eames WO, Rooke GA, Wu RSC, et al. Comparison of the effects of etomidate, propofol, and thiopental on respiratory resistance after tracheal intubation. Anesthesiology 1996; 84: 1307–1311.
  • Habre W, Scalfora P, Sims C, et al. Respiratory mechanics during sevoflurane anesthesia in children with and without asthma. Anesth Analg 1999; 89: 1177–1181.
Year 2008, Volume: 25 Issue: 2, 57 - 66, 29.12.2009

Abstract

References

  • Rooke GA, Choi J-H, Bishop MJ. The effect of isoflurane, halothane, sevoflurane and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiology 1997; 86: 1294–1299.
  • Goff MJ, Arain SH, Ficke DJ, et al. Absence of bronchodilation during desflurane anaesthesia: a comparison to sevoflurane and thiopental. Anesthesiology 2000; 93: 404–408.
  • TerRiet MF, De Souza GJ, Jacobs JS. Which is the pungent: Isoflurane, sevoflurane or desflurane? Br J Anaesth 2000; 85: 305–307.
  • McKay RE, Bostrom A, Balea MC, et al. Airway responses during desflurane versus sevoflurane administration via a laryngeal mask airway in smokers. Anesth Analg 2006; 103: 1147–1154.
  • Eshima R, Maurer A, Lin B, et al. A comparison of airway responses during desflurane and sevoflurane administration via a laryngeal mask airway for maintenance of anesthesia. Anesth Analg 2003; 96: 701–705.
  • Mahmoud NA, Rose DJA, Laurence AS. Desflurane or sevoflurane for gynaecological day-case anaesthesia with spontaneous respiration? Anaesthesia 2001; 56: 171–174.
  • Ebert TJ, Muzi M: Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers: A comparison with isoflurane. Anesthesiology 1993; 79: 444–453.
  • Dikmen Y, Eminoglu E, Salihoglu Z, et al. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 2003; 58: 745–748.
  • Sıvacı R, Orman A, Yılmazer M, et al. The effect of low- flow sevoflurane and desflurane on pulmonary mechanics during laparoscopic surgery. Journal of Laparoendoscopıc Advanced Surgical Techniques. 2005; 15: 125–129.
  • Volta CA, Alvisi V, Petrini S, et al. The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstructive pulmonary disease. Anesth Analg 2005; 100: 348–353.
  • Myles PS. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery; smokers versus non-smokers. Anesthesiology 2002; 97: 842–847.
  • Dennis A, Curan J, Sherriff J, et al. Effects of passive and active smoking on induction of anaesthesia. Br J Anaesth 1994; 73: 450–452.
  • Doi M, Ikeda K: Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane, enflurane, isoflurane and sevoflurane. Can J Anaesth 1993; 40: 122–126.
  • Tanaka S, Tsuchida H, Nakabayashi K, et al: The effects of sevoflurane, isoflurane, halothane and enflurane on hemodynamic responses during an inhaled induction of anesthesia via a mask in humans. Anesth Analg 1996; 82: 821–826.
  • Ebert TJ, Muzi M, Lopatka JW: Neurocirculatory responses to sevoflurane in humans: A comparison to desflurane. Anesthesiology 1995; 83: 88–95.
  • Moore Ma, Weiskopf RB, Eger EI II, et al. Rapid 1% increases of end-tidal desflurane concentration to greater than 5% transiently increase heart rate and blood pressure in humans. Anesthesiology 1994; 81: 94–98.
  • Klock PA, Czeslick EG, Klafta JM, et al. The effect of sevoflurane and desflurane on upper airway reactivity. Anesthesiology 2001; 94: 963–967.
  • Eames WO, Rooke GA, Wu RSC, et al. Comparison of the effects of etomidate, propofol, and thiopental on respiratory resistance after tracheal intubation. Anesthesiology 1996; 84: 1307–1311.
  • Habre W, Scalfora P, Sims C, et al. Respiratory mechanics during sevoflurane anesthesia in children with and without asthma. Anesth Analg 1999; 89: 1177–1181.
There are 19 citations in total.

Details

Primary Language English
Journal Section Surgery Medical Sciences
Authors

Ali Ekşi This is me

F. Emre Üstün This is me

Sezgin Bilgin This is me

İ. Serhat Kocamanoğlu This is me

Elif Bengi Şener This is me

Binnur Sarıhasan This is me

Publication Date December 29, 2009
Submission Date December 25, 2009
Published in Issue Year 2008 Volume: 25 Issue: 2

Cite

APA Ekşi, A., Üstün, F. E., Bilgin, S., Kocamanoğlu, İ. S., et al. (2009). Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması. Journal of Experimental and Clinical Medicine, 25(2), 57-66. https://doi.org/10.5835/jecm.v25i2.1050
AMA Ekşi A, Üstün FE, Bilgin S, Kocamanoğlu İS, Bengi Şener E, Sarıhasan B. Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması. J. Exp. Clin. Med. December 2009;25(2):57-66. doi:10.5835/jecm.v25i2.1050
Chicago Ekşi, Ali, F. Emre Üstün, Sezgin Bilgin, İ. Serhat Kocamanoğlu, Elif Bengi Şener, and Binnur Sarıhasan. “Sigara İçen Ve İçmeyen Hastalarda Desfluran Ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması”. Journal of Experimental and Clinical Medicine 25, no. 2 (December 2009): 57-66. https://doi.org/10.5835/jecm.v25i2.1050.
EndNote Ekşi A, Üstün FE, Bilgin S, Kocamanoğlu İS, Bengi Şener E, Sarıhasan B (December 1, 2009) Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması. Journal of Experimental and Clinical Medicine 25 2 57–66.
IEEE A. Ekşi, F. E. Üstün, S. Bilgin, İ. S. Kocamanoğlu, E. Bengi Şener, and B. Sarıhasan, “Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması”, J. Exp. Clin. Med., vol. 25, no. 2, pp. 57–66, 2009, doi: 10.5835/jecm.v25i2.1050.
ISNAD Ekşi, Ali et al. “Sigara İçen Ve İçmeyen Hastalarda Desfluran Ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması”. Journal of Experimental and Clinical Medicine 25/2 (December 2009), 57-66. https://doi.org/10.5835/jecm.v25i2.1050.
JAMA Ekşi A, Üstün FE, Bilgin S, Kocamanoğlu İS, Bengi Şener E, Sarıhasan B. Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması. J. Exp. Clin. Med. 2009;25:57–66.
MLA Ekşi, Ali et al. “Sigara İçen Ve İçmeyen Hastalarda Desfluran Ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması”. Journal of Experimental and Clinical Medicine, vol. 25, no. 2, 2009, pp. 57-66, doi:10.5835/jecm.v25i2.1050.
Vancouver Ekşi A, Üstün FE, Bilgin S, Kocamanoğlu İS, Bengi Şener E, Sarıhasan B. Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması. J. Exp. Clin. Med. 2009;25(2):57-66.