Evaluation of BIS Monitorization Using Sevoflurane Versus Desflurane During Extracorporeal Circulation in Cardiovascular Surgery Anesthesia

Yıl 2018, Cilt: 40 Sayı: 3, 44 - 52, 01.09.2018

Ebru Karakoç İlkay Ceylan , Belkıs Tanrıverdi

https://doi.org/10.20515/otd.405497

Öz

The risk of awareness in cardiac surgery is 5 times higher
than in other surgeries. The use of cardiopulmonary bypass pump may lead to
inadequate anesthesia depth. In this 
study we aimed to evaluate the awareness and the depth of anesthesia with BIS
monitorization in cardiovascular anesthesia. This study was designed as a
propective randomised controled trial. Sixty patients who underwent coronary
artery bypass grafting and heart valve surgery were included in the study. The patients were divided into 2 groups randomly. Maintenance of anesthesia provided by 2-4%
sevoflurane to Group 1 and 5-8% desflurane to Group 2 including extracorporeal
circulation period. Anesthesia depth adjusted according to hemodynamic and
clinical values. Patients in both groups were followed with BIS monitoring. In
all study groups, fixed dose of remifentanil infusion was initiated following
induction of anesthesia. Patients hemodynamic data, BIS measurements were
recorded during the operation. Considering the ease of recognitions and recall,
from the beginning of extracorporeal circulation, the dog barking was
constantly listened with earphones by patients to assess alertness and
awareness.  On the second postoperative
day, patients were asked whether they remember anything about operation and dog
barking. The obtained data were evaluated with SPSS package program. Similar hemodynamic data and BIS measurements were
obtained in both groups in our study. Postoperative awareness and remembrance
were not found in either group. In cardiovascular surgery, it was observed that
the depth of anesthesia determined by hemodynamic data is correlated with BIS,
but shifted to deeper levels of anesthesia. Although complications were not
seen in the patients, it was concluded that the adjusting the level of
anesthesia with BIS could be safer.

Anahtar Kelimeler

Awareness, BIS monitorization, cardiopulmonary bypass

Kardiovasküler Cerrahi Anestezisinde Ekstrakorporeal Dolaşımda Sevofluran ve Desfluran Kullanımının BIS Monitorizasyonu ile Değerlendirilmesi

Öz

Kardiyovasküler cerrahide anestezi sırasında
farkındalık diğer cerrahilere göre 5 kat fazladır. Kalp akciğer pompası
kullanımı yetersiz anestezi derinliğine sebep olabilir. Çalışmamaızda
sevofloran ve desfloran ile uygulanan kardiak anestezide BİS eşliğinde
farkındalık ve anestezi derinliğini belirlemeyi amaçladık. Prospektif ve
randomize olarak tasarladığımız çalışmamız koroner arter ve kalp kapak
cerrahisi geçirecek 60 kişi dahil edildi. Rastgele 2 gruba ayrılan hastalara
sevofloran ve desfloran ile inhalasyon anestezisi ile analjezi için sabit doz
remifentanil infuzyonu uygulandı. Hemodinamik veriler ve BİS değerleri
kaydedildi. Kolay hatırlanabilmesi nedeniyle tanıdık ses olan köpek havlaması
ekstrakorporeal dolaşım boyunca hastalara dinletildi. Post operatif 2. günde
farkındalık ve uyanıklık için hastalarla görüşme yapıldı ve kaydedildi. Elde
edilen veriler SPSS ile incelendi. Hastalarda benzer hemodinamik veriler ve BİS
değerleri olduğu görüldü. Hastalarda farkındalık ve uyanıklığa rastlanılmadı.Kardiyovasküler
anestezi uygulamasında anestezi derinliğinin hemodinamik veriler ile
belirlenmesinin BİS ile korele olmasına rağmen anestezinin daha derin
seviyeye  doğru kaydığı görüldü. Bu nedenle BİS ile anestezi derinliğinin
güvenli şekilde belirlenebileceği kanısına varıldı. 

Anahtar Kelimeler

farkındalık, BİS monitorizasyonu, kardiyopulmoner bypas

Kaynakça

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