The effect of perioperative use of dexmedetomidine on hemodynamic parameters and surgical stress response in chronic hypertensive patients

Yıl 2013, Cilt: 2 Sayı: 3, 194 - 203, 01.09.2013

Ali Sarpkaya Kazım Karaaslan Hasan Koçoğlu Guler Buğdaycı Hakan Bayır Cemil Çolak

https://doi.org/10.5505/abantmedj.2013.46855

Öz

Objective: The aim of this study was to observe the effects of perioperative use of dexmedetomidine on hemodynamic changes and endocrine parameter which can be affected by surgical stres. Method: Forty two chronic hypertensive patient undergoing abdominal or pelvic surgery, we allocated randomly into two groups. Anesthesia was applied with thiopental, vecuronium, fentanyl, and was maintained with sevoflurane 1.5%-2.5% within N2O/O2 65%-35% in both groups. In Group D n: 21 loading dose of dexmedetomidine 1 µg /kg within 10 min was given to the patients 10 min before induction, and infusion with the dose of 0,5 mcg/kg/h was started together with anesthetic induction until the end of operation. In control group group K, n: 21 saline was given with the similar protocol as applied to the patient of group D. Additional fentanyl was given to patients when mean arterial blood pressure MAP has been increased more than 20% of baseline, and nitroglyserine was infused if hypertension can not be controlled with fentanyl alone. Hemodynamic parameters [systolic arterial blood pressure SAP , diastolic arterial bood pressure DAP , MAP, end-tidal carbon dioxide, heart rate HR , and pulse oxymetry] and additionally used fentanyl and nitrogliceryne were recorded. Venous blood samples were obtained from all patients for measurement of serum glucose, insulin, growth hormone, Adrenocorticotropin hormone ACTH , prolactin, cortisol levels at eight o’clock on the day of operation t0, baseline , 10 min. after surgical incision t1 , postoperative 24th t2 and 48th hours t3 and were compared. Results: SAP, DAP, MAP, and HR values were significantly lower in Group D than in Group K p

Anahtar Kelimeler

Dexmedetomidine, stress response, hypertension

Kronik hipertansif olgularda, perioperatif deksmedetomidin kullanımının stres yanıt ve hemodinami üzerine etkileri

Öz

Amaç: Bu çalışmanın amacı, kronik hipertansif olgularda perioperatif deksmedetomidin kullanımının hemodinamik değişiklikler ve cerrahi stres yanıtın endokrin parametreleri üzerindeki etkilerini araştırmaktır. Yöntem: Elektif batın ve pelvis operasyonu geçirecek 42 kronik hipertansif olgu rastgele iki gruba ayrıldı. Her iki grupta anestezi indüksiyonunda tiyopental, vekuronyum ve fentanil, idamesinde sevofluran %1,5- %2,5 ile N2O/O2 %65-%35 kullanıldı. Grup D Grup Deksmedetomidin olgularına n=21 indüksiyondan 10 dk. önce 1μg /kg deksmedetomidin yükleme dozu 10 dakika içerisinde verildi ve 0,5 μg /kg/saat dozunda infüzyona operasyon sonuna kadar devam edildi. Kontrol grubu olgularına Grup K, n=21 aynı protokol ile izotonik sıvı verildi. Hastaların ortalama arteriyel kan basıncı OAB , bazal değerin %20’sinden daha fazla arttığında her iki gruba da ek fentanil verildi. Hipertansiyon fentanil ile kontrol edilemediğinde, hastalara nitrogliserin infüze edildi. Hemodinamik parametreler [sistolik arter kan basıncı SAB , diyastolik arter kan basıncı DAB , OAB, end-tidal karbondioksit ETCO2 , kalp hızı KAH , SpO2], ek fentanil ile nitrogliserin dozları kaydedildi. Her hastada, serum glukoz, insülin, Growth Hormon, ACTH, prolaktin, kortizol seviyeleri, operasyon sabahı t0 , cerrahi insizyondan 10 dk. sonra t1 , post op. 24. saat t2 , ve 48. saat t3 venöz kan örneği alınarak karşılaştırıldı. Bulgular: SAB, DAB, OAB, KAH değerleri operasyon esnasında Grup D’de Grup K’dan daha düşük bulundu p

Anahtar Kelimeler

Deksmedetomidin, cerrahi stres yanıt

Kaynakça

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