Abdominal Histerektomi Ameliyatlarında Midazolam ile Anestezi İndüksiyonunun Hemodinami Üzerine Etkisi

Abstract

Amaç: Anesteziyolojinin birincil görevi, ameliyat öncesinden ameliyat sonrasına kadar hastanın kan basıncı ve kalp atış hızı dahil olmak üzere hemodinamik değerlerini kontrol etmektir. Anestezi indüksiyonu ve idamesi için birçok ilaç tek başına veya kombinasyon halinde kullanılır. Bu ilaçlara karşı çeşitli hemodinamik yanıtlar gelişebilmektedir. Çalışmamızda abdominal histerektomi yapılan hastalarda intravenöz anestezi indüksiyonunda tek başına kullanılan midazolam ve propofolün hemodinami üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Abdominal histerektomi planlanan toplam 60 ASA I-II hasta çalışmaya dahil edildi. Anestezi indüksiyonu sırasında Grup M'ye (n:30) midazolam (0.2 mg/kg) ve Grup P'ye (n:30) propofol %1 (2 mg/kg) uygulandı. Noninvaziv sistolik kan basıncı, diyastolik kan basıncı, ortalama kan basıncı ve dakika kalp atım hızı değerleri kaydedildi. Bulgular: Entübasyon, cilt insizyonu, ekstübasyon ve derlenme sırasında sistolik kan basıncı P grubunda M grubuna göre anlamlı olarak daha düşüktü. Sonuç: İntravenöz 0,2 mg/kg midazolam ile anestezi indüksiyonu 2 mg/kg propofolden daha yüksek sistolik kan basıncı değerlerine neden olabilir. Anestezi takibi sırasında midazolam kullanımı sonrası oluşacak hemodinamik yanıtın birlikte kullanılan anestezik ilaçlara ve dozlarına bağlı olarak değişeceği göz ardı edilmemelidir.

Keywords

• Genel anestezi
• midazolam
• hemodinami

The Effect of Anesthesia Induction with Midazolam and Propofol on Hemodynamics in Abdominal Hysterectomy Surgeries

Abstract

Objective: The primary task of anesthesiology is to control the patient's hemodynamic values, including blood pressure and heart rate, from pre-operative to post-operative. Many drugs are used alone or in combination for induction and maintenance of anesthesia. Various hemodynamic responses may develop to these drugs. In our study, we aimed to compare the effects of midazolam and propofol used alone in intravenous anesthesia induction on hemodynamics in patients undergoing abdominal hysterectomy. Materials and Methods: A total of 60 ASA I-II patients scheduled for abdominal hysterectomy were included in the study. During anesthesia induction, midazolam (0.2 mg/kg) was administered to Group M (n:30) and propofol 1% (2 mg/kg) was administered to Group P (n:30). Noninvasive systolic blood pressure, diastolic blood pressure, mean blood pressure and minute heart rate values were recorded. Results: Systolic blood pressure was significantly lower in group P than in M during intubation, skin incision, extubation and recovery. Conclusion:As a result, anesthesia induction with intravenous 0.2 mg/kg midazolam may cause higher systolic blood pressure values than 2 mg/kg propofol. It should not be overlooked that the hemodynamic response that will occur after the use of midazolam during anesthesia monitoring will vary depending on the anesthetic drugs and doses used together.

Keywords

• General anesthesia
• midazolam
• hemodynamic

References

1. Arda, N. B., Ulufer, S. G., Tezal, D., Özbakış, Ç., & Hancı, A. (2000). Effects of Propofol-Fentanyl and Midazolam-Fentanyl Combinations and TIVA on Hemodynamics and Recovery. The Medical Bulletin of Sisli Etfal Hospital, 34(3): 20-23.
2. Bosna, G., Yalçıntuna, İ. B., & Aydın, N. (2002). Comparison of the hemodynamic effects of midazolam and propofol in the induction of general anesthesia. Haydarpaşa Numune Training and Research Hospital Medical Journal, 42(2): 19-22.
3. Conway, A., Rolley, J., Sutherland, J. R., & Cochrane Emergency and Critical Care Group. (2016). Cochrane Database of Systematic Reviews: CD009491. https://doi.org/10.1002/14651858.CD009491.pub2.
4. Jeon, S., Lee, H. J., Do, W., Kim, H. K., Kwon, J. Y., Hwang, B. Y., & Yun, J. (2018). Randomized controlled trial assessing the effectiveness of midazolam premedication as an anxiolytic, analgesic, sedative, and hemodynamic stabilizer. Medicine(Baltimore);97(35):e12187. https://doi.org/10.1097/MD.0000000000012187.
5. Kayhan Z (2004). Clinical Anesthesia (3rd Edition) Logos Publishing.
6. Kyeong, T. M., Myeong, H. L., Yong, I. K., & Jong, R. K. (1993). Induction Dose of Midazolam for General Anesthesia. Korean Journal of Anesthesiology; 26(2):233-242. https://doi.org/10.4097/kjae.1993.26.2.233.
7. Mcclune, S., Mckay, A. C., Wright, M.C., Patterson, C.C., & Clarke R.S.J. (1992). Synergistic Interaction Between Midazolam And Propofol. British Journal of Anaesthesia; 69:240-245.
8. Mihalj, M., Karlović, Z., Vladić-Spaić, D., Matić, B., Mikulić, I., Mikulić, V., & Golubović V. (2022). Effects of midazolam co-induction to general anesthesia: A randomized clinical trial. Medicine (Baltimore); 101(45): e31400. https://doi: 10.1097/MD.0000000000031400

9. Nishiyama,T., Misawa, K., Yokoyama, T., & Hanaoka, K. (2002). Effects of combining midazolam and barbiturate on the response to tracheal intubation: changes in autonomic nervous system. Journal of Clinical Anesthesia;14(5):344–8. https://doi.org/10.1016/s0952-8180(02)00370-7.
10. Öztürk, Ç. E. (2007). Comparison of 1% and 2% propofol formulations used in induction in terms of injection pain and hemodynamic response to intubation. [Specialization in Medicine Thesis, Osmangazi University Faculty of Medicine, Eskişehir]. http://openaccess.ogu.edu.tr:8080/xmlui/bitstream/handle/11684/2033.
11. Pagel, P.S., & Warltier, D.C. (1993). Negative inotropic effects of propofol as evaluated by the regional preload recruitable stroke work relationship in chronically instrumented dogs. Anesthesiology ;78:100-8. https://doi.org/10.1097/00000542-199301000-00015.
12. Reves, J. G., Fragen, R.J., Vinik, H. R., & Greenblatt D. J. (1985). Midazolam pharmacology and uses. ; Anesthesiology, 62(3): 310-24.
13. Servin, F. S., Desmonts, J. M., Melloni, C., & Martinelli, G. (1997). A comparison of 2% and 1% formulations of propofol for the induction and maintenance of anaesthesia in surgery of moderate duration. Anaesthesia;52(12):1216-21. https://doi.org/10.1111/j.1365-2044.1997.222-az0357.x.
14. Short, T. G., & Chuı, P. T. (1991). Propofol And Midazolam Act Synergistically In Combination. British Journal of Anaesthesia; 67: 539-545.
15. Short, T. G., Plummer, J. L., & Chui P.T. (1992). Hypnotic and anaesthetic interactions between midazolam, propofol and alfentanil. British Journal of Anaesthesia;69(2):162-7. https://doi.org/10.1093/bja/69.2.162.
16. Win, N.N., Fukayama, H., Kohase, H., & Umino, M. (2005). The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability. Anesthesia and Analgesia;101(1):97-102. https://doi.org/10.1213/01.ane.0000156204.89879.5c