Diyabetik Vakalarda Roküronyumun Nöromusküler Blok Özellikleri

Yıl 2014, Cilt: 39 Sayı: 4, 0 - , 22.07.2014

Ahmet Topal Mehmet Sargın Tayfun Et Sema Tuncer Uzun

https://doi.org/10.17826/cutf.95881

Öz

Amaç: Diyabetik hastalarda motor sinir liflerinde fonksiyonel kayıplar ortaya çıkmakta ve bu durum anestezi yönetimini birçok yönden etkileyebilmektedir. Bu çalışmada roküronyumun nöromusküler blok etkilerinin non-diyabetik hastalara göre tip II diyabetli hastalarda farklı olup olmadığını araştırmayı amaçladık. Materyal ve Metod: 18 diyabetik ve 21 non-diyabetik hastanın, 0,6 mg kg-1 roküronyum uygulanmasından sonra nöromüsküler transport monitörü kullanılarak nöromusküler fonksiyonları değerlendirildi.Etki başlama süresi, klinik etki süresi, derlenme süresi, toplam roküronyum dozu, supramaksimal uyarı şiddeti ve Goldberg entübasyon skoru karşılaştırıldı. Bulgular: Etki başlama (118,33±41,61 sn. & 142,00±28,68 sn.) ve derlenme (13,33±9,83 dak. & 22,38±11,64 dak.) süreleri diyabetik hastalarda daha uzundu (p0,05). Sonuç: Diyabetik hastalarda etki başlama ve derlenme sürelerinde görülen uzamanın, diyabete bağlı gelişen nöropatik bir komplikasyon olduğunu ve roküronyumun farmakodinamiğinde diyabetin etkili olduğunu düşünmekteyiz.

Anahtar Kelimeler

Nöromusküler blok, roküronyum, diyabet, genel anestezi.

Neuromuscular Characteristics of Rocuronium in Diabetic Patients

Öz

Purpose: In diabetic patients, there may be obsserved functional loss of motor nerve fibers and this fact may affect the management of anesthesia in many ways.In our study we aimed to research if there is any differences between non-diabetic patients and the patients who have type 2 diabetes on the side of nueromuscular blockade characteristics of rocuronium. Materials and method: 18 diabetic and 21 non-diabetic patients included to study, each patient evaluated by the NMT device after administiration of 0,6 mg/kg rocuronium intravenously.The onset of action time, clinical acting time , recovery time , total rocuronium dosage for each patient, amplitude of supramaximal excitation and Goldberg score were compared in the two groups. Results: Time of action (118,33±41,61 sn. & 142,00±28,68 sn.) and recovery time (13,33±9,83 dak. & 22,38±11,64 dak.) were longer than in diabetic patients (p0,05). Conclusion: We consider that the prolongation of onset of action time and recovery time in diabetic patients, is a complicaiton of diabetic neuropathy and diabetes may effect the pharmacodynamics of rocuronium.

Anahtar Kelimeler

neuromuscular block, rocuronium, diabetes, general anesthesia

Kaynakça

• Woolf AL, Malins JM. Changes in the intramuscular nerve endings in diabetic neuropathy. J Path Bact. 1957;73:316-8.
• Lawrence DG, Locke S. Motor nerve conduction velocity in diabetes. Arch Neurol. 1961;5:483-9.
• Skillman TG, Johnson EW, Hamwi GJ, et al. Motor nevre conduction velocity in diabetes mellitus. Diabetes. 1961;10:46-51.
• Abu-Shakra SR, Cornblath DR, Avila OL, et al. Conduction block in diabetic neuropathy. Muscle Nerve. 1991;14:858-62.
• Lamontagne A, Buchthal F. Electrophysiological studies in diabetic neuropathy. J Neurosurg Psychiatry. 1970;33:442-52.
• Eady JL, Cobbs KF. Diabetic muscle infarction. J South Orthop Assoc. 1997;6:250-5.
• Muphy GS. Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period. Minerva Anesthesiol. 2006;72:97-109.
• Nitahara K, Sugi Y, Shigematsu K, Haraga I, Abe S, Higa K. Recovery of train-of-four ratio to 0.70 and 0.90 is delayed in type 2 diabetes with vecuroniuminduced neuromuscular block. Eur J Anaesthesiol. 2013;30:80-4. doi: 10.1097/EJA.0b013e32835b9d9b.
• Saitoh Y, Hattori H, Sanbe N, Nakajima H, Akatu M, Murakawa M. Delayed recovery of vecuronium neuromuscular block in diabetic patients during sevoflurane anesthesia. Can J Anaesth. 2005;52:467-73.
• Khuenl-Brady KS, Sparr H. Clinical pharmacokinetics of rocuronium bromide. Clin Pharmacokinet. 1996;31:174-83.
• Robertson EN, Driessen JJ, Booij LHDJ. Pharmacokinetics and pharmacodynamics of rocuronium in patients with and without renal failure. Eur J Anaesth. 2005;22:4-10.
• Cooper RA, Maddineni VR, Mirakhur RK, Wierda JMHK, Brady M, Fitzpatrick KTJ. Time course of neuromuscular effects and pharmacokinetics of rocuronium bromide during isoflurane anaesthesia in patients with and without renal failure. Br J Anaesth. 1993;71:222-6.
• Khalil M, D'Honneur G, Duvaldestin P, Slavov V, De Hys C, Gomeni R. Pharmacokinetics and pharmacodynamics of rocuronium in patients with cirrhosis. Anesthesiology. 1994;80:1241-7.
• Thomas EA. Cecil Essentials of Medicine. 4. Ed. 2001:533-45.
• Büyükdevrim AS. Diyabetolojiye Giriş, Laboratuar ve Klinik Tanı Kriterlerinin Standardizasyonu. İstanbul, Fatih Matbaası. 1996:5-34.
• Arnold GF, Norman EC. Textbook of Diabetic Neuropathy. Stutgart, Thieme. 2003:5-128.
• Saitoh Y, Kaneda K, Hattori H, et al. Monitöring of neuromuscular block after administration of vecuronim in patients with diabetes mellitus. Br J Anesth. 2003;90:480 -6.
• Magorian T, Flannery KB, et al. Comparison of rocuronium, succinylcholine, an vecuronium for rapid sequence inducution of anesthesia in adult patinets. Anesthesiology. 1993;70:913-8.
• Clark L, Leece EA, Brearley JC. Diabetes mellitus affects the duration of action of vecuronium in dogs. Vet Anaesth Analg. 2012;39:472-9. doi: 1111/j.1467-2995.2012.00714.x. Epub 2012 May
• Alper I, Ulukaya S, Makay O, Balcioglu T. The pharmacodynamic effects of rocuronium during general anesthesia in patients with type 2 diabetes mellitus. Minerva Anestesiol. 2010;76:115-9. Epub 2009 Dec 23.
• Armendáriz-Buil I, Lobato-Solores F, AguileraCelorrio L, Morros-Díaz E, Fraile-Jiménez E, VeraBella J. Residual neuromuscular block in type II diabetes mellitus after rocuronium: A prospective observational study. Eur J Anaesthesiol. 2013.
• Lowry DW, Mirakhur RK, McCarthy GJ, Carroll MT, McCourt KC. Neuromuscular effects of rocuronium during sevoflurane, isoflurane and intravenous anesthesia. Anesth Analg. 1998;87:936-40.
• Wulf H, Kahl M, Ledowski T. Augmentation of the neuromuscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total i.v. anaesthesia. Br J Anaesth 1998;80:308–12.
• Hebl JR, Kopp SL, Schroeder DR, Horlocker TT. Neurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy. Anesth Analg. 2006;103:1294-9.
• Yazışma Adresi / Address for Correspondence: Dr. Mehmet Sargın Konya Eğitim ve Araştırma Hastanesi Anesteziyoloji ve Reanimasyon Kliniği KONYA E-mail: [e-mail] G eliş tarihi/Received on : 28.05.2014
• Kabul tarihi/Accepted on: 01.07.2014