The effects of intravenous aminoacid infusion on myocardial functions and postoperative analgesia during abdominal aortic surgery

Öz

Objective: Effects of intravenous aminoacid infusion on myocardial functions and postoperative analgesia in ab­dominal aortic surgery were investigated. Materials and methods: Forty patients were randomly divided into groups of general anaesthesia with or with­out aminoacid infusion (Group 1 and 2, n=10), combined general+epidural with or without amino acid infusion (Group 3 and 4, n=10). Cardiac risk was evaluated using 2007 AHA/ ACC and modified Goldman classifications. Intravenous aminoacid solution of 80 g/L was infused at 2.5 ml/kg/h for a total of 8 hours. General anaesthesia included intravenous remifentanil, rocuronium, sevoflurane. The lumbar epidural include; 10 mL of 0.25% bupivacaine; bolus dose, an infu­sion of 0.25% bupivacaine; 4 ml/h for 24 hours. Heart rate, arterial blood pressures were collected intraoperative ev­ery 10 minute, 1, 24 hour postoperatively. Plasma creatine kinase MB fraction, troponin levels, pain assessment with numeric analog scale were collected preoperatively, 1, 24 hour postoperatively. Postoperative 24 hour analgesic us­age, complications were recorded. Results: Patients with mild and severe cardiac risk were higher in 2007 AHA/ACC classification (26/40, 65%) than modified Goldman risk classification (5/40, 12.5%) (p=0.04). In comparison between groups, myocardial enzyme levels and complications showed no difference (p>0.05). The use of analgesics were lower in group 3 and 4 in comparison to group 1 and 2 (p=0.002). Conclusion: During abdominal aortic surgery, intravenous infusion of amino acid did not show significant changes on intraoperative and postoperative hemodynamic parameters and myocardial enzymes. The patients received combined general plus epidural anaesthesia showed more successful postoperative analgesia.

Anahtar Kelimeler

• Amino acid, abdominal aorta, vascular surgery, epidural anesthesia, general anesthesia, keratin kinase, troponin, postoperative analgesia

Abdominal aort cerrahisinde intravenöz aminoasit infüzyonunun miyokardiyal fonksiyonlar ve postoperatif analjezi üzerine etkileri

Öz

Amaç: Abdominal aort cerrahisinde intravenöz aminoasit infüzyonunun miyokard ve postoperatif analjezi üzerine et­kileri incelendi. Gereç ve yöntem: Ardışık 40 hasta genel anestezide ami­noasit infüzyonu uygulanan ve uygulanmayan (Grup 1 ve 2, n=10), kombine genel/epidural anestezide aminoasit in­füzyonu uygulanan ve uygulanmayan (Grup 3 ve 4, n=10) olarak rastgele ayrıldı. 2007 AHA/ACC ve Modifiye Gold­man ile kardiyak risk değerlendirildi. Genel anestezide int­ravenöz remifentanil, rokuronyum ve sevofluran uygulandı. Kombine genel/epidural anestezide, indüksiyon öncesi lom­ber epidural kateterden 10 mL %0,25 bupivakain sonrası infüzyon %0,25 bupivakain 4 mL/saat, 24 saat uygulandı. İntravenöz aminoasit 80 g/L solüsyonundan 2,5 ml/kg/saat, toplam 8 saat uygulandı. İntraoperatif 10 dakikada bir, pos­toperatif 1. ve 24. saatlerde kan basıncı ve kalp atım hızı değerleri kaydedildi. Plazma kreatin kinaz MB fraksiyonu, troponin değerleri, numerik analog skala ile ağrı değerlen­dirmesi preoperatif, postoperatif 1. ve 24. saatte ölçüldü. Postoperatif 24 saatlik analjezik tüketimi ve yan etkiler kay­dedildi. Bulgular: 2007 AHA/ACC sınıflamasında orta ve yüksek kardiyak riskli hasta sayısı (26/40, %65), modifiye Goldman ile olan hasta sayısından (5/40, %12,5) yüksekti (p=0,04). Gruplar karşılaştırıldığında, miyokardiyal enzimlerin değer­leri ve komplikasyonlar açısından fark bulunmadı (p>0,05). Postoperatif analjeziklerin Grup 3 ve 4\'deki kullanımları Grup 1 ve 2\'den düşük bulundu (p=0,002). Sonuç: Abdominal aort cerrahisinde, intravenöz aminoasit infüzyonunun intraoperatif ve postoperatif hemodinamik parametreler yanısıra miyokardiyal enzim değerlerinde belirgin farklılıklar saptanmadı. Kombine genel + epidural uygulanan hastalarda postoperatif analjezi daha başarılı bulundu.

Anahtar Kelimeler

• Aminoasit, abdominal aorta, vasküler cerrahi, epidural anestezi, genel anestezi, kreatin kinaz, tro­ponin, postoperatif analjezi

Kaynakça

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