Laparoskopik cerrahi geçiren safra taşlı hastalarda volatil anesteziklerin oksidatif stres parametreleri üzerine etkileri Türkçe

Öz

Amaç: Çalışmamızda laparoskopik kolesistektomiye bağlı pnömoperitoneumun katalaz, myeloperoksidaz, seruloplazmin, toplam serbest sülfidril grupları ve lipid hidroperoksit dahil olmak üzere oksidatif ve antioksidatif stres belirteçlerinin üzerine olan etkilerini araştırdık.Gereç ve yöntemler: Laparoskopik cerrahi planlanan 80 hasta çalışmaya dâhil edildi. Hastalar desfluran n=40 ve sevofluran n=40 olmak üzere iki gruba randomize edildi. Anestezi idamesi desfluran grubunda %50 O + %50 hava ve %4–6 desfluran ve sevofluran grubunda ise %50 O + %50 hava ve %2–3 sevofluran ile sağlandı. Operasyondan önce ve sonra katalaz, myeloperoksidaz, seruloplazmin, serbest sülfidril grupları ve lipid hidroperoksit seviyeleri ölçülmesi için kan örnekleri alındı. Bulgular: Gruplar arası demografik özellikler, hemodinamik veriler, end tidal CO periferik oksijen 2, satürasyonu, anestezi ve cerrahi süreleri açısından operasyon öncesi ve sonrasında anlamlı bir fark yoktu p> 0.05 . Desfluran grubunda sevofluran grubuna göre postoperatif lipid hidroperoksit seviyesi anlamlı olarak yüksek bulundu p< 0.05 . Sonuç: Safra taşı nedeniyle laparoskopik kolesistektomi yapılan hastalar operasyon sırasında lipid hidroperoksit aktivitesinin artışına paralel olarak oksidatif strese maruz kalmaktadır. Sevofluran ve desfluran grupların antioksidatif stress üzerine benzer etkileri vardır. Desfluran grubunda operasyon sonrası dönemde lipid hidroperoksit düzeyleri artmaktadır p< 0,05

Anahtar Kelimeler

• Laparoskopi,oksidatif stres,sevofluran,desfluran

The effects of volatile anesthetics on oxidative stress parameters in gallstone patients undergoing laparoscopic surgery

Öz

Background: Herein, we investigated the effects of pneumoperitoneum on oxidative and antioxidative stress markers including catalase, myeloperoxidase, ceruloplasmin, total free sulfhydryl groups SH and lipid hydroperoxide LOOH during laparoscopic cholecystectomy.Methods: Eighty patients scheduled for laparoscopic surgery. The patient group was randomized to desflurane group n= 40 and sevoflurane group n= 40 . In group desflurane with 4-6% desflurane + %50 air + %50 O , in grup seveflurane with 2-3 % sevoflurane + %50 air+ %50 O the perpetuation of anesthesia is provided. Blood samples were obtained in the preoperative and postoperative period. Catalase CAT , myeloperoxidase MPO , ceruloplasmin, total free sulfhydryl groups SH and lipid hydroperoxide LOOH levels were measured. Results: Demographic, hemodynamic data, ETCO , peripheral oxygen saturation, anesthesia and surgery times were not significantly among groups. The postoperative LOOH levels were higher in Desflurane group in comparison to Sevoflurane group p< 0.05 . Conclusions: Patients with gallstone are exposed to a potent oxidative stress ifluencing LOOH level activity. Sevoflurane and desflurane had similar effects on oxidative stress during laporoscopic surgery. LOOH was increased in the desflurane group in the postoperative period

Anahtar Kelimeler

• Laparoscopy,oxidative stres,sevoflurane,desflurane

Kaynakça

1. ) Weltman DI, Zeman RK. Acute diseases of the gallbladder and biliary ducts. Radiol Clin North Am ; 32(5): 933-50. ) Koksal H, Kurban S. Total oxidant status, total antioxidant status, and paraoxonase and arylesterase activities during laparoscopic cholecystectomy. Clinics. ; 65(3): 285-90. ) Tutaş B, Tütüncü A.Ç, Ekici B, Altındaş F, Kaya G. Laparoskopik Hiatal Herni Cerrahisinde Epidural ve İntravenöz Analjezinin Stres Yanıta Etkilerinin Karşılaştırılması. Türk Anest Rean Der Dergisi 2012; (3): 144-53.
2. ) Gilliand TM, Traverso W. Modern standarts for comparison of cholecystectmoy with alternative methods for symptomatic cholelithiazis with emphasis on long term relief of symptoms. Surg Gynecol Obstet ; 170(1): 39-44. ) Yalçın S, Aydoğan H, Serdaroğlu H, Yıldız S, Büyükfırat E, et al. Impact of Volatile Anesthetics on Oxidative Stress in Patients Undergoing Laparoscopic Cholecystectomy for Gallstones Turkiye Klinikleri J Med Sci 2012; 32(1): 112-9.
3. ) Sivaci R, Kahraman A, Serteser M, Sahin DA, Dilek ON. Cytotoxic effects ofvolatile anest hetics with free radicals undergoing laparoscopic surgery. Clin Biochem. 2006; 39(3): 293-8.
4. ) Sies H. Oxidative stress: from basic research to clinical application. Am J Med. 1991; 91(3C): 31-8.
5. ) Ellman GL. Tissue sulfhydryl groups. Arch Biochem Biophys. 1959; 82(1): 70-7.
6. ) Hu ML, Louie S, Cross CE, Motchnik P, Halliwell B. Antioxidant protection against hypochlorous acid in human plasma. J Lab Clin Med. 1993; 121(2): 257-62.
7. ) Klebanoff SJ, Clark FA. The neutrophil: function and clinical disorders, 1. Amsterdam, The Netherlands: Elsevier/North Holland Biomedical Press; 1978. p. 810
8. ) Catalase Aebi H. In: Bergmeyer HU, editor. Methods of Enzymatic Analysis. NewYork and London: Academic Pres Inc.; 1974. p. 673–7

9. ) Ravin, HA (1956): Lancet, 1: 726. Alındı: Yenson, M.
10. (1986): Klinik Biyokimya Ders Notları. Beta Yayın Ltd. Şti. İstanbul.
11. ) Ozmen MM, Kessaf Aslar A, Besler HT, Cinel I. Does splanchnic ischemia ocur during laparoscopic cholecystectomy? Surg Endosc 2002; 16(3): 468-71.
12. ) Glantzoinis GK, Tselepis AD, Tambaki AP, Trikalinos TA, Manataki AD, Galaris DA, et al. Laparoscopic surgery-induced changes in oxidative stres markers in human plasma. Surg Endosc 2001; 15(11): 1315-9.
13. ) Zulfikaroglu B, Koc M, Soran A, Isman FK, Cinel I. Evaluation of oxidative stress in laparoscopic cholecystectomy. Surg Today 2002; 32(10): 869-74.
14. ) Bickel A, Drobot A, Aviram M, Eitan A. Validation and reduction of the oxidative stress following laparoscopic operations: a prospective randomized controlled study. Ann Surg. 2007; 246(1): 31-5.
15. ) Bukan MH, Bukan N, Kaymakcıoglu N, Tufan T. Effects of open vs laparoscopic cholecystectomy on oxidative stres. Tohoku J Exp Med 2004; 202(1): 51-6.
16. ) Shishehbor MH, Brennan ML, Aviles RJ, Fu X, Penn MS, Sprecher DL, Hazen SL. Statins promote potent systemic antioxidant effects through specific inflammatory pathways. Circulation 2003; 108 (4): 426-431.
17. ) Gál I, Róth E, Lantos J, Varga G, Jaberansari MT. Inflammatory mediators and surgical trauma regarding laparoscopic access: free radical mediated reactions. Acta Chir Hung. 1997; 36(1-4): 97-9.
18. ) Hu ML: Measurement of protein thiol groups and glutathione in plasma. Meîhod Enzymol 233: 380. ) Polat C, Yilmaz S, Serteser M, Koken T, Kahraman A, Dilek ON. The effect of different intraabdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy. Surg Endosc. 2003; 17(11): 22.
19. ) Olakowski M, Lampe P, Mekle H, Stefański L. Changes in activity of antioxidant enzymes in the early period after classical and laparoscopic cholecystectomy. Wiad Lek. ; 50 (1): 213-7. ) Di Vita G, Sciumè C, Milano S, Patti R, Lauria GL, Di Bella G, Caruso R, Leo P, Cillari E. Inflammatory response in open and laparoscopic cholecystectomy. Ann Ital Chir. ; 72(6): 669-73.