Septorinoplasti ameliyatlarında trigeminokardiyak refleks, QT, QTc ve anestezi ilişkisi

Year 2020, Volume: 12 Issue: 3, 525 - 533, 20.10.2020

İsmail Konuk , İlknur Suidiye Yorulmaz , Onur Ozlu , Derya Özçelik Fatih Alper Akcan , Pelin Çetin

https://doi.org/10.18521/ktd.785571

Abstract

Amaç: Trigeminokardiak refleks trigeminal sinirin uyarılması sonucu gelişen hipotansiyon, bradikardi, gastrik hipermotilite veya asistoli ile karakterize bir refleksdir. Genel ve lokal anestezi altında yapılan septorinoplasti operasyonları sırasında trigeminokardiyak refleks gelişebildiği gözlenmiştir. Retrospektif çalışmamızda genel anestezi altında yapılan septorinoplasti operasyonlarında birincil olarak cerrahi olarak refleksin uyarıldığı düşünülen periyodlarda trigeminokardiyak refleks gelişimi araştırılmıştır. İkincil olarak da farklı inhalasyon anestezik ajanların bu refleksin ortaya çıkışında etkisi araştırılmıştır.

Yöntem: 01/ Ocak/2016- 30/Kasım/2016 tarihleri arasında opere edilmiş septorinoplasti vakalarının anestezi notları ve Datex Ohmeda icentral merkezi monitör kayıtları ve MİA-MED Hastane Bilgi Yönetim Sistemi yazılımı üzerinden retrospektif olarak incelenerek saptandı. İndüksiyon, lokal anestezi uygulaması, cerrahi insizyon, insizyon sütürasyonu başlangıcı ve ekstübasyondan 5 dakika sonra değerleri kayıtlardan saptandı. Kriterlere uyan 60 hastada 2 farklı inhalasyon anestezik madde uygulandığı tespit edilerek grup sevofluran ve grup desfluran olarak 2 ayrı grupta analizler yapıldı ve QT, QTc ve Trigeminokardiyak refleks gelişimi araştırıldı.

Bulgular: Gruplar arasında fark olmamasına rağmen bazal değerler ile diğer periyodlar karşılaştırıldığında TKR gelişiminin ve QT, QTc uzmanlarının en fazla sınırlı uyuşturma uygulaması, cerrahi insizyon, insizyon sütürasyonu periyotlarında izlendiği saptandı. (p<0,001)

Sonuç: En fazla sevofluran grubunda olmak üzere kullanılan inhalasyon anestezik ajanların özellikle trigeminal sinirin maksimal uyarıldığı periyodlarda kümülatif etki yaratarak TKR gelişiminde kolaylaştırıcı bir rol oynadığını düşünmekteyiz.

Keywords

Trigeminokardiyak refleks, QT intervali, QTc, electrokardiyogram, anestezi, septorinoplasti

Supporting Institution

Yoktur

Project Number

Yoktur

Relationship between trigeminocardiac reflex, QT, QTc and anesthesia in septorhinoplasty surgeries

Abstract

Objective: Trigeminocardiac reflex is a reflex characterized by hypotension, bradycardia, gastric hypermotility or asystole that develops as a result of stimulation of the trigeminal nerve. In our retrospective study, in septorhinoplasty operations performed under general anesthesia, trigeminocardiac reflex development was investigated primarily during the periods where the reflex was surgically stimulated. Secondly, the effect of different inhalation anesthetic agents on the emergence of this reflex was investigated.

Method: Anesthesia notes and Datex Ohmeda icentral central monitor records of septorhinoplasty cases operated between 01 / January / 2016 - 30 / November / 2016 were retrospectively examined and detected through the Hospital Information Management System software. Induction, application of local anesthesia, surgical incision, initiation of incision suturing and 5 minutes after extubation were recorded from the records. It was determined that two different inhalation anesthetics were administered in 60 patients who met the criteria, and analyzes were performed in 2 separate groups as group sevoflurane and group desflurane, and the development of QT, QTc and Trigeminocardiac reflex was investigated.

Results: Although there was no difference between the groups, when the basal values were compared with the other periods, it was found that the development of TKR and QT and QTc experts were mostly observed in the periods of local anesthesia, surgical incision and incision suturing. (p <0.001)

Conclusion: We think that the inhalation anesthetic agents used mostly in the sevoflurane group play a facilitating role in the development of TKR, especially by creating a cumulative effect during periods when the trigeminal nerve is maximally stimulated.

Keywords

Trigeminocardiac reflex, QT interval, QTc, electrocardiogram, anesthesia, septorhinoplasty surgery

Project Number

Yoktur

References

• Referans1 Meuwly C, Chowdhury T, Sandu N, Reck M, Erne P, Schaller B. Anesthetic influence on occurence and treatment of the trigemino-cardiac reflex. Medicine.2015;94(18):e807
• Referans2 Chowdhury T, Belachew A, Sandu N, Meuwly C, Schaller B. The trigeminocardiac reflex- An example of reflexive heart rhythm change. Abnormal cardiac ritm.Ed. Francisco R. Brejio-Marquez. 2015. Chapter 5. Intech Open Publication. ISBN:978-953-51-2148-0
• Referans3 Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex induced by an intraorbital foreign body. Ophtalmica. 2006;220:348.
• Referans4 Schaller B. Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas. Clin Neurol Neurosurg. 2005;107:468-474.
• Referans5 Schaller BJ, Weigel D, Fillis A, Buchfelder M. Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas: methodological descriptionof a prospective Skull base study protocol. Brain Res 2007;1149:69-75.
• Referans6 Arasho B, Sandu N, Spiriev T, Prabhakar H, Schaller B. Management of the trigeminocardiac reflex: facts and own experience. Neurol India. 2009;57:375-380.
• Referans7 Schaller B, Cornelius JF, Prabhakar H, et al. The trigemino-cardiac reflex: an update of the current knowledge. J Neurosurg Anesthesiol.2009;21:187-195.
• Referans8 Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg 1999;90:215-220.
• Referans9 Chowdhury T, Sandu N, Meuwly C, Cappellani RB, Schaller B. Trigeminocardiac reflex:Differental behaviour and risk factors in the course of the trigeminal nerve, Future Neurology 2014;9:41-47.
• Referans10 Paton JF, Boscan P, Pickering AE, Nalivaiko E. The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisted. Brain Res. Rev.2005;49:455-565.
• Referans11 Özçelik D, Toplu G, Türkseven A, Sezen G, Ankaralı H. The importance of the trigeminocardiac reflex in rhinoplastic surgery. Ann Plast Surg. 2015. Aug;75(2):213-218.
• Referans12 Meuwly C, Chowdhury T, Sandu N, Reck M, Erne P, Schaller B. Anesthetic influence on occurance and treatment of the trigemino-cardiac reflex: a systematic literature review. Medicine (Baltimore). 2015;94(18):e807.
• Referans13 Schmeling WT, Warltier DC, McDonald DJ, Madsen KE, Atlee JL, Kampine JP. Prolongation of the QT interval by enflurane, isoflurane, and halothane in humans, Anesth Analg 1991; 72(2): 137–144.
• Referans14 Bond AN, Beerle BJ, Arnold RW. Dexmedetomidine nasal sedation procedures more Oculocardiac reflex during strabismus surgery. J Pediatr Ophthalmol Strabismus. 2016;53(5):318.
• Referans15 Arnold RW, Biggs RE, Beerle BJ. Intravenous dexmedetomidine augments the oculocardiac reflex. J AAPOS. 2018;22(3):211-213.e211.
• Referans16 Lindgren L, Yli-Hankala A, Randall T, Kirvela M, Scheinin M, Neuvonen P.J. Haemodynamic and catecholeamine responces to induction of Anaesthesia and tracheal intubation: comparison between propofol and thiopentone. Br J Anaesth 1993;70(3):306-310.
• Referans17 Nathanson MH, Fredman B, Smith I, White PF. Sevoflurane versus desflurane for outpatient anesthesia: A comparison of maintance and recovery profiles. Anesth Analg. 1995;81:1186-1190.
• Referans18 Viskin S, Rosovski U, Sands A.J, Chen E, Kistler P.M, Kalman J.M, Rodriguez Chavez L, İtturale Tores P, Cruzz F.F, et al. İnaccurate electrocardiographic interpretation of long QT: The majority of phsysicians cannot recognize a long QT when they see one, Heart Rhythm 2005; 2(6): 569-574.
• Referans19 Luo S, Michler K, Johnston P, Macfarlane P.W. A comparison of commonly used QT correction formulae: The effect of heart rate on the QTc of normal ECGs . J Electrocardiol, 2004;37:81-90.
• Referans20 Whyte SD, Sanatani S, Lim J, Booker PD. A comparison of the effect on dispersion of repolarization of age-adjusted MAC Values of sevoflurane in children. Anesth Analg, 2007;104(2):277-282.
• Referans21 Stamelos CM, Stavroulakis E. Impact of anesthetic drugs and adjuvants on ECG markerin of torsadogenisity. Br J Anaesth. 2014;112(2):217-230.
• Referans22 Kruenzberg E, Loeckinger A, Kleinsasser A, Lindner KH, Puehringer F, Hoermann C. Sevoflurane progresively prolongs the QT interval in unpremedicated female adults, Eur J Anaesthesiol, 2000;17:662-664.
• Referans23 Leung J, Pastor M, Darwin A. Dissociation between hemodinamics and sympathetic activation during anaesthetic induction with desflurane. Can J Anaesth. 1998;45:533-540.