The effect of desflurane to the respiratory mechanics in smokers patients with coronary artery bypass grafting

Yıl 2014, Cilt: 6 Sayı: 3, 1 - 4, 01.12.2014

Taner Şerif Küçükcerit Tülay Örki Atakan Erkılınç Rezan Yaltırık Halide Oğuş Füsun Güzelmeriç Tuncer Koçak

Öz

This study was planned coronary artery bypass graft surgery in patients who smoke to investigate the effect of desflurane respiratory mechanics Method: ASA II-III group, undergoing coronary artery bypass surgery were classified as smokers and non-smokers. After induction of intravenous anesthesia, FiO2 60 - 80% of dry air into a mixture of oxygen and 1 MAC 6% desflurane was started. Desflurana except for the period of cardiopulmonary bypass was continued during the operation.Two groups, heart rate HR , mean arterial pressure MAP , peripheral oxygen saturation SpO2 , end-tidal CO2 Et CO2 and respiratory mechanics parameters airway resistance Paw , dynamic compliance Cdyn , peak airway pressure PIP after intubation baseline after the initiation of breathing desflurane 5th and 20th minutes, opening the sternum, sternal closure at 0, 5th and 20th minutes were compared. Results: All measurement periods HR, MAP, EtCO2, SpO2, PIP, Paw, Cdyn values were not significantly different between the two groups. Conclusions: Similar effects are seen in both groups. It may be due to smokers in the study having normal preoperative pulmonary function tests.

Anahtar Kelimeler

desflurane, coronary artery bypass grafting, smoking

Desfluranın sigara içen koroner arter bypass hastalarında solunum mekaniklerine etkisi

Öz

Amaç: Bu çalışmada koroner arter bypass cerrahisi planlanan sigara içen hastalarda desfluranın solunum mekaniklerine etkisi araştırıldı. Metod: Randomize, kontrollü, prospektif olarak elektif koroner arter bypass cerrahisi planlanan ASA II-III grubu, 30–80 yaş arası hastalar sigara içen ve kontrol grubu olarak iki gruba ayrıldı. İntravenöz anestezi indüksiyonundan sonra FiO2 % 60 – 80 oksijen ve kuru hava karışımı içine 1 MAC % 6 desfluran başlandı. Kardiyopulmoner bypass dönemi hariç operasyon süresince desflurana devam edildi. İki grubun kalp atım hızı KAH , ortalama arter basıncı OAB , periferik oksijen satürasyonu SpO2 , endtidal CO2 Et CO2 değerleri ve solunum mekaniği parametreleri havayolu direnci Paw , dinamik kompliyans Cdyn , tepe hava yolu basıncı PIP entübasyon sonrası başlangıç desfluran solumaya başlandıktan sonra 5. ve 20. dakika, sternum açılma, sternum kapama 0., 5. ve 20. dakikalarda kaydedildi. Bulgular: Her iki grup arasında tüm dönemlerde KAH, OAB, SpO2, EtCO2, Paw, Cdyn, PIP değerleri benzer bulundu p>0.05 . Sonuç: İki grup arasında anlamlı bir fark bulunmaması; sigara içen hastaların preoperatif solunum fonksiyon testlerinin normal sınırlarda olmasına bağlı olabilir.

Anahtar Kelimeler

desfluran, koroner arter bypass, sigara

Kaynakça

• Rooke GA, Chi J-H, Bishop MJ. The effect of isoflurane, halothane, sevoflurane and thi- opental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesi- ology 1997; 86 (6): 1294-1299.
• Dikmen Y, Eminoğlu E, Salihoğlu Z, Demiroluk S. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. An- aesthesia 2003; 58(8): 745-748.
• Cheney FW, Posner KL, Caplan RA. Adverse respiratory events infrequently leading to malpractice suits. Anesthesiology 1991; 75 (6): 932-939.
• Volta CA, Alvisi V, Petrini S et al. The effect of volatile anesthetics on respiratory system resistance in patients with chronic obstruc- tive pulmonary disease. Anesth Analg 2005; 100(2): 348–353.
• Dennis A, Curan J, Sherriff J, Sherriff J, Kinnear W. Effects of passive and active smoking on induction of anaesthesia. Br J Anaesth 1994; 73(4): 450-452.
• McKay RE, Bostrom A, Balea MC, McKay WR. Airway responses during desflurane versus sevoflurane administration via a laryngeal mask airway in smokers. Anesth Analg 2006; 103(5): 1147-1154.
• Erskine R, Murphy PJ, Langton JA. Effect of stopping smoking on upper airway reflexes. Br J Anaesth 1993; 70 (1): 478-481.
• Goff MJ, Arain SR, Ficke DJ, Uhrich TD, Ebert TJ. Absence of bronchodilation during desflu- rane anaesthesia: a comparison to sevoflurane and thiopental. Anesthesiology 2000; 93(2): 404-408.
• TerRiet MF, De Souza GJ, Jacobs JS, et al. Which is the pungent: Isoflurane, sevoflurane or des- flurane? Br J Anaesth 2000; 85(2): 305-307.
• Brichant JF, Gunst SJ, Warner DO, Rehder K. Halothane, enflurane and isoflurane depress the peripheral vagal motor pathway in isolated canine tracheal smooth muscle. Anesthesiolo- gy 1991; 74(2): 325-332.
• Brown RH, Zerhouni EA, Hirschman CA. Com- parison of low concentrations of halothane and isofl. as bronchodilators. Anesthesiology 1993; 78(6): 1097-1101.
• Eshima RW, Maurer A, King T, et al. A com- parison of airway responses during desflurane and sevoflurane administration via a laryngeal mask airway for maintenance of anesthesia. Anesth Analg 2003; 96(3): 701-705.
• Mahmoud NA, Rose DJ, Laurence AS. Desflu- rane or sevoflurane for gynaecological day- case anaesthesia with spontaneous respira- tion? Anaesthesia 2001; 56(2): 171-174.
• Wanner A, Salathe M, O’Riordan TG. Mucocil- iary clearance in the airways. Am J Respir Crit Care Med 1996; 154(6 Pt 1): 1868-1902.
• Wightman JAK:A prosvective survey of the incidence of postoperative pulmonary compli- cations. Br J Surg 1968 55(2):85-91.
• Taube C, Lehnisk B, Paasch K, Kirsten DK, Jörres RA, Magnussen H. Factor analysis of chang- es in dyspnea and lung function parameters after bronchodilation in chronic obstuructive pulmonary disease. Am J Respir Crit Care 2000; 162(1) 216-220.