Periferik Arter Hastalarının Spinal Anestezisinde %0.5 Bupivacain ve %0.5 Levobupivacain’nin Anestezik ve Hemodinamik Parametreler Yönünden Karşılaştırılması

Yıl 2011, Cilt: 3 Sayı: 1, 10 - 14, 01.04.2011

Nuh Göğebakan Tülay Kayacan Örki Füsun Güzelmeriç Halide Oğuş Fahriye Güler Tuncer Koçak

Öz

Amaç: Bu çalışmada, Kardiyovasküler hastalık potansiyeli taşıyan periferik arter hastalarının spinal anestezisinde %0,5 bupivikain ve %0,5 levobupivakain'in anestezik ve hemodinamik parametreler yönünden karşılaştırılması amaçlandı. Yöntemler: ASA II-III grubu 40 hasta randomize olarak 2 gruba ayrıldı; Grup B'de 3.5 mL %0,5&'39;lik bupivakain, Grup L'de 3.5 mL %0.5'lik levobupivakain intratekal yoldan uygulandı. Sempatik blok soğuk sprey, duyusal blok düzeyi pinprick test ve motor blok derecesi Bromage skala ile değerlendirildi. Motor blok, sempatik blok ve duyusal blok başlama, üst segment yükselme süreleri kaydedildi. Duyusal bloğun en üst segmentten iki segment gerilemesi iki segment gerileme süresi, motor bloğun bir derece azalması bloğun geri dönüş zamanı, Bromega skala 0 motor blok kalkma zamanı olarak kaydedildi. Ortalama arter basıncı OAB , kalp atım hızı KAH ve periferik oksijen satürasyonu SpO2 değerleri spinal anestezi öncesi ölçülerek başlangıç değerleri olarak kabul edildi ve işlem sonrası 1, 5, 10, 15, 20, 30, 45, ve 60. dakikalarda değerlendirildi. Postoperatif ağrı düzeyleri vizüel anolog skala VAS ile değerlendirildi. Bulgular: İstatistiksel Değerlendirmelerde, gruplar arasında demografik özellikler, SpO2, VAS değerleri benzer bulundu. OAB ve KAH&'39;nın; başlangıç değerine göre tüm ölçüm zamanlarında her iki grupta da anlamlı olarak azaldığı, ancak gruplar arasında bir fark olmadığı saptandı p>0,05 . Sempatik, duyusal ve motor blok başlama, üst dermatomlara ulaşma, motor blok gerileme ve motor blok kalkma süreleri iki gruptada benzer bulundu p>0,05 . İki segment gerileme süresi grup B&'39;deki olgularda grup L&'39;e göre ileri düzeyde anlamlı olarak düşük saptandı p

Anahtar Kelimeler

bupivikain, levobupivakain, kardiyovasküler hastalık, hemodinami

Comparison of 0,5% Bupivacain and 0,5% Levobupivacain in Terms of Anesthetic and Hemodynamic Parameters in Spinal Anesthesia for The Peripheral Artery Disease Patients

Öz

Objective: In this study, it is aimed to compare 0,5% bupivacain and 0,5% levobupivacain in spinal anesthesia for the peripheral arterial disease patients who have a probability of cardiovascular diseases in terms of anesthetic and hemodynamic parameters. Methods: 40 patients in ASA class II or III are randomly separated into 2 groups; in Group B 3,5 ml of bupivacain and in Group L 3,5 ml of levobupivacain have injected intrathecally. Symphatetic blockage is evaluated by cold spray, sensorial blockage is evaluated by pinprick test and the motor blockage is evaluated by Bromage Scale. The beginning and the ascencion to a higher level times of the motor, sympathetic and the sensorial blockages are noted down. 2 levels of regression from the highest level of the sensorial blokcage time is noted as the “2 levels regression time”, 1 grade decrease of the motor blockage time is noted as the “reversion of the motor blockage” and Bromage Scale grade 0 time is noted as the “end of the motor blockage time”. Mean arterial pressure MAP , heart rate HR and peripheral oxygen saturation SpO2 values are measured before the spinal anesthesia and noted as the beginning values and datas at 1, 5, 10, 15, 20, 30, 45 and 60 minutes after the spinal anesthesia are noted. Postoperative pain levels are evaluated with visual analog scale VAS . Results: Statistical evaluations of the demographic characteristics, SpO2 and VAS values between the two groups are found similar. MAP and HR are found statistically significantly lower in all of the measurement times in both groups but there is no statistically difference between the two groups p>0,05 . The times of the beginning and the reach to the higher dermatomes of the sympathetic, sensorial and motor blockages, decrease and the end times of the motor blockage are found similar in both groups p>0,05 . 2 levels regression times in Group B are found extremely lower than Grop L p

Anahtar Kelimeler

bupivacain, levobupivacain, cardiovascular disease, hemodynamic

Kaynakça

• Mangano DT: Perioperative cardiac morbidity. Anest- hesiology 1990, 72:153-184.
• McKenna M, Wolfson S, Kuller L: The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis 1991, 87:119-128.
• Criqui MH, Langer RD, Fronek A, et al: Mortality over a period of 10 yeras in patients with peripheral arteri- al disease. N Engl J Med 1992, 326:381-386.
• Smith GD, Shipley MJ, Rose G: Intermittent claudica- tion, heart disease risk factors, and mortality. The Whitehall Study. Circulation 1990, 82:1925-1931.
• Newman AB, Sutton-Tyrrell K, Vogt MT, Kuller LH: Morbidity and mortality in hypertensive adults with low ankle/arm blood pressure index. JAMA 1993, 270:487-489.
• Muluk SC, Muluk VS, Kelley ME, et al: Outcome events in patients with claudication: A 15-year study in 2777 patients. J Vasc Surg 2001, 33:251-257.
• Dormandy JA, Rutherfort RB: Management of perip- heral arterial disease(PAD). TASC Working Group. TransAtlantic Inter-Society Concensus(TASC). J Vasc Surg 2000, 31: 1-296.
• Groban L, Deal DD, Vernon JC, James RL, Butterworth J. Ventricular arrhythmias with or without program- med electrical stimulation after incremental overdose- ge with lidocaine, bupivacaine, levobupivacaine and ropivacaine. Anesth Analg 2001; 93: 743-748.
• Cassar K, Bachoo P, Ford I, et al.: Platelet activation is increased in peripheral arterial disease. J Vasc Surg 2003, 38:99-103.
• Curi MA, Skelly CL, Baldwin ZK, et al: Long-term out- come of infrainguinal bypass grafting in patients with serologically proven hypercoagulability. J Vasc Surg 2003: 37; 301-306.
• Cook PT, Davies MJ, Cronin KD, Moran P: A prospec- tive randomized trial comparing spinal anaesthesia using hyperbaric cinchocaine with general anesthesia for lower lim. Vascular surgery. Anaesth Intensive Ca- re 1986, 14:373-380.
• Detsky AS, Abrams HB, McLaughlin JR, et al: Predic- ting cardiac complications in patients undergoingnon-cardiac surgery. J Gen Intern Med 1986, 1:211- 219.
• Bardsley H, Gristwood R, Baker H, et al: A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998, 46: 245-249.
• Glaser C, Marhofer P, Zimpfer G, et al: Levobupivaca- in versus racemic bupivacain for spinal anesthesia.Anesth Analg 2002, 94:194-198.
• ChristophersonR, Glavan NJ, Norris EJ, Beattie C, Rock P, et al.: Perioperative Ischemia Randomized Anesthesia Trial Study Group: Control of blood pressure and heart rate in patients randomized to epidural or gene- ral anesthesia for lower extremity vasculer surgery. J Clin Anesth. 1996 ; 8: 578-584.