Sigara İçen ve İçmeyen Hastalarda Desfluran ve Sevofluranın Solunum Mekaniklerine Etkilerinin Karşılaştırılması

Yıl 2008, Cilt: 25 Sayı: 2, 57 - 66, 29.12.2009

Ali Ekşi F. Emre Üstün Sezgin Bilgin İ. Serhat Kocamanoğlu Elif Bengi Şener Binnur Sarıhasan

Öz

Bu çalışmada desfluran ve sevofluranın solunum mekaniklerine etkilerini, sigara içen ve içmeyen hasta gruplarında değerlendirmeyi amaçladık.
Çalışmamıza 30-55 yaş arası, ASA I-II, akciğer hastalığı olmayan 100 hasta alındı. Sigara içen ve içmeyen gruplarda hastaların yarısında desfluran diğer yarısında sevofluran kullanılarak 25’er kişilik 4 grup oluşturuldu. Standart indüksiyon sonrası idamede O2/kuru hava karışımı içinde %6 desfluran veya %2 sevofluran uygulandı. Hastaların dinamik kompliyans (DK), hava yolu direnci (HYD cmH2O/L/sn) ve tepe hava yolu basıncı değerleri indüksiyon sonrası, entübasyondan sonraki 5., 25. dakikalar ve cerrahi sonunda kaydedildi.
Gruplar arasında demografik ve hemodinamik parametreler yönünden fark bulunmadı. Desfluran grubunda sigara içmeyenlerde entübasyon sonrası 5. dk da HYD (7.36±1.18.) indüksiyon dönemine (6.56±1.08) göre yüksekken (p<0.01), 25.dk değeri (6.36±1.35) başlangıç değerinden farksızdı. Sigara içenlerdeyse 5. dakika ve 25. dakika değerleri başlangıca göre yüksekti (sırasıyla p<0.001, p<0.01). Sigara içmeyenlerde HYD 5 ve 25. dakikalarda içenlere göre düşüktü (p<0.001). Sevofluran grubunda sigara içen ve içmeyenlerde 5. ve 25. dakikalarda HYD indüksiyon öncesine göre düşüktü (p<0.001). Sigara içen ve içmeyen grup arasında fark yoktu. Sevofluran ve desfluran grupları karşılaştırmasında; bazal değerler hariç tüm ölçüm dönemlerinde, desfluran grubunda HYD daha yüksekti. Kompliyans ve tepe basıncı değişimleri HYD’deki değişimlerle uyumluydu.
Literatürde iki ajanın karşılaştırılmış üç çalışmanın ikisinde sevofluranın yanıtları baskılamada üstün olduğu, birinde fark olmadığı bildirilmiştir. Sigara içiminin etkisi araştırılmamıştır. Çalışmamızda sadece iki inhalasyon ajanını karşılaştırdığımızda, entübasyona bronkokonstrüktör yanıtlar desfluran grubunda daha şiddetliydi. Sevofluran grubunda sigara içen ve içmeyenler arasında fark bulunmazken, desfluran grubunda sigara içenlerdeki yanıtlar daha fazla idi. Sonuçta, sigara içen ve bronşiyal hiperaktivitesi olan hastalarda sevofluranın desflurana tercih edilebileceği kanısına varıldı.



The Comparison of Effects of Sevoflurane and Desflurane on Respiratory Mechanics in Smokers and Nonsmokers
In our research we aimed to evaluate effects of sevoflurane and desflurane on respiratory mechanics in smokers and nonsmokers.
100 patients who were with an age between 30 and 55 years, in ASA I-II risk group and who does not have any pulmonary diseases were participated. With using Sevoflurane and desflurane randomly in smokers and nonsmokers patient groups, 4 patient groups that each has 25 patients were constituted. After a standart anesthetic induction, desflurane of %6 and sevoflurane of %2 in O2/dry air of %50 applied for maintenance. Dynamic compliance, airway resistance and peak airway pressure of patients were recorded after induction (ind.), in the 5th (ent.5) and 25th (ent.25) after intubation.
Demographic characteristics between patient groups did not differ significantly. In nonsmokers in desflurane group, airway resistance values in ent.25 (6.36±1.35) were not different than baseline value, whereas airway resistance in ent.5 (7.36±1.18.) were greater than ind. period (6.56±1.08; p<0.01). In smokers, either 5th or 25th minute values were greater than baseline value (p<0.001, p<0.01, respectively). Airway resistance (in ent.5 and ent.25) of smokers in desflurane group were greater than nonsmokers (p<0.001). In the sevoflurane group the airway resistance values at the 5th. and 25th. minutes were either in the smokers or nonsmokers lower than the baseline values (p<0.001). Values between smokers and nonsmokers did not differ from each other. Airway resistance in desflurane group were greater and compliance in desflurane group were lower than in sevoflurane group in all measurement periods except for baseline values. The changes in Dynamic compliance and peak airway pressure were compatible with the changes in the airway resistance. We found three articles who have comparised these two agents, and in two of them it is reported that sevoflurane is better than desflurane in supressing the airway responses, in the other one it was not found any difference. The effects of smoking is not studied.
We found that bronchoconstriction responses to intubation in desflurane group were more severe than the responses in sevoflurane group. The responses in smokers did not differ from nonsmokers in sevoflurane group, whereas these responses in smokers were greater than in nonsmokers in desflurane group. In conclusion we decided that; in patients, who are smokers or have an increrased bronchial hiperactivity, it would a better choise to use sevoflurane than desflurane.

Anahtar Kelimeler

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Kaynakça

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