Farklı Anestezik Ajanların Rejyonel İntravenöz Anestezi Yapılan Hastalarda Elektrokardiyografik Değişiklikler Üzerine Etkisi

Yıl 2020, , 210 - 220, 30.06.2020

İlknur Suidiye Yorulmaz , Gökçe Akman Köse Yavuz Demiraran , Şengül Cangür

https://doi.org/10.26453/otjhs.581681

Öz

Amaç: Çalışmamızda lidokain ve lidokain+ ketamine ile intravenöz rejyonel anestezi (İVRA) uygulanan hastalardaki elektrokardiyografik değişiklikleri karşılaştırmayı amaçladık.
Materyal ve Metot: Çalışmamız prospektif, gözlemsel, randomize ve çift kör olarak yapıldı. İVRA altında kol ve önkol operasyonu geçirecek ASA I -II statüsünde 18-60 yaş arası 70 hasta çalışmaya alındı. Çift kaflı turnike opere edilecek ekstremiteye yerleştirildi. Hastalar randomize ve olarak 2 gruba ayrıldı. Group 1: % 0,5 Lidokain+Ketamin 0,8 mg/kg; 40 ml. Group 2: % 0,5 Lidokain 40 ml olarak belirlendi. Enjeksiyondan 20 dakika sonra distal kaf şişirilerek proksimal kaf 3 dakikada bir 50 mmHg hızda indirildi. Zaman periyodları turnike indirilmesinin başlamasından itibaren 0, 5, 10, 15, 30, 45, 60. dakika ve turnike indirilmesinden 10 dakika sonra olarak belirlendi. İnvaziv olmayan kan basıncı değerleri, kalp atım hızı, puls oksimetre değerleri kaydedildi. Elektrokardiyografik kayıtlar alınarak PR, RR, QT intervalleri, QTc değerleri kaydedildi.
Bulgular: Lidokain+ketamin grubunda QT basal değerleri QT5. dk, QT10. dk, QT15. dk , QT30. dk, QT45. dk, QT60. dk ve QTtur10 değerlerinden düşük bulundu. QTc bazal değerleri grup lidokain + ketamin QTctur10 değerlerinden daha düşük bulundu (p <0.001).
Sonuç: Lidokain grubunda belirgin bir değişiklik gözlenmedi. Turnike indirilmesinden sonra lidokain+ketamin grubunda QT, QTc değerlerinde ve özellikle noninvaziv kan basıncı değerlerinde belirgin artış gözlendi.

Anahtar Kelimeler

Elektrokardiyogram, İVRA, ketamin, lidokain

Destekleyen Kurum

Destekleyen kurum bulunmamaktadır

Effect of Different Anesthetic Agents Management on Electrocardiographic Changes of Patients Operated under Regional Intravenous Anesthesia

Öz

Objective: We compared cardiac effects, electrocardiographic changes by intravenous regional anesthesia (IVRA) with lidocaine and lidocaine + ketamine.

Materials and Methods: Prospective, randomised, double blind study was performed in the operating room of Düzce University Hospital. Seventy patients between 18-60 years, ASA I-II and who were undergo IVRA for arm and forearm operations. Patients were divided into two groups randomly. Group 1: 0.5% Lidocaine+Ketamine 0.8 mg/kg; 40 ml. Group 2: 0.5% Lidocaine 40 ml. 20 minutes after injection the distal cuff was inflated, and the proximal cuff deflated with a rate of 50 mmHg in every 3 minutes. Time periods of the recordings were 0, 5, 10, 15, 30, 45, 60th minutes after the beginning of deflation and 10 minutes after the deflation. Non-invasive blood pressure values, heart rate, pulse oximetry values ​​were recorded. Electrocardiographic changes on PR, RR intervals, QT, QTc were recorded.

Results: QT basal value measured in Group Lidocaine+Ketamine is significantly lower than QT5th min, QT10th min, QT15th min, QT30th min, QT45th min, QT60th min and QTtur10. QTcbasal values measured in Group Lidocaine+Ketamine were significantly lower than QTc tur10 values (p <0.001). 

Conclusions: In Group Lidocaine, no significant differences was observed. After the deflation of tourniquet was completed, QT and QTc values and noninvasive blood pressures were significantly higher in Group Lidocaine+Ketamine.

Anahtar Kelimeler

Electrocardiogram, IVRA, ketamine, lidocaine

Kaynakça

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