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

Yıl 2020, Cilt: 5 Sayı: 2, 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

• 1. Barry LA, Balliana SA, Galeppi AC. Intravenous Regional Anesthesia (Bier Block): Tecniques in Regional Anesthesia and Pain Management. 2006;10:123-131.
• 2. Henderson CL, Warriner CB, McEwen JA, Merrick PM. A North American survey of intravenous regional anesthesia. Anaesth Analg. 1997;85(63):858.
• 3. Guay J. Adverse events associated with intravenous regional anesthesia (Bier block) a systematic review: Journal of Clinical Anesthesia. 2009;21(8):585-594.
• 4. Owczuk R, Wujtewicz MA, Sawicka W, Piankowski A, Polak-Krzeminska A, Morzuch E, et al. The effect of intravenous lidocaine on QT changes during tracheal intubation. Anesthesia. 2008;63(9):924-31.
• 5. Shah RR. The significance of QT interval in drug development. Br J Clin Pharmacol. 2002;54(2):188-202.
• 6. Owczuk R, Sawicka W, Wujitewcz MA, Kawecka A, Lasec J, Wujitewcz M. Influence of spinal anesthesia on corrected QT interval. Reg Anesth Pain Med. 2005;30(6):548-52.
• 7. Khan IA. Clinical and therapeutic aspects of congenital and acquired long QT syndrome. Am J Med. 2002;112(1):58-66.
• 8. Wisely NA, Shipton EA. Long QT syndrome and anesthesia. Eur J Anaesthesiol. 2001;19:853-9.
• 9. Hamlin RL, Kijtawornrat A, Keene BW, Hamlin DM. QT and RR intervals in conscious and anesthetized guinea pigs with highly varying RR intervals and given QTc-lengthening test articles. Toxicological Sciences. 2003;76(2):437-442.
• 10. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. British Journal of Anaesthesia 2003; 90: 349– 66.
• 11. Rosenberg PH. 1992 ASRA lecture. Intravenous regional anesthesia: nerve block by mu anesthesia? Saudi J Anaesth. 2010;4(2):55-62.
• 12. 1JP Sharma, R Salhotra. Tourniquets in orthopedic surgery. Indian J Orthop. 2012;46(4): 377–383.
• 13. Tetzlaff JE, Yoon HJ, Walsh M. Regional Anaesthetic technique and the incidence of tourniquet pain. Can J Anaesthesia. 1993;40(7):591.
• 14. Abdulla WY, Fadhil NM. A new approach to intravenous regional anesthesia. Anesth Analg. 1992;75(4):597-601.
• 15. Choyce A, Peng P. A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures. Can J Anaesth. 2002;49(1):32-45.
• 16. Barry LA, Balliana SA, Galeppi AC. Intravenous Regional Anesthesia (Bier Block): Tecniques in Regional Anesthesia and Pain Management. 2006;10:123-131.
• 17. Guinet P, Estebe JP, Ratajczak-Enselme M, Bansard JY, Chevanne F, Bec D, Lecorre P, Wodey E, Ecoffey C. Electrocardiographic and hemodynamic effects of intravenous infusion of bupivacaine, ropivacaine, levobupivacaine, and lidocaine in anesthetized ewes. Reg Anesth Pain Med. 2009;34(1):17-23.
• 18. Gristwood RW, Greaves JL. Levobupivacaine: a new safer long acting local anaesthetic agent. Expert Opin Investig Drugs. 1999;8(6):861-76.
• 19. Clarkson CW, Hondeghem LM. Mechanism for bupivacaine depression of cardiac conduction. Fast block of sodium channels during the action potential with slow recovery from block during diastole. Anesthesiology 1985;62(4):396-405.
• 20. Passariello M, Almenrader N, Canneti A, Rubeo L, Haiberger R, Pietropaoli P. Caudal analgesia in children: S (+)-ketamine vs S(+)-ketamine plus clonidine. Pediatric Anesthesia. 2004;14:851-855.
• 21. Himmelseher S, Ziegler-Pithamitsis D, Argiriadou H, Martin J, Jelen-Esselborn S, Kochs E. Small dose S (+) ketamine reduces postoperative pain when applied with ropivacaine in epidural anesthesia for total knee arthroplasty. Anesth Analg. 2001;92(5):1290-1295.
• 22. Almenrader N, Passariello M, D'Amico G, Haiberger R, Pietropaoli P. Caudal additives for postoperative pain management in children: S(+) ketamine and neostigmine. Paediatr Anaesth. 2005;15:143.
• 23. Acalovschi I, Cristea T. Intravenous regional anesthesia with meperidine. Anesth&Analg. 1995;81(3):539.
• 24. Bigat Z, Boztuğ N. RİVA’da lidokain ve lidokaine eklenen tenoksikam ve deksametazonun karşılaştırılması. Türk Anest Rean Der. 2004;32:200.
• 25. Kleinschmidt S, Stockl W, Wilhelm W, Larsen R. The addition of clonidine to prilocaine for intraveneous regional anaesthesia. Eur J Anaesthesiol. 1997;14(1):40.
• 26. Turan A, Memis D, Karamanlıoglu B, Güler T, Pamukçu Z. Intravenous regional anesthesia using lidocaine and magnesium. Anesth Analg. 2005;100:1189.
• 27. Kumar A, MD DNB (Anaes), Sharma DK, B. Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study. J Anaesthesiol Clin Pharmacol. 28(4): 501–504.