Supramaximal Tonuslu Rat Bronşlarında Propofol ile Karşılaştırılan Thiopental'in Şaşırtıcı Üstünlüğü
Öz
Giriş: Bronkospazm, operasyonun ve anestezinin
tüm aşamalarında ve istenmeyen bir fenomendir. Anestezi indüksiyonu sonrası
trakeal entübasyon, sıklıkla bronkokonstriksiyona neden olan solunum sisteminin
direncinde ölçülebilir bir artışa neden olur. Propofol ve tiyopental uzun
yıllardan beri anestezi indüksiyonunda intravenöz anestezik ajan olarak kullanılmaktadır.
Barbitüratlar, bronkospazmaya neden olan etkilerinden dolayı riskli hastalarda kullanılması tavsiye edilmez.
Bronkodilatasyon ve kas gevşetici etkisi nedeniyle astım
ve bronkospazm riski olan hastalarda genellikle propofol önerilir. Bu çalışmada,
rat bronşlarında supramaksimal tonus oluşturulmuş bronkospazm modelinde
propofolun thiopentale olan bu üstünlüğünü göstermeyi
amaçladık.
Gereç ve yöntemler: Toplam 30 erişkin erkek sıçan
dört gruba ayrıldı. Çift-kör grup T1 supramaximal kontraksiyonda 1x10-5 M
tiyopental aldı. Grup T2'de supramaksimal kontraksiyonda 1x10-6M tiyopental,
supramaksimal kontraksiyonda Grup P1 1x10-1M propofol ve Grup P2'de 1x10-2M
propofol uygulandı. Doku voltajları MAY GTA0303 GENIUS TRANSDUCER AMPLITUDE®
ile ölçüldü ve Acqunowledge MP100® programına kaydedildi.
Bulgular: Grup T1'de tonustaki azalma
istatistiksel olarak anlamlı bulundu (tahmini ortalama fark, -0.41;% 95 güven
aralığı [CI], -0.36 ile 1.18; p = 0.000. T2 grubunda tonus farkı istatistiksel
olarak anlamlıydı (tahmini). ortalama fark, -0.20;% 95 güven aralığı [CI],
-0.62 ile 1.03; p = 0.001). Uygulama öncesi ve sonrası P1 grubu ve grup P2'de
tonus seviyeleri arasında istatistiksel olarak anlamlı bir fark bulunmadı.
Sonuç: Çalışmamızda in vitro bronkospazm
modelinde rat bronş dokusunda iki farklı tiyopental dozunda gevşeme etkisi
gösterilmiştir. Propofolün iki ayrı dozunda ise herhangi bir gevşeme veya
kasılma yanıtı saptanmamıştır. Şaşırtıcı olarak, bu çalışma propofolun doğrudan
bronkodilatör etkisinin olmadığını ve tiyopentalin direkt olarak bronkodilatasyon
sağladığını göstermektedir. Sonuç olarak, tiyopental doza bağımlı bronkodilatasyonun
etkisinin literatürde iyi tartışma olmadığını fark ettik. Bu nedenle daha ileri
klinik ve deneysel çalışmalarda tiyopental direkt bronkodilatasyon dozları
belirlenmelidir.
Anahtar Kelimeler
Kaynakça
- References1. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-50.References2. Shander A, Fleisher LA, Barie PS, et al. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 2011;39:2163-72.References3. Subramanyam R, Yeramaneni S, Hossain MM, et al. Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia: Development and Validation of a Risk Prediction Tool. Anesth Analg 2016;122:1578-85.References4. Kumeta Y, Hattori A, Mimura M, et al. [A survey of perioperative bronchospasm in 105 patients with reactive airway disease]. Masui 1995;44:396-401.References5. Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009 Dec;103 Suppl 1:i57-65.References6. K. Kobayashi, F. Yoshino, S.S. Takahashi, et al., Direct assessments of the antioxidant effects of propofol medium chain triglyceride/long chain triglyceride on the brain of stroke-prone spontaneously hypertensive rats using electron spin resonance spectroscopy, Anesthesiology 109 (2008) 426–435). References7. Shukla A. Intraoperative bronchospasm with thiopental. Indian J Anaesth. 2010 Mar;54(2):181-2. References8. Hirota K, Ohtomo N, Hashimoto Y, Kudo T, Kudo M, Ishihara H, Matsuki A.Effects of thiopental on airway calibre in dogs: direct visualization method using a superfine fibreoptic bronchoscope. Br J Anaesth. 1998 Aug;81(2):203-7.Kabara S, Hirota K, References9. Yoshioka H, Kudo T, Ishihara H, Matsuki A. Differential effects of thiopental on methacholine- and serotonin-induced bronchoconstriction in dogs. Br J Anaesth. 2003 Sep;91(3):379-84.References10. Adriani J, Rovenstine EA. The effect of anesthetic drugs upon bronchiand broncioles of excised lung tissue. Anesthesiology. 1943;4:253-62.References11. Fletcher SW, Flacke W, Alper MH. The actions of general anestheticagents on tracheal smooth muscle. Anesthesiology. 1968:29;517-22.References12. Edney SM, Downes H: Contractor effect of barbiturates on smooth muscle. Arch Int Pharmacodyn:1975;217:180-96.References13. Lenox WC, Mitzner W, Hirshman CA. Mechanism of thiopental-induced constriction of guinea pig trachea. Anesthesiology. 1990 May;72(5):921-5.References14. Mustafa S, Thulesius L, Thulesius O. The contractile response of thiopental in large and small ovine airways. Acta Anaesthesiol Scand. 1994 Jul;38(5):499-504.References15. Hirota K, Ohtomo N, Hashimoto Y, Kudo T, Kudo M, Ishihara H, Matsuki A. Effects of thiopental on airway calibre in dogs: direct visualization method using a superfine fibreoptic bronchoscope. Br J Anaesth. 1998 Aug;81(2):203-7.References16. Kabara S, Hirota K, Yoshioka H, Kudo T, Ishihara H, Matsuki A. Differential effects of thiopental on methacholine- and serotonin-induced bronchoconstriction in dogs. Br J Anaesth. 2003 Sep;91(3):379-84.References17. I. Bagcivan, O. Cevit, M.K. Yildirim, et al., Investigation of the relaxant effects of propofol on ovalbumin-induced asthma in guinea pigs, Eur. J. Anaesthesiol. 24 (2007) 796–802. References18. N. Ouedraogo, R. Marthan, E. Roux, The effects of propofol and etomidate on airway contractility in chronically hypoxic rats, Anesth Analg. 96 (2003) 1035–1041.References19. S.M. Burburan, D.G. Xisto, P.R. Rocco, Anaesthetic management in asthma, Minerva Anestesiol. 73 (2007) 357–365. References20. W. Yao, G. Luo, G. Zhu, et al., Propofol activation of the Nrf2 pathway is associated with amelioration of acute lung injury in a rat liver transplantation model, Oxidative Med. Cell. Longev. 2014 (2014) 258567.References21. C. Liang, J. Cang, H. Wang, et al., Propofol attenuates cerebral ischemia/reperfusion injury partially using heme oxygenase-1, J. Neurosurg. Anesthesiol. 25 (2013) 311–316. References22. H.H. Wang, H.Y. Zhou, C.C. Chen, et al., Propofol attenuation of renal ischemia/reperfusion injury involves heme oxygenase-1, Acta Pharmacol. Sin. 28 (2007) 1175–1180).References23. Z. Bao, S. Guan, C. Cheng, et al., A novel antiinflammatory role for andrographolide in asthma via inhibition of the nuclear factor-kappaB pathway, Am. J. Respir. Crit. Care Med. 179 (2009) 657–665.References24. Zhang Q, Wang L, Chen B, Zhuo Q, Bao C, Lin L. Propofol inhibits NF-κB activation to ameliorate airway inflammation in ovalbumin (OVA)-induced allergic asthma mice. Int Immunopharmacol. 2017 Oct;51:158-164.
Öz
Introduction: Bronchospasm is an undesirable phenomenon in all phases of operation and anesthesia.Tracheal intubation after induction of anesthesia causes a measurable increase in the resistance of the respiratory system, which often results in bronchoconstriction.Propofol and thiopental have been used as an intravenous anesthetic agent in induction of anesthesia for many years.Barbiturates are recommended not be used in patients with risks due to bronchospasm-causing effects. Propofol is generally recommended for patients with asthma and bronchospasm due to bronchodilatation and muscle relaxant effects. In our study, we aimed to demonstrate this superiority of propofol to thiopental in rat bronchi with supramaximal tonus in a bronchospasm model.
Materials and methods:A total of 30 adult male rats were divided into four groups. Double-blinded group T1 received 1x10-5 M thiopental at supramaximal contraction. In Group T2, 1x10-6M thiopental was applied at supramaximal contraction while in Group P1 1x10-1M propofol was applied at supramaximal contraction and in Group P2, 1x10-2M propofol was applied. Tissue voltages were measured with MAY GTA0303 GENIUS TRANSDUCER AMPLITUDE® and recorded in the Acknowledge MP100® program.
Results:In Group T1, the reduction in tonus was statistically significant (estimated mean difference, -0.41; 95% confidence interval [CI], -0.36 to 1.18; p=0.000. In Group T2, the tonus difference was statistically significant (estimated mean difference, -0.20; 95% confidence interval [CI], -0.62 to 1.03; p=0.001).There was no statistically significance between tonus levels in neither group P1 nor group P2 before and after the implementation
Conclusion: In our study, relaxation effect in two different doses of thiopental was shown in rat bronchus tissue in in vitro bronchospasm model. Propofol did not show any relaxation or contraction responses in two separate doses. Surprisingly, Our results suggest that propofol has no direct bronchodilatation effect and thiopental provides bronchodilation. Consequently, we noticed that the effect of thiopental dose-dependent bronchodilatation is not well debate in the literature. For this reason, bronchodilatation doses of thiopental should be determined in further clinical and experimental studies.
Anahtar Kelimeler
Kaynakça
- References1. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-50.References2. Shander A, Fleisher LA, Barie PS, et al. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 2011;39:2163-72.References3. Subramanyam R, Yeramaneni S, Hossain MM, et al. Perioperative Respiratory Adverse Events in Pediatric Ambulatory Anesthesia: Development and Validation of a Risk Prediction Tool. Anesth Analg 2016;122:1578-85.References4. Kumeta Y, Hattori A, Mimura M, et al. [A survey of perioperative bronchospasm in 105 patients with reactive airway disease]. Masui 1995;44:396-401.References5. Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009 Dec;103 Suppl 1:i57-65.References6. K. Kobayashi, F. Yoshino, S.S. Takahashi, et al., Direct assessments of the antioxidant effects of propofol medium chain triglyceride/long chain triglyceride on the brain of stroke-prone spontaneously hypertensive rats using electron spin resonance spectroscopy, Anesthesiology 109 (2008) 426–435). References7. Shukla A. Intraoperative bronchospasm with thiopental. Indian J Anaesth. 2010 Mar;54(2):181-2. References8. Hirota K, Ohtomo N, Hashimoto Y, Kudo T, Kudo M, Ishihara H, Matsuki A.Effects of thiopental on airway calibre in dogs: direct visualization method using a superfine fibreoptic bronchoscope. Br J Anaesth. 1998 Aug;81(2):203-7.Kabara S, Hirota K, References9. Yoshioka H, Kudo T, Ishihara H, Matsuki A. Differential effects of thiopental on methacholine- and serotonin-induced bronchoconstriction in dogs. Br J Anaesth. 2003 Sep;91(3):379-84.References10. Adriani J, Rovenstine EA. The effect of anesthetic drugs upon bronchiand broncioles of excised lung tissue. Anesthesiology. 1943;4:253-62.References11. Fletcher SW, Flacke W, Alper MH. The actions of general anestheticagents on tracheal smooth muscle. Anesthesiology. 1968:29;517-22.References12. Edney SM, Downes H: Contractor effect of barbiturates on smooth muscle. Arch Int Pharmacodyn:1975;217:180-96.References13. Lenox WC, Mitzner W, Hirshman CA. Mechanism of thiopental-induced constriction of guinea pig trachea. Anesthesiology. 1990 May;72(5):921-5.References14. Mustafa S, Thulesius L, Thulesius O. The contractile response of thiopental in large and small ovine airways. Acta Anaesthesiol Scand. 1994 Jul;38(5):499-504.References15. Hirota K, Ohtomo N, Hashimoto Y, Kudo T, Kudo M, Ishihara H, Matsuki A. Effects of thiopental on airway calibre in dogs: direct visualization method using a superfine fibreoptic bronchoscope. Br J Anaesth. 1998 Aug;81(2):203-7.References16. Kabara S, Hirota K, Yoshioka H, Kudo T, Ishihara H, Matsuki A. Differential effects of thiopental on methacholine- and serotonin-induced bronchoconstriction in dogs. Br J Anaesth. 2003 Sep;91(3):379-84.References17. I. Bagcivan, O. Cevit, M.K. Yildirim, et al., Investigation of the relaxant effects of propofol on ovalbumin-induced asthma in guinea pigs, Eur. J. Anaesthesiol. 24 (2007) 796–802. References18. N. Ouedraogo, R. Marthan, E. Roux, The effects of propofol and etomidate on airway contractility in chronically hypoxic rats, Anesth Analg. 96 (2003) 1035–1041.References19. S.M. Burburan, D.G. Xisto, P.R. Rocco, Anaesthetic management in asthma, Minerva Anestesiol. 73 (2007) 357–365. References20. W. Yao, G. Luo, G. Zhu, et al., Propofol activation of the Nrf2 pathway is associated with amelioration of acute lung injury in a rat liver transplantation model, Oxidative Med. Cell. Longev. 2014 (2014) 258567.References21. C. Liang, J. Cang, H. Wang, et al., Propofol attenuates cerebral ischemia/reperfusion injury partially using heme oxygenase-1, J. Neurosurg. Anesthesiol. 25 (2013) 311–316. References22. H.H. Wang, H.Y. Zhou, C.C. Chen, et al., Propofol attenuation of renal ischemia/reperfusion injury involves heme oxygenase-1, Acta Pharmacol. Sin. 28 (2007) 1175–1180).References23. Z. Bao, S. Guan, C. Cheng, et al., A novel antiinflammatory role for andrographolide in asthma via inhibition of the nuclear factor-kappaB pathway, Am. J. Respir. Crit. Care Med. 179 (2009) 657–665.References24. Zhang Q, Wang L, Chen B, Zhuo Q, Bao C, Lin L. Propofol inhibits NF-κB activation to ameliorate airway inflammation in ovalbumin (OVA)-induced allergic asthma mice. Int Immunopharmacol. 2017 Oct;51:158-164.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019 |