Deksmedetomidinin hemodinami ve entübasyon koşullarına etkisi
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Date
2009
Authors
Yıldırım, Arzu
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda genel anestezi indüksiyonu öncesi uygulanan 2 farklı deksmedetomidin dozunun endotrakeal entübasyona bağlı hemodinamik yanıtlar, entübasyon koşulları ve nöromusküler ileti üzerine etkilerini incelemeyi amaçladık.Randomize, plasebo kontrollü ve çift kör olarak planlanan çalışmaya, etik kurul onamı alındıktan sonra genel anestezi altında endotrakeal entübasyon uygulanacak ve elektif cerrahi geçirecek, ASA I-II grubu, 18-70 yaş arası 75 olgu alındı. Standart anestezi indüksiyonu öncesi, olgular serum fizyolojik (20 cc) (Grup Kontrol), deksmedetomidin 0.5 µg/kg (Grup D 0.5) veya deksmedetomidin1 µg/kg (Grup D 1) 20 cc volümde 10 dk içinde uygulanmak üzere rasgele 3 gruba ayrıldı. Kalp atım hızı (KAH) ve ortalama arteriyel kan basıncı (OAB) çalışma ilacı verilmeden önce ve sonra, indüksiyondan önce ve sonra, laringoskopi sırasında, endotrakeal entübasyondan hemen sonra ve 1., 3., 5., 10. ve 15. dakikalarda kaydedildi. Nöromusküler iletide %90 ve %100 blok oluşum zamanı, oluşan bloğun %25 (T25), %50 (T50) ve %75 (T75) düzeyinde geri dönmesine kadar geçen süreler ve derlenme endeksi değerleri kaydedildi. Entübasyon koşullarının kalitesi de değerlendirildi.Laringoskopi ve entübasyondan hemen sonra KAH'de gözlenen yükselmedekmedetomidin gruplarında kontrol grubuna göre düşük bulundu (Grup D 1: p<0.001, p<0.001; Grup D 0.5: p<0.01, p<0.05). Entübasyonun 1. dakikasında görülen artış D 1 grubunda D 0.5 ve kontrol gruplarına göre daha az saptandı (her iki grup için; p<0.05). Ayrıca, deksmedetomidin gruplarında laringoskopi döneminde ölçülen OAB değerleri Kontrol grubu ile karşılaştırıldığında düşük gözlendi (her iki grup için; p<0.01). D 0.5 ve D 1 gruplarında %90 ve %100 blok oluşum zamanları Kontrol grubuna göre anlamlı olarak kısa bulundu (tüm karşılaştırmalar için; p<0.01). D 0.5 grubunda T75 ve derlenme endeksi (p<0.01, p<0.01), D 1 grubunda ise T25, T50, T75 ve derlenme endeksi Kontrol grubuna göre uzun bulundu (p<0.05, p<0.01, p<0.001, p<0.001). Nöromüsküler ileti özellikleri deksmedetomidin grupları arasında benzer gözlendi. Entübasyon koşullarının kalitesi üç grupta benzerdi.Deksmedetomidinin endotrakeal entübasyona bağlı hemodinamik yanıtı kalp hızı üzerine daha belirgin olmak üzere doza bağlı azaltırken, nöromusküler blok oluşum zamanını kısalttığı, derlenme süresini ise dozdan bağımsız olarak uzattığı kanısındayız.
In our study, we aim to investigate the effects of two different preanesthetic doses of dexmedetomidine on hemodynamic response to endotracheal intubation, intubation conditions and neuromuscular block.After ethics committee approval 75 ASA status I-II patients, aged18 to70 years, who required tracheal intubation for elective surgery undergoing general anesthesia were allocated to this randomized, placebo controlled double-blind study. Before standard anaesthesia induction, patients were randomly divided into three groups to receive either saline as placebo (20 cc) (Group Control), dexmedetomidine 0.5 µg/kg (Group D 0.5) or dexmedetomidine 1 µg/kg (Group D 1) in a total volume of 20 cc in 10 min. Heart rate (HR) and mean arterial pressure (MAP) were recorded before and after administration of the study drug, before and after induction, during laryngoscopy, 0. (immediately), 1., 3., 5.,10., and 15. min after endotracheal intubation. Time to achive 90% and 100% neuromuscular block, time to recovery from neuromuscular block 25% (T25), 50% (T50), 75% (T75) and recovery index values were noted. Quality of endotracheal intubation was also assessed.The increases in HR after laryngoscopy and imediately intubation were lower in two dexmedetomidine groups than control group (Group D1: p<0.001, p<0.001; Group D0.5: p<0.01, p<0.05, respectively). The increase İn HR at 1 min after intubation was lower in Group D1 than Group D 0.5 and Group Control (p<0.05 for both groups). Values of MAP during laryngoscopy were lower in Group D 1 and Group D 0.5 compared with Group Control (p<0.01 for both groups). Times to achive 90% and 100% neuromuscular block were found significantly lower in dexmedetomidine groups than Group Control (p<0.01 for all groups). Values of T75 and recovery index in Group D 0.5 (p<0.01, p<0.01), T25, T50, T75 and recovery index in Group D 1 were longer than control group (p<0.05, p<0.01, p<0.001, p<0.001). Neuromuscular block properties were similar between dexmedetomidine groups. Quality of endotracheal intubation was similar in three groups.We conclude that dexmedetomidine decreased hemodynamic response to endotracheal intubation, especially heart rate dose dependently, whereas it decreased time to achieve neuromuscular block and increased time to recovery from neuromuscular block as independent from dose.
In our study, we aim to investigate the effects of two different preanesthetic doses of dexmedetomidine on hemodynamic response to endotracheal intubation, intubation conditions and neuromuscular block.After ethics committee approval 75 ASA status I-II patients, aged18 to70 years, who required tracheal intubation for elective surgery undergoing general anesthesia were allocated to this randomized, placebo controlled double-blind study. Before standard anaesthesia induction, patients were randomly divided into three groups to receive either saline as placebo (20 cc) (Group Control), dexmedetomidine 0.5 µg/kg (Group D 0.5) or dexmedetomidine 1 µg/kg (Group D 1) in a total volume of 20 cc in 10 min. Heart rate (HR) and mean arterial pressure (MAP) were recorded before and after administration of the study drug, before and after induction, during laryngoscopy, 0. (immediately), 1., 3., 5.,10., and 15. min after endotracheal intubation. Time to achive 90% and 100% neuromuscular block, time to recovery from neuromuscular block 25% (T25), 50% (T50), 75% (T75) and recovery index values were noted. Quality of endotracheal intubation was also assessed.The increases in HR after laryngoscopy and imediately intubation were lower in two dexmedetomidine groups than control group (Group D1: p<0.001, p<0.001; Group D0.5: p<0.01, p<0.05, respectively). The increase İn HR at 1 min after intubation was lower in Group D1 than Group D 0.5 and Group Control (p<0.05 for both groups). Values of MAP during laryngoscopy were lower in Group D 1 and Group D 0.5 compared with Group Control (p<0.01 for both groups). Times to achive 90% and 100% neuromuscular block were found significantly lower in dexmedetomidine groups than Group Control (p<0.01 for all groups). Values of T75 and recovery index in Group D 0.5 (p<0.01, p<0.01), T25, T50, T75 and recovery index in Group D 1 were longer than control group (p<0.05, p<0.01, p<0.001, p<0.001). Neuromuscular block properties were similar between dexmedetomidine groups. Quality of endotracheal intubation was similar in three groups.We conclude that dexmedetomidine decreased hemodynamic response to endotracheal intubation, especially heart rate dose dependently, whereas it decreased time to achieve neuromuscular block and increased time to recovery from neuromuscular block as independent from dose.
Description
Keywords
Nöromusküler blokaj, Deksmedetomidin, Entübasyon, Hemodinamik yanıt, Neuromuscular blockadge, Dexmedetomidine, Intubation, Hemodynamic response
Citation
Yıldırım, A. (2009). Deksmedetomidinin hemodinami ve entübasyon koşullarına etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.