Servikal vertebra cerrahisi geçirecek, sigara içen ve içmeyen hastalarda TİVA'dan uyanma sırasında üst havayolu reflekslerine deksmedetomidinin etkileri
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Date
2012
Authors
Yazıcı, Hünkar Şule
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Genel anesteziden derlenme sırasındaki öksürük özellikle servikal spinal cerrahide sorunlu olabilir. Servikal vertebra cerrahisi geçirecek, sigara içen ve içmeyen hastalarda hedef kontrollü total intravenöz anestezi (HKİ) uygulamasına cerrahi bitiminden 5 dk önce eklenen 10 dk süresince 0.5 mcg/kg deksmedetomidin infüzyonunun (Dİ) derlenmedeki üst havayolu reflekslerine etkilerini araştırdık.UÜTF Etik Kurul onayı ile sigara içen ve içmeyen, ASA I-II, 18-65 yaş, 80 olgu 4 gruba randomize edildi; Grup I: sigara içen+Dİ verilmeyecek olgular, Grup II: sigara içen+Dİ verilecek olgular, Grup III: sigara içmeyen+Dİ verilmeyecek olgular, Grup IV: sigara içmeyen, Dİ verilecek olgular. Kalp atım hızları (KAH), kan basınçları (KB) ve SpO2 değerleri indüksiyon öncesi ve sonrası farklı zamanlarda, operasyon sonu, ekstübasyon sonrası ve ayılma odasında kaydedildi. İlk spontan solunum (İSS), düzenli spontan solunum başlama (DSS), sözlü eİirlere uyma (SEZ), kaf indirilme (KAF), ekstübasyon zamanları (EZ) ve öksürük/laringospazm kaydedildi. İstatistiksel analizlerde Mann-Whitney U, Kruskal Wallis, Wilcoxon testleri kullanıldı. p< 0,05 anlamlı kabul edildi.Grup II ve III'te İSS daha kısa idi, ancak sadece Grup II ile I (p<0.05) ve Grup II ile IV (p<0.01). arasındaki fark anlamlıydı. Grup I ve II arasında DSS'deki fark anlamlıydı (p<0.05). Farklı dönemlerde 18 hastada öksürük görüldü. Grup I'de öksürük insidansı yüksek olmasına rağmen fark anlamlı saptanmadı. İndüksiyon sonrası tüm zamanlarda KAH, KB değerleri anlamlı düşük iken, gruplar arasında anlamlı farklılık saptanmadı.Sonuç olarak, sigara içenlerde öksürüğün daha sık oluştuğu ve deksmedetomidinin ekstübasyon sırasındaki öksürük refleksini önemli ölçüde baskıladığı görülmüştür. Bu etkisinin ise sempatolitik, sedatif ve analjezik özelliklerinden dolayı laringeal stimülasyonun daha az hissedilmesine bağlı olarak oluştuğu kanısındayız.
Coughing during emergence from general anaesthesia may be hazardous, especially after cervical spine surgery. We aimed to research the efficacy of dexmetedomidine infusion (DI) 0.5 mcg/kg added for 10 minutes to TCI for total intravenous anesthesia on upper airway reflexes, 5 minutes before the end of surgery during emergence from anethesia, in the smokers or non-smokers who would undergo servical spine surgery.After Local Ethics Committee approval, 80 cases of smokers or non-smokers, ASA I-II status, age 18-65 years were randomized into 4 groups. Group I: smokers+no DI, Group II: smokers+DI, Group III: non-smokers+no DI, Group III: non-smokers+DI. The heart rates (HR), blood pressures (BP) and SpO2 values were recorded before and after the induction at certain times, at the end of the operation, after the extubation and in the emergence room. First spontaneous breathing trial (SBT), the beginning of regular spontaneous breathing (RSB) the times of obeying verbal commands, deflating cuff, and extubation and the cough and /or laryngospasm in the meantime were recorded.SBT in Groups II and III was shorter, but only between group II and I (p<0.05), and group II and IV (P<0.01) were statistically significant. RSB was significantly different between group I and II. Cough was observed in 18 patients. Although cough incidence was high in group I, there was no significant difference. HR and BP were significantly low in all times after the induction, but a significant difference between groups was not determined. Mann-Whitney U, Kruskal Wallis, Wilcoxon tests were used for statistical analyses. A p value was < 0,05 was considered to be statistically significant.As a conclusion; it was noted that cough was more frequent in smokers and dexmedetomidine suppressed the cough reflex significantly during extubation. We believe that the cause of this effect is the reduction of feeling of laryngeal stimulation due to sympatholytic, sedative and analgesic effects of dexmedetomidine.
Coughing during emergence from general anaesthesia may be hazardous, especially after cervical spine surgery. We aimed to research the efficacy of dexmetedomidine infusion (DI) 0.5 mcg/kg added for 10 minutes to TCI for total intravenous anesthesia on upper airway reflexes, 5 minutes before the end of surgery during emergence from anethesia, in the smokers or non-smokers who would undergo servical spine surgery.After Local Ethics Committee approval, 80 cases of smokers or non-smokers, ASA I-II status, age 18-65 years were randomized into 4 groups. Group I: smokers+no DI, Group II: smokers+DI, Group III: non-smokers+no DI, Group III: non-smokers+DI. The heart rates (HR), blood pressures (BP) and SpO2 values were recorded before and after the induction at certain times, at the end of the operation, after the extubation and in the emergence room. First spontaneous breathing trial (SBT), the beginning of regular spontaneous breathing (RSB) the times of obeying verbal commands, deflating cuff, and extubation and the cough and /or laryngospasm in the meantime were recorded.SBT in Groups II and III was shorter, but only between group II and I (p<0.05), and group II and IV (P<0.01) were statistically significant. RSB was significantly different between group I and II. Cough was observed in 18 patients. Although cough incidence was high in group I, there was no significant difference. HR and BP were significantly low in all times after the induction, but a significant difference between groups was not determined. Mann-Whitney U, Kruskal Wallis, Wilcoxon tests were used for statistical analyses. A p value was < 0,05 was considered to be statistically significant.As a conclusion; it was noted that cough was more frequent in smokers and dexmedetomidine suppressed the cough reflex significantly during extubation. We believe that the cause of this effect is the reduction of feeling of laryngeal stimulation due to sympatholytic, sedative and analgesic effects of dexmedetomidine.
Description
Keywords
İntravenöz infüzyon, Deksmedetomidin, Sigara içiciliği, Öksürük, İnfusions intravenous, Dexmedetomidine, Smoking cigarette, Cough
Citation
Yazıcı, H. Ş. (2012). Servikal vertebra cerrahisi geçirecek, sigara içen ve içmeyen hastalarda TİVA'dan uyanma sırasında üst havayolu reflekslerine deksmedetomidinin etkileri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.