Z. Özlem ULUBAY, Banu AYHAN, Meral KANBAK, Bilge ÇELEBİOĞLU, Ülkü AYPAR

Açık kalp cerrahisinde uygulanan sevofluran, desfluran ve izofluranın iskemi-reperfüzyon hasarı üzerine etkilerinin karşılaştırılması

Amaç: Halojenli anestezikler, iskemi-reperfüzyon hasarına karşı miyokardı enfarkt boyutunda azalma ve reperfüzyon sırasında kontraktil fonksiyonlarda hızlı bir iyileşme sağlayarak korurlar. Biz bu çalışmada; açık kalp cerrahilerinde izoşuran, sevoşuran ve desşuran uygulamasının, iskemi-reperfüzyon hasarı üzerindeki etkilerini karşılaştırmayı amaçladık. Yöntem: Etik komite izni alındıktan sonra, 25-75 yaşlarında 36 hasta, randomize ve prospektif olarak çalışmaya alındı. Hastalar aldıkları volatil ajanlara göre sevoşuran (Grup S), desşuran (Grup D) ve izoşuran (Grup İ) olarak gruplara ayrıldı. Her üç inhalasyon ajanı; indüksiyondan operasyon sonuna kadar, KPB periyodu dışında, 1 MAK konsantrasyonda uygulandı. Tüm anestezi boyunca hastalara remifentanil infüzyonu yapıldı. Hemodinamik değişiklikler (KH, OAB, SVB, KD, Kİ, PAB, PAUB, SVR, PVR, SV ve Sİ), hastane ve yoğun bakımda kalış süreleri kaydedildi. Laboratuvar parametreleri (CKMB, TnT, BNP), beş zaman aralığında (T1: İndüksiyon sonrası, T2: KPB sırasında, T3: Operasyon sonu, T4: Postoperatif 24.saat, T5: Postoperatif 48.saat) ve IL-6 ve IL-10 düzeyleri T1, T4, T5te saptandı. Bulgular: Tüm gruplarda, OAB (T3,T5), SVB (T4,T5), PAB (T3-T5), PKUB (T3-T5), SVR (T3-T5), PVR (T3-T5) değerleri bazal değerlere göre azalmış; KH (Sevo, T3-T5), KD, Kİ, SV ve Sİ değerleri (T3-T5) ise artmıştır. CKMB, TnT (T2-T5), BNP ve IL-6 (T4, T5), IL-10 (T4) değerleri, bazal değerler ile karşılaştırıldığında artmıştır ancak, üç grup arasında fark bulunamamıştır. Kan ve kan ürünleri, inotrop ihtiyacı, yoğun bakım ve hastanede kalış süreleri açısından gruplar arasında fark görülmedi. Kan şekeri ve insülin ihtiyacı ise, desşuran grubunda yüksek bulundu. Sonuç: Açık kalp cerrahisi uygulanan hastalarda, Sevoşuran, Desşuran ve İzoşuranın benzer hemodinamik ve kardiyak koruyucu etkilere sahip olduğu sonucuna varılmıştır.

Comparison of the effects of sevoflurane, desflurane and isoflurane against ischaemia/reperfusion injury in open heart surgery

Objective: Most of the investigations demonstrate that halogenated anaesthetics protect the myocardium against ischaemia/ reperfusion(I/R) injury by reducing the infarct size and providing a fast recovery of contractile functions during reperfusion. The aim of this study was to compare the effects of sevoflurane, desflurane and isoflurane on I/R injury during open heart surgery. Method: Following ethical committee approval, 36 patients aged 25-75 years were included in this prospective, randomized study. The patients were randomly allocated to groups according to the volatile anaesthetics they received, sevoflurane (Group S), desflurane (Group D) and isoflurane (Group I). Inhalation agents were administered at 1 MAC concentration from anaesthesia induction until the end of the operation, excluding the CPB period. All patients received infusion of remifentanil throughout the operation. Haemodynamic variables (HR, MAP, CVP, CO, CI, PAP, PCWP, SVR, PVR, SV, SI), length of ICU and hospital stay were recorded. Laboratory parameters (CKMB, TnT, BNP) were obtained at five periods (T1:After induction, T2:During CPB, T3:End of the operation, T4:Postop 24th hrs, T5:Postop 48th hrs) and IL-6, IL-10 were recorded at T1, T4, T5. Results: MAP (T3, T5), CVP (T4, T5), PAP, PCWP, SVR, PVR (T3-T5) levels were decreased and HR (Sevo, T3-T5), CO, CI, SV, SI (T3-T5) were increased in all groups according to the basal values. The values of CKMB and TnT (T2-T5), BNP and IL-6 (T4, T5), IL-10 (T4) were increased when compared with the basal values, but no difference was observed between the groups. There were no differences in blood and blood products, inotropic requirements, length of ICU and hospital stay between the groups. Blood sugar and insulin requirements were higher in the desflurane group compared to the other groups. Conclusion: Sevoflurane, desflurane and isoflurane have similar haemodynamic and cardiac protective effects in patients undergoing open heart surgery.

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