İbrahim ÖZDİLMAÇ, Fatiş ALTINTAŞ, ZİYA SALİHOĞLU, Şener DEMİROLUK, SEVAL AYDIN, Hafize UZUN

Alt batın cerrahisinde genel anestezi ile epidural+genel anestezi uygulamasının stres yanıta etkileri

Alt batın cerrahisinde standart genel anestezi ile genel+epidural anestezi kombinasyonunun cerrahi stres yanıta etkisinin karşılaştırılması amaçlandı. Büyük batın cerrahisi uygulanacak, ASA I-II grubundan 30 olgu rastgele iki gruba ayrıldı. Grup GA'ya (n=I5) standart genel anestezi uygulandı. Grup GA-EA'daki olgulara (n=15) ameliyattan önce lomber epidural kateter yerleştirildi. Test dozu olarak 3 mL %2 lidokain ardından 10 mL % 0.25 bupivakain verildikten sonra genel anestezi uygulandı. Ameliyat süresince kalp atım hızı, invazif kan basıncı ve santral ven basıncı izlendi. Ortalama arter basıncı ve kalp atım hızı ameliyat öncesi, cilt insizyonundan 30 dakika, l saat, 2 saat, 6 saat ve 24 saat sonra 6 kez kaydedildi. Stres yanıt belirteçleri olarak, ameliyattan önce ve ameliyattan 2, 6, 24 saat sonra serum kortizol, glukoz, interlökin-6, C-reaktif protein, malondialdehit, nitrik oksit ve süper oksit dismutaz düzeylerine bakıldı. Ameliyat sonrası ağrı tedavisi Grup GA'da intravenöz hasta kontrollü analjezi (IVHKA), Grup GA-EA'da epidural HKA yöntemiyle sağlandı. Ağrı şiddeti postoperatif 1/2, 2, 6 ve 24. saatlerde VAS'a göre değerlendirildi. Her iki grup arasında hemodinamik açıdan bir farklılık saptanmadı (p>0.05). Grup GA-EA'da tüm dönemlerde VAS daha düşüktü (p

Anahtar Kelimeler:

Cerrahi işlemler, operatif, Anestezi, genel, Bupivakain, Lidokain, Anestezi, epidural

The effect of general anesthesia and epidural combined with general anesthesia on the response of surgical stress during abdominal surgery

The effect of standard general (GA) and epidural anesthesia (EA) combined with GA on the response of surgical stress we-re compared. Thirty patients with ASA I-II physical status undergoing major abdominal surgery were randomly divided into two groups either to receive standard general anesthesia (Group-GA, n=15) or lombar epidural catheter placed to subjects in group GA-EA (n=15) before surgery. Following employment of 2 % lidocaine 3 mL as test dose 0.25 % bupivacaine 10 mL were given and then, general anesthesia was carried out. Heart rate, invasive blood pressure and central venous pressure were followed closely throughout the surgery. Mean arterial pressure and heart rate were recorded 6 times consecutively; before operation, at 30 min, I h, 2 hs, 6 hs and, 24 hours after skin incision. Serum levels of cortisol, glucose, interleukine-6 (IL-6), C-reactive protein, malonyldialdehyde, nitric oxide (NO) and Superoxide dismutase were measured preoperatively and 2, 6, and 24 hours after the operation as parameters of stress response. Postoperative pain therapy was accomplished by PC A in group-GA and epidural PCA in group GA-EA. The degree of pain was evaluated according to VAS, at 1/2, 2 nd , 6, th, and 24 th hours postoperatively. There was no difference between the two groups in terms of hemodynamic parameters (p>0.05). When compared to group-GA, VAS scores were lower in all periods in group GA-EA (p<0.05). IL-6 and NO levels increased in both groups but it was more pronounced in group-GA (p<0.05 There was no difference in the other stress parameters between the two groups. It was found that general anesthesia combined with epidural anesthesia was superior to general anesthesia for preventing stress response partly in patients undergoing major lower abdominal surgery.

Keywords:

Surgical Procedures, Operative, Anesthesia, General, Bupivacaine, Lidocaine, Anesthesia, Epidural,

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