Yetkin ÖZER, Hanife ALTUNKAYA, Serefden AÇIKGÖZ, Cengiz Bekir DEMİREL, HİLAL AYOĞLU, IŞIL ÖZKOÇAK TURAN

Cerrahi populasyonda plazma psödokolinesteraz aktivitesi üzerine cinsiyet ve yaşın etkisi

Anesteziyoloji uygulamalarında; süksinilkolin, mivakuryum, kloroprokain, diamorfin gibi ilaçların metabolizmasında görev alan psödokolinesteraz (PChE), organofosfat entoksikasyonunun tanı ve tedavisinde de kullanılan önemli bir enzimdir. Hepatit, siroz gibi karaciğer hastalıklarında, malignite, malnütrisyon, üremi, yanık durumlarında, toksik inhibisyon ve genetik enzim varyantlarında PChE aktivitesi azalabilmektedir. İlaç metabolizmasında görev alan oksidatif enzimler ile yaş arasındaki ilişkiyi araştıran çalışmaların birçoğunda, yaşlanmanın enzim aktivitesi üzerine bir etkisi olmadığı bildirilmektedir. Biz çalışmamızda, cerrahi hastalardan oluşan bir populasyonda, PChE düzeyi ile cinsiyet ve yaş arasındaki ilişkiyi araştırmayı planladık. Organ yetmezliği, malignite, enzim indüksiyonu veya inhibisyonu yapan ilaç kullanım öyküsü olanlar ile gebeler dışındaki 492 olguda preoperatif PChE düzeyleri ölçüldü. Erkek olgularda ortalama PChE düzeyleri, kadın olgulardan anlamlı yüksek bulundu. 60 yaşından sonra erkeklerde enzim seviyesi azalırken, kadınlarda 18-44 yaş arası en düşük enzim düzeylerinin gözlendiği dönemdi. Cerrahi populasyonda psödokolinesteraz aktivitesi, ileri yaştaki erkekler ile doğurganlık dönemindeki yetişkin kadınlarda en düşük düzeylere inmektedir. Bu çalışma, tanımlanan yaş gruplarındaki olgularda, PChE ile metabolize olan anestezik ilaçların kullanımında, 'uzamış apne' riskinin artacağını işaret etmektedir.

Anahtar Kelimeler:

Cinsiyet faktörleri, Yaşlanma, Cerrahi işlemler, operatif, Yaş faktörü, Anestezikler, Psödokolinesteraz

The effects of gender and ageing on plasma pseudocholinesterase activity in a surgical population

Pseudocholinesterase (PChE) is a significant drug metabolizing enzyme of succinylcholine, mivacurium, choloroprocain and diamorphine, which is used as a diagnostic and therapeutic parameter in organophosphate toxicity. PChE activity may decrease following hepatic and renal failure, malnutrition, malignancy, burns and toxic inhibition or due to inherited enzyme variants. Most studies which have examined the relationship between ageing and oxidative enzymes of drug metabolism have been consistent in finding no effect of ageing. In our study, we planned to investigate age and gender related influences on PChE activity in a surgical population. We measured the level of PChE preoperatively in 492 patients excluding those who were pregnant, had solid organ failure or malignancies or who were taking drugs known to induce or inhibit enzyme activity. The mean enzyme level was found to be significantly higher in males than in their female counterparts. While the enzyme levels of males decreased significantly in those over 60 years of age, the minimum mean enzyme levels in females was in the 18-44 age group. The PChE activity decreased to a minimum level in the elderly men and the mature prolific women of the surgical population. Our findings suggest that the risk of 'prolonged apnea' is likely to increase in these age groups when anesthetic drugs which are metabolized by PChE%are used.

Keywords:

Sex Factors, Aging, Surgical Procedures, Operative, Age Factors, Anesthetics, Pseudocholinesterase,

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