Onur ÖZLÜ, A. K. TÜRKER, Asuman ÖZKARA, Turgay ÖCAL

Çocuklarda propofol anestezisi ve metabolik asidozis

Çalışmamızda, kısa süreli anestezi uygulamalarında propofol infizyonunun asit-baz dengesi üzerine etkisini incelemeyi amaçladık. Çocuklarda, propofol infüzyonu ile uygulanan anestezinin trigliserid, kolesterol, AST, ALT, CK-MB, keton cismi ve arteriyel kan gazına etkileri araştırıldı. 3-12 yaş arasında ASA l grubunda 36 olguya, anesteziden 30 dk önce 0.5 mg kg-1 midazolam peroral uygulandı. İki eşit gruptan Grup P'de (n=18) 3 mg kg-1 indüksiyondan sonra, 10 dk ara ile 20, 15,10 mg kg-1 sa-1 dozlarında propofol ile anesteziye devam edildi. Grup H'da (n=18) 5 mg kg-1 tiyopental ile indüksiyondan sonra % 2-3 halotan ile anestezi sürdürüldü. Tüm olgulara analjezi için 2 $mu$ kg-1 sa-1, iv fentanil verildi ve 0.1 mg kg-1 vekuronyum verilerek entübe edildiler. Olgulara kontrollü solunum uygulandı. İndüksiyondan hemen sonra, anestetik ajanlar kesildikten 30, 60 ve 120 dakika sonra trigliserid, kolesterol, AST, ALT, LDH, CK-MB, asetoasetat ölçümleri ve arteriyel kan gazı analizleri yapıldı. AST, ALT kolesterol değerlerinde grup içi ve gruplar arasında farklılık gözlenmedi. Bütün postoperatif trigliserid düzeyleri Grup P'de Grup H'dan yüksek; pH değerleri ise düşük gözlendi (p

Anahtar Kelimeler:

Pediatri, Asidoz, Anestezikler, Propofol, Asit-baz dengesi

Propofol anaesthesia and metabolic acidosis in children

We aimed to investigate the effect of propofol infusion anesthesia on acid-base status in healthy children during short term anesthesia. The blood triglyceride cholesterol, AST, ALT, LDH, CK-MB, asetoasetat levels and acid base status in children receiving propofol to provide total intravenous anaesthesia were determined. 36 Children aged 3-12 years were premedicated with midazolam, 0.5 mg kg-1 perorally 30 minutes before the operation. In Group P (n=18) induction and maintenance were performed with propofol, 3 mg kg-1 and 20-15-10 mg kg-1 h-1 with ten minutes intervals respectively. In Group H (n=18) following induction with 5 mg kg-1 thiopenthal, anaesthesia was maintained with 2-3 % halothane. All patients recieved 2 $mu$ kg-1 h-1, iv fentanil for analgesia. Endotracheal entubation was performed with 0.1 mg kg-1 vecoronium. Arterial and venous blood samples were obtained following anaesthesia induction and 30, 60 and 120 min after discontinuation of anaesthesia for analysis. There was no significant difference in AST, ALT and cholesterol levels between and within the groups. All postoperative triglyceride levels were significantly higher in Group P than Group H (p<0.05) and all postoperative pH levels were lower in Group P than Group H (p<0.05). However, we did not observe metabolic acidosis and any change other biochemical parameters in all patients. We concluded that, propofol had no effect on acid-base status, liver and myocardial enzymes levels and could be used in short term anaesthesia of children.

Keywords:

Pediatrics, Acidosis, Anesthetics, Propofol, Acid-Base Equilibrium,

PDF

___

1. Browne BL, Prys-Roberts C.Wolf AR. Propofol and alfentanyl in children:infusion technique and dose requirement for total iv anaesthesia. Br J Anaesth 1992;69:570-6.
2. Richards MJ, Skues MA, Jarvis AP, Prys-Roberts C. Total iv anaesthesia with propofol and alfentanil. dose requirements for propofol and the effect of premedicalion with clonidine. Br J Anaesth 1990;65:157-63.
3. Esener Z. Pediatrik Anestezi. Ankara, Feryal Matbaacılık 1995; 135-46.
4. Vangerven M, Hemelrijck J, Wouters P, Vandermeersch E, Van Aken H. Light anesthesia with propofol for pediatric MRI. Anesthesia 1992; 47: 706-7.
5. Aun CS, Sung RY, OMera ME, Short TG, Oh TE. Cardiovascular effects of iv induction in children: comparison between propofol and thiopentone. Br J Anaesth 1993; 70: 647-53.
6. Susla GM. Propofol toxicity in critically ill pediatric patients. Show us the proof. Crit Care Med 1998;26: 1959-60.
7. Parke TJ, Stevens JE, Rice ASC, et.al., Metabolic acidosis and fatal myocardial failure after propofol infusion in children: Five case reports. BMJ 1992; 305: 613-6.
8. Strickland RA, Murray MJ. Fatal metabolic acidosis in a pediatric patient receiving an infusion of propofol in the intensive care unit: Is there a relationship? Crit Care Med 1995; 23: 405-8.
9. Bray RJ.. Propofol infusion syndrome in children. Paed Anaesth 1998;8:491-9
10. Hanna JP, Ramundo ML. Rhabdomyolysis and hypoxia associated with prolonged propofol infusion in children. Neurology 1998; 50: 301-3.
11. Hatch DJ. Propofol infusion syndrome in children. The Lancet 1999;353: 1117-8.
12. Ohkawa H, Iwakawa T, Ohmoto W, et a!., Clinical study on intra-operative hyperketonemia in non-diabetic surgical patients under general anesthesia. Masui 1993; 42: 1803-7.
13. Martin PH, Murthy BVS, Petros AJ. Metabolic, biochemical and haemodynamic effects of infusion of propofol for long-term sedation of children undergoing intensive care. Br J Anaesth 1997; 79 :276-9.
14. Şiniklioğlu N, Günday I, Karamanlıoğlu B ve ark., Propofol'ün serum total lipid, kolesterol ve trigliserid düzeyleri üzerine etkisi. Türk Anest. Ve Rean. Cem. Mecm 1992; 20: 416-8.
15. Atalay Ş, Çukurova Z, Oba S, ve ark., İsofluran ve propofol anestezilerinin lipid metabolizması üzerine etkileri. Türk Anest Rean Cem Mecm 1997; 25: 414-21.
16. Erol U, Başgül E, Öcal T, ve ark., Propofol infüzyonunun serum lipidleri üzerine etkisi. Türk Anest Rean Cem Mecm 1992; 20: 169-71.
17. D'Souza JP, Sine HE, Horvitz RA, Kubasik NP, Brody BB, Barolds SS. The significance of the MB isoenzyme in patients with acute cardiovascular disease with a normal or borderline total CPK activity. Clin Biochem 1978; 11:204-6.