Perihan EKMEKÇİ, Filiz TÜZÜNER, Baturay KAZBEK, Mehmet Ali Yavuzekinci, Ülkü KÖKSOY, Hakan YILMAZ, Tuba ÇANDAR

Entübasyon Öncesi Yapılan Esmolol ve Deksmedetomidinin İskemi Modifiye Albumin Seviyeleri Üzerine Etkisi: Randomize Prospektif Bir Çalışma

Amaç: Laringoskopi ve entübasyonun hipertansiyon, taşikardi ve aritmiye sebep olduğu bilinmektedir. İskemi modifiye albumin (İMA); endotelyal veya ekstraselüler hipoksi, asidoz ve serbest oksijen radikallerine bağlı oluşur ve iskeminin erken dönemlerinde saptanabilir. Bu çalışmada İMA seviyelerinin ölçümü üzerinden hipertansiyon ve taşikardinin önlenmesinde kullanılan iki ajanın etkisinin karşılaştırılması amaçlanmıştır. Yöntem: Etik onam alınması ve randomizasyonun ardından Grup D’de (n=21) 0,5 μg kg-1 deksmedetomidin, Grup E’de (n=21) ise 0,5 mg kg-1 esmolol 20 mL serum fizyolojik içerisinde sulandırılarak indüksiyondan 5 dak önce infüzyon şeklinde verildi. Grup C’deki (n=21) hastalara ise yalnızca 20 mL serum fizyolojik verildi. Çalışma solüsyonlarının verilmesinde 4 mL dak-1 hıza ayarlanmış otomatize perfüzör kullanıldı. İskemi modifiye albumin ölçümü için kan örnekleri monitörizasyondan sonra ve entübasyondan sonraki 10 ve 20. dakikalarda alındı. Bulgular: Entübasyondan sonraki 10. dakikada ölçülen İMA değerleri açısından bir fark bulunmadı. İskemi modifiye albumin seviyeleri 20. dakikada Grup C’de Grup E ve D ile karşılaştırıldığında anlamlı olarak düşüktü (sırasıyla p=0,025 ve 0,015). Grup E ve D arasında anlamlı bir fark saptanmadı (p=0,980). Grup D ve E’de sistolik, diyastolik ve ortalama arter basınçlarında çalışma ilaçları verildikten sonra başlangıca göre anlamlı düşüş gözlendi. Gruplar ilk 5 dakika boyunca kalp hızı açısından benzerdi fakat 6. dakikadan başlayarak çalışma periyodunun sonuna kadar Grup E ve D’de kalp hızı düşük izlendi. Sonuç: Sonuç olarak, entübasyona hemodinamik yanıtın inhibisyonunun negatif sonuçları olabileceği düşünülerek buna yönelik farmakolojik müdahaleler özellikle kritik hastalarda dikkatli yapılmalı ve yakın hemodinamik monitörizasyonun önemi akılda tutulmalıdır.

The Effect of Pre-Intubation Esmolol and Dexmedetomidine on Ischemia Modified Albumin Levels: A Prospective Randomized Trial

Objective: Laryngoscopy and intubation cause hypertension, tachycardia and arrhythmia. Ischemia modified albumin (IMA) is formed secondary to endothelial or extracellular hypoxia, acidosis and free oxygen radicals and can be detected in the early stages of ischemia. In this study, we aimed to compare the effects of two agents on preventing hypertension and tachycardia by measuring IMA levels. Methods: Following ethics approval and randomization, dexmedetomidine 0.5 μg kg-1 in Group D (n=21) or esmolol 0.5 mg kg-1 in Group E (n=21) diluted in 20 mL saline was given as infusion for 5 minutes prior to induction. Patients in Group C (n=21) received only 20 mL saline infusion. An automated perfusor was set at 4 mL min-1 for the delivery of study solutions. Blood samples for IMA measurement were taken following monitorization and at 10th and 20th minutes after intubation. Results: There was no statistically significant difference concerning IMA levels at 10 minutes following intubation. However, IMA levels in Group C were significantly lower compared to Group E and Group D (p=0.025 and 0.015 respectively) at 20 minutes. There was no significant difference between Group E and Group D (p=0.980). In Group D and E, a significant drop in systolic, diastolic and mean arterial pressures compared to baseline was observed after the study drugs were given. Groups were similar in terms of heart rate in the first 5 minutes however Groups E and D had lower heart rates compared to Group C starting from the 6th minute until the end of study period. Conclusion: Inhibiton of hemodynamic response to intubation may have negative results, and pharmacological interventions for this should be carried out with caution in critical patients and close hemodynamic monitorization should be kept in mind.

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