Ali ALAGÖZ, Günal Hilal SAZAK, Eser ŞAVKILIOĞLU, Uğur GÖKTAŞ, Ergül ULUÇINAR

Göğüs cerrahisinde torakal epidural analjezinin hemodinami, glukoz ve kortizol düzeyleri üzerine etkilerinin değerlendirilmesi

Çalışmamızda, göğüs cerrahisinde, torakal epidural analjezi (TEA) ve total intravenöz anestezi (TIVA) kombinasyonu ile TIVA'nın hemodinami, glukoz ve kortizol düzeylerine etkilerinin karşılaştırılması amaçlandı. Pulmoner rezeksiyonplanlanan 30 olgu rasgele iki gruba ayrıldı. Tüm olgularda indüksiyonda 0,05 mg kg midazolam, 2 ßg kg fentanil, 2 mg kg propofol ve 0,1 mg kg'1 vekuronyum; idamede 6-7 mg kg propofol, fentanil ve vekuronyum boluslari kullanıldı. EKG, kalp atım hızı, periferik oksijen saturasyonu ve arteriyel kan basıncı monitörize edilip, çift lümenli tüp yerleştirildi. Grup 1f de sadece propofol ile TIVA uygulanırken grup I'de;ek olarak, epidural kateterden 6-10 mL % 0,5 bupivakain puşesini takiben, 6 mL sa % 0,375 bupivakain başlandı (TİVA+TEA). Preoperatif, intraoperatif ve postoperatif dönemde toplam 11 kez hemodinamik, beş kez glukoz ve üç kez kortizol düzeyi ölçümü yapıldı. Ek fentanil, atropin ve efedrin gereksinimleri kaydedildi. Grup Y de hemodinamik değerler istatistiksel olarak anlamlı düzeyde düşük seyretmiş ve daha az fentanil gereksinimi (Grup V de 25,7±39,9 μg, Grup II'de 170,7±73,l μg) olmuştur (p

Anahtar Kelimeler:

Toraks cerrahisi, Anestezi, ven içi, Hidrokortizon, Glukoz, Anestezi, epidural

An evaluation of the effects of thoracal epidural anesthesia on hemodynamia, glucose and cortisol levels during thoracic surgery

We aimed to compare the effects of total intravenous anesthesia (TIVA) with a thoracal epidural anesthesia (TEA) and TIVA combination on hemodynamia, glucose and Cortisol levels during thoracic surgery. Thirty cases scheduled for pulmonary resection were divided into two groups randomly. In all cases, 0.05 mg kg' midazolam, 2 ßg kg' fentanyl, 2 mg kg' propofol and 0.1 mg kg' vecuronium were given for induction and 6-7 mg kg' hr' propofol, fentanyl and vecuronium bolus were used in maintenance. ECG, heart rate, peripheric oxygen saturation and arterial blood pressure were monitored and double-lumen tubes were inserted. Anesthesia was maintained by propofol infusion (TTVA) in both groups. The patients in Group I also received 0.375 % bupivacaine (6 mL hr') following 6-10 mL 0.5 % bupivacaine bolus epidurally (77-VA+TEA). In the preoperative, intraoperative and postoperative periods, the hemodynamic parameters, glucose and Cortisol levels were measured 11,5 and 3 times respectively. Supplemental fentanyl, atropine and efedrine requirements were recorded. In Group I, the hemodynamic values and fentanyl requirement (Group 1:25.7±39.9 ßg, Group II: 170.7±73.1 pg) were found to be significantly lower (p<0.05). Compared to initial values, the increase in the plasma glucose level was statistically significant in both groups (p<0.05). The difference between the plasma Cortisol levels of the two groups was not significant (p>0.05). Incre-ases in the levels of glucose and Cortisol were limited in Group I. Compared to TTVA, the TEA and TTVA combination was thought to decrease hemodynamic responses and analgesic requirements while inducing a similar response to stress.

Keywords:

Thoracic Surgery, Anesthesia, Intravenous, Hydrocortisone, Glucose, Anesthesia, Epidural,

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