Melek SAKARYA, Fatma Zekiye AŞKAR, Berna ONGUN, ABDURRAHİM DERBENT, Hülya SUNGURTEKİN

İzofluran ve propofolün hipoksik pulmoner vazokonstrüksiyona etkisi

İzofluran ve propofolün tek akciğer ventilasyonu (TAV) sırasında, intrapulmoner şant fraksiyonuna etkisi ASA I-III grubuna dahil 20 hastada araştırıldı. Benzer premedikasyon ve anestezi indüksiyonu uygulanan hastalar randomize olarak 2 gruba ayrıldı. Anestezi idamesinde 10 hastada izofluran (İ), 10 hastada propofol (P) kullanıldı. Tüm hastalara uygun çapta sol endobronşial tüp yerleştirildi. Anestezi idamesi İ grubunda %0.5-1 konsantrasyonda izofluran ve 0.05 mg.kg-1.dk-1 fentanil infüzyonu ile; P grubunda 10'ar dakikalık sürelerle sırası ile 10 mg.kg-1.st-1 8 mg.kg-1.st-1 ve operasyon bitimine kadar 6 mg.kg-1.st-1 propofol ve 0.05 mg/kg/dk fentanil infüzyonu yapıldı. Radial ve pulmoner arter kateteri yerleştirildikten sonra hastalar lateral dekübitüs pozisyonuna alındı ve 10 dakika sonra kontrol ölçümler (I) yapıldı. Ölçümler sırasında kalp atım hızı (KAH), ortalama arteriyel basınç (OAB), pulmoner kapiller köşe basıncı (PCWP), sistemik vasküler rezistans (SVR), pulmoner rezistans (PVR) ve kardiyak output (Q) kaydedildi. Eş zamanlı olarak arteriyel ve mikst venöz kan gazları analizi ve hemoblobin tayinleri yapılarak standart formüller yardımı ile pulmoner şant oranı (Qs/Qt) hesaplandı. %100 oksijen ile ventile edilerek TAV başlatılan hastalarda 20 dakika sonra II. ölçümler ve tekrar iki akciğer ventilasyonuna geçildikten 20 dk sonra III. ölçümler yapıldı. TAV sırasında KAH, MAP, PCWP, SVR, PVR ve Q'da değişiklik gözlenmedi. Her 2 grupta da TAV sırasında şant fraksiyonlarında kontrol ölçüme göre hafif bir artış oluşmasına rağmen, PaO2 de anlamlı bir değişiklik gözlenmedi. Sonuç olarak her iki ajanında hipoksik pulmoner vazokonstrüksiyonu (HPV) minimal inhibe ettiği ancak klinik önemi olmadığı sonucuna varıldı.

Anahtar Kelimeler:

Oksijensizlik, Propofol, Pulmoner dolaşım, Akciğer, Vazokonstriksiyon, İzofluran, Pulmoner ventilasyon, Pulmoner cerrahi işlemleri, Anestezi

The effect of isoflurane or propofol on hypoxic pulmonary vasoconstriction

We have compared the effects of maintaining anesthesia with isoflurane or propofol infusion on shunt fraction during pulmonary surgery with one-lung ventilation (OLV) in 20 ASA I-III patients received same premedication and anesthesia induction. The patients were randomized to 2 groups, either to receive isoflurane (I) or propofol (P). All patients were intubated with a left-sided double-lumen endobronchial tube. Patients in group I received isoflurane at an inspired concentration of 0.5-1% during fentanyl infusion at a rate of 0.05 mg.kg-1.min-1 Patients in the P group were given an infusion of 10 mg.kg-1.h-1 initially. Then it was reduced to 8 mg.kg-1.h-1 and then 6 mg.kg-1.h-1 plus fentanyl infusion at a rate of 0.05 mg.kg-1.min-1 with 10 minutes intervals, respectively. After insertion of all catheters, patients were placed in lateral decubitus position and 10 min later baseline measurements (I) were obtained. Measurements included the following: heart rate (HR), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), cardiac output (Q). Arterial and mixed venous blood gas values and hemoglobin concentration were obtained and venous admixture (Qs/Qt) was calculated using established formulae. OLV (dependent lung) was started with 100% oxygen according to the upper established formulae. 20 min later all measurements were performed (II) and repeated 20 min after onset of two-lung ventilation (TLV). No changes in HR, MAP, PCWP, SVR, PVR and Q occurred during OLV. Although initiation of OLV caused no significant changes in PaO2, there was a slight increase in mean shunt fraction during TLV which returned to baseline levels in both groups. We concluded that either propofol or isoflurane slig htly inhibited hypoxic pulmonary vasoconstriction during OLV which was not clinically important .

Keywords:

Anoxia, Propofol, Pulmonary Circulation, Lung, Vasoconstriction, Isoflurane, Pulmonary Ventilation, Pulmonary Surgical Procedures, Anesthesia,

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