Serap ÖZTÜRK, Dilek KARAASLAN, SADIK ÖZMEN, Pakize KIRDEMİR, Recep SÜTÇÜ, H.Yusuf KARA, Betül ALTINIŞIK

Jinekolojik ameliyat geçiren olgularda inhalasyon anestezisi ve titreme sıklığının melatonin düzeyleri ile ilişkisi

Amaç: Jinekolojik ameliyat geçirecek hastalarda izofluran ve sevofluran kullanımının ameliyat sırası ve sonrası melatonin düzeyleri üzerine etkisini ve ameliyat sonrası titreme sıklığı ile melatonin düzeyleri arasındaki ilişkiyi incelemeyi amaçladık. Yöntem: Kırk iki hasta çalışmaya dahil edildi. Propofol, fentanil ve veküronyum ile indüksiyonun ardından hastalar rastgele iki gruba ayrıldı. Anestezi idamesi Grup I’de %1.5-2 sevofluran, Grup II’de %0.7-1.2 izofluran ile sağlandı. Ameliyat boyunca ve sonrasında merkezi ve periferik sıcaklık değerleri, ameliyat sonrası titreme sıklığı ile ameliyat öncesinde, ameliyatın 30. dakikasında ve ekstübasyondan sonra plazma melatonin düzeyleri kaydedildi. Ameliyat sonrası titreme sıklığı ile melatonin değerleri arasındaki ilişki incelendi. Bulgular: Her iki grupta da ameliyat boyunca ve sonrasında merkezi ve periferik sıcaklıklarda düşüş gözlendi. Grup I’de 9, Grup II’de ise 12 hastada ameliyat sonrasında titreme saptandı. Gruplar arasında titreme sıklığı yönünden fark yoktu. Her iki grupta da ameliyatın 30. dakikasında ve ekstübasyon sonrasında ölçülen melatonin değerleri bazal değerden düşüktü. Melatonin düzeylerinde gözlenen düşüş izofluran grubunda sevofluran grubuna göre daha belirgindi (p

An evaluation of the relationship between the incidence of postoperative shivering and melatonin levels in patients undergoing gynecological surgery

Objective: Our purpose was to investigate the effect of the use of sevoflurane and isoflurane on melatonin levels and the correlation between the incidence of postoperative shivering and melatonin levels in patients undergoing gynecological operation. Method: Fourty-two patients were included in the study. Following the induction of anesthesia with propofol, fentanyl and vecuronium, the patients were randomly allocated into two groups: The anesthesia was maintained with sevoflurane 1.5-2% in Group I and, isoflurane 0.7-1.2% in Group II. In the perioperative and postoperative period, central and peripheral temperatures and the incidence of postoperative shivering were recorded. The levels of melatonin were recorded preoperatively, at the 30th minute of the operation and following extubation. The correlation between the incidence of postoperative shivering and melatonin levels was examined. Results: In both groups, we observed a decrease in the central and peripheral temperatures. Nine patients in Group I, and twelve patients in Group II shivered postoperatively. There was no difference between the two groups regarding the incidence of shivering. In both groups, the levels of melatonin at the 30th minute of the operation and after the extubation were lower than ba- sal levels. The decrease in melatonin levels was more accentuated in the isoflurane group. No significant correlation between the incidence of shivering and melatonin levels was found. Conclusion: Isoflurane use caused a greater decrease in melatonin levels. Postoperative shivering incidences following the use of both inhalational anesthetics were similar. Our results reflect that there is no correlation between the incidence of shivering and melatonin levels.

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1. De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology Anesthesiology 2002; 96: 467-84.
2. Annadata R, Sessler DI, Tayefeh F, Kurz A, Dechert M. Desflurane slightly increases the sweating threshold but produces marked, non-linear decreases in the vasoconstruction and shivering thresholds.Anesthesiology 1995; 83: 1205-11.
3. Barker SJ, Shah NK. Effects of motion on the performance of pulse oximeters in volunteers. Anesthesiology 1996; 85: 774-81.
4. Ciofolo MJ, Clergue F, Devillliers C, Ben-Ammar M, Viars P. Changes in ventilation, oxygen uptake, and carbon dioxide output during recovery from isoflurane anesthesia. Anesthesiology 1989; 70: 737-41.
5. Claustrat B, Brun J, Chazot G. The basic physiology and pathophysiology of melatonin. Sleep Med Rev 2005; 9:11- 24.
6. Yönel EE, Yaprak M, Yıldız Y. Yüksek ve düşük doz ekzojen melatoninin erkek ratlarda vücut ısısına etkileri. Trakya Üniversitesi Tıp Fakültesi Dergisi 1996; 13: 1-4.
7. Nakahara K, Kawano T, Shiota K, Murakami N. Effects of microinjection of melatonin into various brain regions of Japanese quail on locomotor activity and body temperature. Neurosci Lett 2003; 345: 117-20.
8. Macchi MM, Bruce JN. Human pineal physiology and functional significance of melatonin. Front in Neuroendocrinol 2004; 25: 177-95.
9. Tsuzuki K, Okamoto-Mizuno K, Mizuno K. Effects of humid heat exposure on sleep, thermoregulation, melatonin and microclimate. J Ther Biol 2004; 29: 31-4.
10. Karkela J, Vakkuri O, Kaukinen S, Huang WQ, Pasanen M. The influence of anaesthesia and surgery on the circadian rhythm of melatonin. Acta Anaesthesiol Scand 2002; 46: 30-6.
11. Reber A, Huber PR, Ummenhofer W ve ark. General anesthesia for surgery can influence circulating melatonin during daylight hours. Acta Anaesthesiol Scand 1998; 42: 1050-6.
12. Guo X, Kuzumi E, Charman SC, Vuylsteke A. Perioperative melatonin secretion in patients undergoing coronary artery bypass grafting. Anesth Analg 2002; 94: 1085-91.
13. Derenzo J, Macknight B, DiVittore NA, Bovafide CP, Cronin AJ. Postoperative elevated cortisol excretion is not associated with suppression of 6-sulfatoxymelatonin excretion. Acta Anaesthesiol Scand 2005; 49: 52-7.
14. Bourne RS, Mills GH. Melatonin: possible implications for the postoperative and critically ill patient. Intensive Care Med 2006; 32: 371-9.
15. Arai YC, Ueda W, Okatani Y, Fukaya T, Manabe M. Isoflurane increases but sevoflurane decreases blood concentrations of melatonin in women. J Anesth 2004; 18: 228-31.
16. Instructions for use. 125-Melatonin-RIA. p:13 www.idsltd.com/ Downloads/CV-RE29301.pdf
17. Umbrain V, Keeris J, D’Haese J ve ark. Isoflurane, desflurane and sevoflurane for carotid endarterectomy. Anaesthesia 2000; 55: 1052-7.
18. Cheong KF, Low TC. Propofol and postanaesthetic shivering. Anaesthesia 1995; 50: 550-2.
19. Horn EP, Werner C, Sessler D, Steinfath M, Schulte am Esch J. Late intraoperative clonidine administration prevents postanesthetic shivering after total intravenous or volatile anesthesia. Anaesth Analg 1997; 84: 613-7.
20. Yuwiler A. Effect of steroids on serotonin-N-acetyltransferase activity of pineals in organ culture. J Neurochem 1989; 52: 46-53.
21. Kellner M, Yassouridis A, Manz B, Steiger A, Holsboer F, Wiedemann K. Corticotropin-releasing hormone inhibits melatonin secretion in healthy volounteers- a potential link to low-melatonin syndrome in depression? Neuroendocrinology 1997; 65: 284-90.
22. Padmavathamma K, Joshi BN. Thermotropic effects of melatonin in adrenalectomized and thyroidectomized rats. Bio Signals 1994; 3: 53-8.
23. Cagnacci A, Elliott JA, Yen SS. Melatonin : a major regulator of the circadian rhythm of core temperature in humans. J Clin Endocrinol Metab 1992; 75: 447-52.
24. Harris A, Burgess HJ, Dawson D. The effects of day-time exogenous melatonin administration on cardiac autonomic activity. J Pineal Res 2001; 31: 199-205.
25. Cagnacci A, Soldani R, Yen SS. Hypothermic effect of melatonin and nocturnal core body temperature decline are reduced in aged women. J Appl Physiol 1995; 78: 314-7.
26. Cagnacci A, Soldani R, Romagnolo C, Yen SS. Melatonin induced decrease of body temperature in women: atreshold event. Neuroendocrinology 1994; 60: 549-52.