Güldeniz ARGUN, Özlem BARAN, Dikmen Saadet MENTEŞ, Nesrin ERTUNÇ

Kalsiyum kanal blokerlerinin pankuronyumun nöromusküler bloğuna etkisi

Genel anestezi altında batın operasyonu planlanmış 44 olguda;çeşitli kalsiyum kanal blokerlerinin, pankuronyumun nöromusküler sistemdeki rolüne etkileri ve hemodinamide oluşturdukları değişiklikler karşılaştırıldı.Olgular dört gruba ayrıldı.İndüksiyondan 3 dak.önce 1.Gruba (n=11) hiçbir ilaç uygulanmazken, II. Gruba (n=11) 10 mg sublignual nifedipin. III.Gruba (n=11) 0.075 mg $kg^{-}1$ verapimil, IV.Gruba (n=11) 0.15 mg $kg^{-}1$ diltiazem intravenöz (iv) uygulandı.İndüksiyon 0.1 mg fentanil ve 5-7 mg $kg^{-}1$ tiyopental iv ile sağlandı.Kas gevşemesi için 0.1 mg $kg^{-}1$ pankuranyum iv uygulandı.Nöromusküler fonksiyonlar TOF stimülasyonları ile izlendi.Dört grubun maksimal blok zamanı (To), etki süresi (ES) ve derleme indeksi (RS) değerleri karşılaştırıldı.To; nidedipin, verapamil ve diltiazem gruplarında kontol değerine göre anlamlı olarak uzamış bulundu.(p0.05).Diltiazem grubunda (IV.Grup) etki süresinde kontrol grubuna göre bir farklılık saptanmadı.Derlenme indeksi ise kalsiyum kanal blokeri kullanılan 3 grupta da kontrol grubuna göre istatistiksel açıdan anlamlı olarak uzun bulundu.(p>0.05) Kontrol grubunda entübasyon sırasında sistolik kan basıncında yükselme gördük.Kalsiyum kanal blokerleri kullanılan diğer gruplarda bu izlenmedi.Ancak bu gruplarda entübasyondan sonraki 10. dakikada sistolik kan basıncında kontrol değere göre anlamlı düşme gözlendi (p

Anahtar Kelimeler:

Anestezi, genel, Kalsiyum kanal blokörleri, Pankuroniyum, Nifedipin, Verapamil, Diltiazem

The influence of calcium channel blockers on the pancuronium's neuromuscular block

This study investigated the influence of various calcium channel blockers on the known neuromuscular and hemodynamic effects of pancuronium in 44 patients undergoing abdominal operations under general anesthesia.The patients were divided into four groups.Three minutes before induction,Group I (n=11) received nothing, Group II (n=11) received 10 mg sublingual nifedipin,Group III (n=11) 0.075 mg $kg^{-}1$ intravenous (iv) verapamil and Group IV ( n=11) 0.15 mg $kg^{-}1$ iv diltiazem.Induction was provided with 0.1 mg fentanyl and 5-7 mg $kg^{-}1$ tiopenthal iv.Neuromuscular functions were monitered by TOF stimulations.The four groups were compared, regarding maximal block time (To), duration of effect and recovery index.All three agents caused significant prolongation of To, compared with the control (p<0.05 for all comparisons).Although insignificant (p>0.05), the duration of effect was longer in Groups II and III than the Control Group.The recovery index was also significantly higher in all three study groups than the control group.(p<0.05 for all comparisons). The increase in the systolic blood pressure observed in the control group was not noted in the other three groups receiving calcium channel blockers.On the other hand, a significant decrease compared with the control levels, heart rate increased significantly in all four groups during intubation (p<0.05).Therefore, all of the calcium channel blockers studied resulted in an increase in the maximal block time and potency of pancuronium.

Keywords:

Anesthesia, General, Calcium Channel Blockers, Pancuronium, Nifedipine, Verapamil, Diltiazem,

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