Dilek ÖZDAMAR, Hakan CANATAY, Yavuz GÜRKAN, Levent KILIÇKAN, Kamil TOKER

Kombine spinal-epidural anestezi ve /veya genel anestezi ile postoperatif analjezinin metabolik endokrin stres cevaba etkisi

Stres yanıt, zararlı uyaranlara karsı oluşturulan otonom nöroendokrin metabolik ve immün yanıtların bütünüdür. Kombine spinal epidural anestezi + genel anestezi yöntemi ve postoperatif analjezi ile stres yanıtın baskılanabilirliğini araş¬tırmak amacıyla alt batın operasyonlarında rastgele seçilen ASA I- III, 45 hasta çalışmaya katıldı. Grup Ve genel anestezi, Grup II'ye kombine spinal epidural anestezi, Grup IH'e kombine spinal epidural + genel anestezi, uygulandı. Postoperatif dönemde Grup I'e iv, Grup II ve III'e epidural hasta kontrollü analjezi uygulandı. Preoperatif, peroperatif 15. dk ve postoperatif 1., 2., 4., 10., 24., 48. st'lerde beyaz küre (BK), kan glukoz düzeyi ve preoperatif, postoperatif 1., 2., 24., 48. st'lerde kortizol, büyüme hormonu (GH), tümör nekrozis faktör-a (TNF-a), interlökin-2 (IL-2), C-reaktif protein (C-RP) düzeylerine bakıldı. BK, 15. dk, l.ve 2. st'de, kan glukoz düzeyleri postoperatif 1. ve 2. st'lerde Grup I'de yüksekti (p

Anahtar Kelimeler:

Anestezi, genel, Anestezi, spinal, İleriye dönük çalışma, Anestezi, epidural, Anestezi, blok, Analjezi

The effect of combined spinal-epidural anesthesia/general anesthesia and postoperative analgesia on metabolic endocrine stress response

Stress response is the combination ofautonomic neuroendocrine metabolic and immun responses against harmful stimuli. In order to examine the stress response supression by combined spinal epidural anesthesia + general anesthesia and postoperative analgesia, 45 ASA I-II and III patients, undergoing lower abdominal surgery were enrolled in this study. In Group I general anesthesia, in Group II combined spinal epidural anesthesia, in Group HI combined spinal epidural anesthesia + general anesthesia was performed. Postoperatively Group I received iv, Group II and Group HI received epidural fentanyl by patient controlled analgesia. White Blood Cell (WBC) counts and serum glucose levels were examined preoperatively and at the 15th minute peroperatively and postoperatively at the 1st, 2th, 4th, 10th, 24th and 48th hours. Cortisol, Growt Hormon (GH), Tumor necrosis factor-a (TNF-a), Interleukin-2 (IL-2), C-reactive protein (CRP) levels were examined preoperatively and postoperatively at the 1st, 2th, 24th and 48th hours. WBC counts were high in the 15th minute and 1st, 2nd hours in Group I (p<0,05). The serum glucose level was significantly increased in Group I at the 1st and 2nd postoperative hours, compared with other groups (p<0,05). At the postoperative 2nd hour a significant increase in the levels of cortisol and GH was noticed in the Group I. At 24th and 48th hours, TNF-a levels and at 48th hour CRP levels in Group HI, was significantly higher than Group I (p<0,05). In the Group III, suppression in the levels of IL-2 was noticed. Postoperatif pain was evaluated with Visual Analogue Scale and (VAS) and VAS values were higher especially at the first hours in Group I. As a result, stress response can be supressed by different anaesthesia tecniques but cannot completely. We think that combined spinal epidural anesthesia + general anesthesia and postoperative epidural analgesia combination was found to be more efficient in suppressing the stress response than the other tecniques.

Keywords:

Anesthesia, General, Anesthesia, Spinal, Prospective Studies, Anesthesia, Epidural, Anesthesia, Conduction, Analgesia,

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