Suna GÖREN, Gülsen KORFALI, Nuray KAPLAN, Şükran ŞAHİN

Koroner arter cerrahisi anestezisinde rokuronyum ve pankuronyumun hemodinamik etkilerinin karşılaştırılması

Elektif koroner arter cerrahisi uygulanacak 50 olguda rokuronyumun kardiyovasküler sistem üzerine olan etkilerini, pankuronyum ile karşılaştırmayı amaçladık. Olgulara iv 0.05 mg kg-1 midazolam verildikten sonra anestezi indüksiyonu iv 25 µg kg-1 fentanil ile gerçekleştirildi. İki eşit gruba ayrılan olgulara kas gevşetici ajan olarak; 0.1 mg kg-1 pankuronyum (Grup P) veya 0.6 mg kg-1 rokuronyum (Grup R) uygulandı. Hemodinamik parametreler kalp atım hızı (KAH), ortalama arter basıncı (OAB), santral venöz basınç (SVB), ortalama pulmoner arter basıncı (OPAB), pulmoner arter oklüzyon basıncı (PAOB), kardiyak indeks (Kİ), strok volüm indeksi (SVI), sol ve sağ ventrikül iş yükü indeksleri (LVSWI, RVSWI), sistemik ve pulmoner vasküler rezistans indeksleri (SVRI ve PVRI) sırasıyla, anestezi indüksiy'onundan önce (10) ve sonra (IS), entübasyondan 2, 5 ve 10 dk sonra (E-2, E-5, E-10) olmak üzere 5 dönemde kaydedildi. İndüksiyon öncesi değerlerle karşılaştırıldığında, her iki grupta KAH'nda entübasyondan 2 dk sonra anlamlı artış gözlendi (p

Anahtar Kelimeler:

Pulmoner wedge basıncı, Koroner arter köprüleme, Santral venöz basınç, Fentanil, Kalp hızı, Midazolam, Pankuroniyum

Comparison of the hemodynamic effects of rocuronium and pancuronium during anesthesia of coronary artery surgery

The aim of the study was to compare the cardiovascular effects of rocuronium and pancuronium in 50 elective coronary artery surgical patients. After iv 0.05 mg kg-1 midazolam administration, anesthesia was induced with 25 µg kg-1 fentanyl. Then the patients were allocated into two equal groups to receive either 0.1 mg kg-1 pancuronium (Group P) or 0.6 mg kg-1 rocuronium (Group R). Hemodynamic parameters, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), stroke volume index (SVI), left and right ventricular stroke work index (LVSWI, RVSWI), systemic and pulmonary vascular resistance index (SVRI, PVRI) were measured at 5 intervals, before and after anesthesia induction, 2, 5 and 10 minutes after the tracheal intubation. Heart rate increased 2 minutes after intubation in both groups when compared with baseline values (p<0.05). MAP decreased only in Group R after induction and 10 minutes after intubation (p<0.05). CI decreased after induction, 5 and 10 minutes after intubation periods (p<0.05); also SVI decreased significantly after induction and 10 minutes after intubation periods (p<0.01) in both groups. RVSWI and LVSWI decreased significantly after induction and this reduction continued until the end of the study in both groups (p<0.05). But there were no significant differences between the groups. As a result, rocuronium administered with fentanyl caused minimal changes in hemodynamic parameters which were similar to those of pancuronium during anesthesia in coronary artery surgery.

Keywords:

Pulmonary Wedge Pressure, Coronary Artery Bypass, Central Venous Pressure, Fentanyl, Heart Rate, Midazolam, Pancuronium,

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