Lale YÜCEYAR, Özlem ÜNLÜSOY, Ömer SÜZER, Hülya EROLÇAY

Midazolam-fentanil perfüzyonunun izole sıçan kalbine etkileri: İskemi-reperfüzyon modelinde dobutamin ve enoksimon ile etkileşimleri

Bu çalışmada kardiyovasküler anestezide sıklıkla kullanılan midazolam-fentanil ikilisinin ve eş zamanlı kullanılan dopamin ve enoksimonun iskemi uygulanan izole sıçan kalbine olan etkileri araştırıldı. "Wistar" sıçan kaleleri izole edilerek "Langendorff" düzeneğinde modifiye Tyrode solüsyonu ile perfüze edildi. Her grupta 6 sıçan olan 4 grup olarak düzenlenen çalışmanın (Grup 1 = Kontrol-Enoksimon, Grup II = Kontrol-Dobutamin, Grup III = Midazolam-Fentanil+Enoksimon, Grup IV = Midazolam-Fentanil + Dobutamin) tüm gruplarında 20 dk stabilizasvon süresinden sonra ölçüm yapıldı ve bu değerler başlangıç değeri olarak alındı. I. ve II. Gruplarda kalpler Tyrode solüsyonu ile perfüze edilirken, III. ve IV, Grup kalplere midazolam ve fentanil (sırasıyla 10-6M, 10-8 M) perfüzyonu başlanarak deney boyunca uygulandı. 15 dk süre ile nonnotermik iskemi uygulanan kalpler 10 dk süre ile reperfüze edildiler. Bu dönemin sonunda dobutamin ve enoksimon (sırasıyla 5x10-7M, 10-4 M) uygulandıktan sonra son ölçümler yapıldı. Tüm kalplerde kalp hızı, koroner kan akımı, izovolumetrik sol ventrikül maksimum basıncı ve deriveleri (+dp/dt max, -dp/ dt max) ölçüldü. Midazolam ve fentanilin birlikte kullanıldıklarında normal ve iskemi uygulanan reperfüze kalplerde depressif etkilerinin olmadığı gözlendi. Midazolam-fentanil perfüzyonu reperfüze kalplerde dobutamin ile en yüksek koroner kan akımını sağlarken kalp hızını da artırdı. Kasılma fonksiyonuna bakıldığında enoksimonun dobutamine göre belirgin bir üstünlük sağlamadığı görüldü.

Anahtar Kelimeler:

Enoksimon, Dobutamin, İskemi, Sıçan, Wistar, Kalp, Midazolam, Kalp hızı, Fentanil, Koroner dolaşım

The effects of midazolam-fentanyl perfusion on the isolated rat heart: Interactions with enoximone and dobutamine in an ischemia-reperfusion model

In this study cardiac effects of midazolam and fentanil when perfused together and in the presence of dobutamine and enoximone were assessed in reperfused rat hearts. 24 "Wistar" rat hearts were isolated and perfused with modified Tyrode solution according to "Langendorff". The hearts were divided into 4 groups (n=6 for each group; Group I (Control-Enoximone), Group II (Control-Dobutamine), Group III (Midazolam-Fentanyl+ Enoximone), Group IV (Midazolam-Fentanyl+Dobutamine). Following a 20 mill, of stabilization period baseline measurements were recorded. In the next period while the hearts in groups I and II were perfused with Tyrode solution, in group III and IV midazolam -fentanyl (10-6M, 10-8M respectively) was added to the perfusion solution and applied to the hearts throughout the study. Then the hearts underwent 15 minutes of normothermic ischemia followed by 10 min of reperfusion. In the last period dobutamine and enoximone (5x10-7M, 10-4M respectively) were applied to each group. Isovolumetric left ventricular pressure and its derivatives (+dp/dt max, -dp/dt max), heart rate and coronary flow were measured continuously. Midazolam and fentanyl combination had no depressive effect on contractile function of normal and reperfused hearts and produced an increase in coronary flow and in heart rate with dobutamine in reperfused hearts. Assessing the contractile function, it has been suggested that enoximone exerts no superiority to dobutamine.

Keywords:

Enoximone, Dobutamine, Ischemia, Rats, Wistar, Heart, Midazolam, Heart Rate, Fentanyl, Coronary Circulation,

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