Nefrektomi olgularında levobupivakain ile sağlanan peroperatif epidural analjezinin oksidatif stres üzerine etkisi
Amaç: Bu çalişmada; açik nefrektomi yapilan ürolojik vakalarda genel anestezi ile genel anestezi + peroperatif epidural analjezi kombinasyonunun oksidatif stres yanita etkisinin karşilaştirilmasi amaçlandi. Gereç ve Yöntem: TYEAH etik kurul onayi alindiktan sonra nefrektomi operasyonu planlanan ASA I -II grubu 30 hasta, Grup I: genel anestezi- torakal epidural analjezi (n=15) ve Grup II: genel anestezi (n=15) olacak şekilde randomize iki gruba ayrildi. Grup Ideki hastalara operasyondan 1 saat önce T8- L1 intervertebral bölgenin uygun bir araliğindan epidural kateter yerleştirildi. Epidural araliğa levobupivakain (1.25 mg mL-1) +fentanil (2 μg mL-1) içeren mayiden 8-10 mL verilerek epidural analjezi sağlandi ve hasta kontrollü analjezi (HKA) cihaziyla 6-8 mL saat-1 olacak şekilde epidural analjeziye devam edildi. Tüm hastalardan serum MDA, TAK ve SH grubu düzeylerinin ölçümü için; epidural analjezi öncesi (T1), nefrektomiden hemen önce (T2), operasyon sonunda (T3) ve postoperatif 4. saatte (T4) olmak üzere 4 kez kan alindi. Ayrica hastalarin yoğun bakim ve hastane kaliş süreleri kaydedildi. Bulgular: Her iki grupta bazal TAK, SH ve MDA değerleri benzerdi. Her iki grupta; MDA düzeyleri bazal değere oranla diğer dönemlerde anlamli olarak artmiş bulundu (p 0.05). SH düzeylerinde ise; hem grup içi hem de gruplar arasinda anlamli fark saptanmadi (p>0.05). Yoğun bakim ve hastane kaliş süreleri karşilaştirildiğinda; gruplar arasi anlamli fark yoktu (p>0.05). Sonuç: Oksidatif etkiyi gösteren lipid peroksidasyon ürünü MDA ve antioksidan yaniti değerlendirdiğimiz TAK ve SH grubu düzeylerindeki değişim yönünden genel anesteziye eşlik eden torasik epidural analjezinin her iki grup arasinda fark oluşturmadiği belirlendi.
The effect of peroperative epidural analgesia with levobupivacaine on the response of oxidative stress during nefrectomy operations
Objective: In this study; the effect of general anesthesia (GA) and peroperative epidural analgesia (EA) combined with GA on the response of oxidative stress were compared during open nefrectomy operations. Material and method: After TYEAH Ethical Committee approval, 30 patients in ASA I-II physical status, who were scheduled for open nefrectomy operation were allocated randomly into two groups, Group I: General Anesthesia (GA) + thoracic epidural anesthesia (EA) (n=15) and group II: GA (n=15). Thoracic epidural catheter was inserted in T8- L1 intervertebral area an hour before surgery. The epidural analgesia was provided by giving 8-10 mL from the solution that has contained levobupivacaine (1.25 mg mL-1) + fentanyl (2 μg mL-1). And epidural analgesia was provided with PCA (patient control analgesia) device and the dose of 6-8 mL h-1. Blood was drawn four times from all patients in order to measure serum levels of malonyldialdehyde (MDA), total antioxidant capacity (TAC) and sulphidryl groups (SH), before epdural analgesia (T1), before nefrectomy (T2), at the end of the operation (T3) and postoperative fourth hour (T4). Also, the time the patients stay in the hospital and intensive care unit was recorded. Result: Basic TAC, SH and MDA values were similar in both groups. The levels of MDA were significantly increased in both of the group when compared with basic data (p <0.05). There was no difference between the two groups in the terms of the levels of MDA. While there was statistically significant increase in the levels of TAC in group I (p=0.02), there were no difference in group II. There was no difference between the two groups in terms of levels of TAC (p>0.05). There was no difference in the groups or between the two groups in the levels of SH also. Conclusion: Thoracic epidural analgesia combined with general anesthesia caused no difference in MDA levels which indicates lipid peroxidation and also TAC or SH levels which shows antioxidant effect.
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