Zeliha Özer KOÇAK, Özlem AYDIN, Ali Aydın ALTUNKAN, Kemal GÖRÜR, Uğur ORAL

Propofol ve allerjik reaksiyonlar

Propofolün vücudun değişik anatomik bölgelerinden elde edilen mast hücrelerinden vazoaktif ve proinflamatuvar mediyatörlerin salınımına neden olduğu saptanmış, ancak burun mukozası araştırılmamıştır.Çalışmamızın amacı, propofolün burun mast hücrelerinde allerjik reaksiyonların bir mediyatörü olan triptaz salınımı üzerine olan etkilerinin araştırılmasıdır. Hastane etik kural onayı ile; septoplasti operasyonu planlanan, yaşları 18-44 yıl arasında olan 21 olgu (ASA I-II) çalışma grubuna alındı.Olgular rasgele 3 gruba (n=7) ayrılarak; I. grup genel anestezi,II.Grup genel anestezi + lokal anestezi, III. Grup lokal anestezi (kontrol) grubu olarak kabul edildi.Allerjik reaksiyon öyküsü olan olgular çalışma kapsamı dışında tutuldu. I ve II.Grupta anestezi indüksiyonu 2 mg $kg^{-}1$ propofol ve 0.1 mg $kg^{-}1$ vekuronyum bromür, anestezinin devamı, propofol infüzyonu ve % 66 $N_2$O / % 33 $O_2$ ile sağlandı. Lokal anestezi uygulaması için lidokain-adrenalin karışımı kullanıldı. Anestezi indüksiyonu izleyen 15' dk' da I.Grupta lokal anestezi uygulanmadan, II.Grupta uygulandıktan sonra inferiyor konkadan sürüntü materyali ve punch biyopsi örnekleri alındı.Kontrol grubu olarak kabul edilen olgularda aynı işlemler lokal anestezi uygulandıktan hemen sonra yapıldı. Sürüntü materyalinden hazırlanan yayma preparatlar May Grünwald Giemza ile boyanarak 10 büyük büyütme alanı (x 40 ) mast hücresi için tarandı.Doku örneklerine ait parafın kesitlere immünohistokimyasal yöntemle Mast Cell Tryptase uygulandı.Intraepitelyal ve subepitelyal bölgede 10 büyütme alanındaki triptaz için pozitif boyanma gösteren ortalama mast hücre sayısı belirlendi. Her üç grup doku örneklerinde, subepitelyal mast hücre sayılarının intraepitelyal alana oranla fazla olduğu saptandı (p

Anahtar Kelimeler:

Aşırı duyarlılık, Mast hücreleri, Propofol, Burun mukozası, Anestezi, lokal

Propofol and allergic reactions

Propofol has been determined to induce the release of vasoactive and proinflammatory mediators fem different types human mast cells, but no data was available of nasal tissue.The goal of the study was to investigate the effect of propofol on release of tryptase, a mediator of allergic reactions, from nasal mast cells. Following institutional approval, 21 patients (ASA I-II) , aged 18-44 years undergoing elective septoplasty operation were randomly divided into 3 groups (n=7) as follows; general anaesthesia (Group I), general anaesthesia + local anaesthesia (Group II) and local anaesthesia (Group III, control group).The exclusion criteria was the history of allergic disease. Anaesthesia was induced with 2 mg $kg^{-}1$ propofol -0.1 mg $kg^{-}1$ vecuronium in Group I and II, and was maintained with % 33 $O_2$ / % 66 $N_2$O plus propofol infusion.Lidocaine and adrenaline mixture was used for local anaesthesia. Fifteen minutes after anaesthesia induction, brushing materials and blopsies were taken from inferior concha before local anaesthetic administration in Group I and after administration in Group II. In patients admitted for control group, same procedures were repeated just after local anaesthesia was applied. The smears of brushing material stained with May-Grünwald-Giemsa were examined for mast cells in 10 high power field (x40). Paraffin sections were stained with Mast Cell Tryptase immunohistochemically and the mean number of intraepithelial and subepithelial tryptase positive mast cells in 10 high power field was determined. Number of subepithelial mast cells were found more than intraepithelial cells in Group I, II and III (p<0.05). Subepithelial mast cells revealed a significant increase comparing to control values in Group I and II (p<0.04).Intraepithelial mast cells of both groups showed no difference with control group and there was no difference in the number of mast cells between Group I and II. The increase in trytase (+) mast cells were thought to be the evidence of propofol related allergic reaction occured in nasal tissue.

Keywords:

Hypersensitivity, Mast Cells, Propofol, Nasal Mucosa, Anesthesia, Local,

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