Reyhan ŞAHİN, MEHMET İLKE BÜGET, AHMET KEMALETTİN KOLTKA, Zerrin ÜLKE SUNGUR, TÜLAY ÖZKAN SEYHAN, Ayşe YAVRU, Emre ÇAMCI

Renin anjiyotensin blokajı yapılan hastalarda hangi intravenöz indüksiyon ajanı?

Amaç: Genel anestezi indüksiyonu sonrası görülen hipotansiyon özellikle hipertansif hastalar için özel bir sorun oluşturmaktadır. Bu çalışmada hipertansiyon tedavisi nedeniyle kronik olarak ADE ve/veya ARA kullanan hastalarda üç değişik intravenöz ajanla yapılan genel anestezi indüksiyonu sonrası gelişen hipotansiyonu araştırmayı amaçladık. Yöntem: 90 hasta çalışmaya dahil edildi. Hastaların, kan basınçları, demografik bilgileri, ilaç geçmişleri sorgulandı. Kullanılan son ADEI ve/veya ARA dozundan ameliyata kadar geçen süre kaydedildi. Hastalar propofol, etomidat ve tiyopental olmak üzere üç gruba randomize edildi. Arteriyel kan basıncı ve kalp hızının postindüksiyon ilk 15 dakika ve ekstübasyondaki değerleri kaydedildi. Tedavide öncelikle pozisyon ve bolus sıvı uygulaması, cevap alınamazsa efedrin uygulaması denendi. Hipotansiyon sıklığı ve uygulanan tedaviler kaydedildi. Bulgular: Anestezi indüksiyonu sonrası hastaların sistolik kan basıncı (SKB) 4. ve 10. dakikalarda farklılık gösterdi. Dördüncü dakikada propofol ve tiyopental gruplarında ölçülen SKB etomidat hastalarına göre anlamlı olarak düşük bulundu (p:0.003), indüksiyon sonrası 10. dakikada ise tiyopental grubunun SKBı diğer iki gruba göre anlamlı olarak düşük bulundu (p:0.007). Diyastolik ve ortalama kan basınçları değerlerinin de etomidat grubunda diğer gruplara göre yüksek olduğu saptandı. ndüksiyonu takip eden ilk onbeş dakika içinde hipotansiyon gelişme sıklığı propofol ile indüklenen grupta anlamlı olarak yüksek (p:0.049), ancak tedavi ve tedaviye yanıt gruplar arasında benzer bulundu. Sonuç: Kronik olarak RAS blokajı yapılmış hastaların anestezi indüksiyonunu takip eden ilk 15 dakika içinde özellikle indüksiyonu propofol ile yapılan hastalarda kan basıncında gözlenen düşüş, tiyopental ve etomidat hastalarına göre daha çok yaşanmışıtır. Kısmen tiyopental ama özellikle etomidat ile yapılan anestezi indüksiyonunun bu grup hastada daha güvenli olduğu sonucuna varılmıştır.

Which intravenous induction agent for patients with renin-angiotensin blockade?

Aim: Hypotension after induction of general anesthesia is a special consideration in hypertensive patients. In this study, we aimed to investigate the incidence of occurrence of hypotension after the induction of general anesthesia following administration of three different intravenous agents in patients who were being chronically treated with ACEI and/or ARA. Methods: Ninety patients were enrolled in the study. Blood pressures, demographic information and drug use, and the time pased after the last use of ACEI and/or ARA dosage till the surgery were recorded. Patients were randomized to three groups according to the anesthetic agents used during induction; propofol, etomidate, and thiopenthal, respectively. Arterial blood pressure and heart rate values within the first 15 minutes of post-induction period and during extubation period were recorded. Hypotension was treated with position, bolus fluid infusion and ephedrine bolus administration, in case of no response. The frequency of hypotension and applied treatments were recorded. Results: The systolic blood pressure (SBP) showed differences in the 4th and 10th minutes after induction. SBP was significantly lower in propofol and thiopenthal groups than in etomidate group in the 4th minute (p:0.003). SBP was significantly lower in the 10th minute in thiopental group than in other groups (p:0.007). Diastolic and mean arterial pressure values of etomidate group were higher than the other groups. The frequency of hypotension was significantly higher in propofol group (p:0.049) 15 minutes after induction, but the treatment and the reaction to treatment were similar between groups. Conclusion: The decrease observed in blood pressure was higher in propofol group, compared to thiopental and etomidate groups for hypertensive patients who were being chronically treated with RAS blocking agents, within the first 15 minutes after induction. We conclude that, for this patient group, anesthetic induction with thiopental, although partially, and etomidate are safer compared to propofol.

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