Çetin KAYMAK, Aytül Ş. KILINÇ, Turgut ÇAVUŞOĞLU, Filiz TÜMER, Fırat UNCUGİL, Ferah DÖNMEZ, Lale KARABIYIK

Sevofluran anestezisi altında torakal epidural analjezi uygulamasının stres yanıt üzerine etkisi

Stres yanıt vücut hemostazisini sağlamak ve sürdürmek amacıyla oluşturulan otonom, endokrin ve metabolik değişikliklerdir. Çalışmamızda, açık kolesistektomi olgularında, genel anestezi altında gelişen stres yanıtın, torakal epidural analjezi ile azaltılabilmesinin mümkün olup olmadığı araştırıldı. Çalışmaya, 20-60 yaş arasındaki 30 olgu dahil edildi. Hastalar iki gruba ayrıldılar. Grup I' deki olgulara (n=15) sadece genel anestezi; Grup II' deki olgulara (n=15) genel anestezi öncesi T9-11 aralığından torakal epidural kateter yerleştirilerek 12 mL % 0.25 bupivakain uygulandı. Gruplarda, genel anestezi indüksiyonu 7 mg kg'1 tiyopental ile sağlandı. Endotrakeal entübasyon 0.1 mg $kg^-1$ vekuronyum verilerek gerçekleştirildi. İdamede %l-3 sevofluran ve %50 N2O/O2 kullanıldı. Hastaların anestezi derinliği Bispektral İndeks (BİS) ile kontrol edildi. Olgulardan preoperatif-kontrol (Evre 1), entübasyon sonrası (Evre 2), intraoperatif 30. dk (Evre 3), ekstübasyondan hemen sonra (Evre 4) ve postoperatif 30. dakika (Evre 5); plazma kortizol, prolaktin, growth hormon (GH) ve glukoz düzeylerini saptamak için kan örnekleri alındı. Grup'I de kortizol değerlerinde 4. ve V. evredeki; Grup H'de ise V. evredeki değerler, kontrol değerine göre anlamlı artış gösterdi. Plazma prolaktin seviyelerinde Grup I'e ait hastalarda 2., 3.,4. ve 5. evrelere ait değerlerde, Grup II de 3,4. ve 5. evrelerde kontrole göre anlamlı artış bulundu. Grup I ve II'deki glukoz değerlerinde 4. ve 5. evrelere ait değerlerde anlamlı artış bulundu. Plazma GH değerlerinde, tüm örneklerin grup içi ve gruplar arası karşılaştırılmalarında anlamlı değişiklik izlenmedi. Sonuç olarak; sevofluran anestezisi ile kombine olarak tek ve düşük doz bupivakain ile torakal epidural analjezi uygulaması ile cerrahi stres yanıtının etkin olarak baskılanamadığı kanısına varıldı.

Anahtar Kelimeler:

Anestezikler, inhalasyon, Analjezi, epidural, Bupivakain

The effects of thoracic epidural analgesia on stress response in patients under sevoflurane anesthesia

The stress response consists ofautonomic, endocrinologic and metabolic alterations to provide homeostasis of the body. in this study we aimed to investigate whether the stress response could be attenuated with thoracic epidural analgesia in patients undergoing upper abdominal surgery under general anesthesia. This study was performed in 30 patients between 20-60 years of age. Patients were divided into two groups. Group I received general anesthesia. in Group II, in addition to general anesthesia, an epidural catheter was inserted at T9-11 and 12 mL 0.25 % bupivacaine was given. Induction of anesthesia was performed using thiopental 7 mg $kg^-1$ I.V. in both groups. Ali patients were intubated after administmtion of 0.1 mg $kg^-1$ vecuronium. Sevoflurane at 1-3 % concentration in 50% N2O/O2 mixture was used for maintenance of anesthesia. Venous blood samples were collected preoperatively (control) (1), after intubation (2), at 30th minute intraoperatively (3), after extubation (4) and 30th minute postoperatively (5) in order to determine plasma levels ofcortisol, prolactin, growth hormone and glucose. There was a significant increase in plasma cortisol levels of samples 4 and 5 in Group I, and sample 5 in Group II, compared to control levels. Prolactin levels measured in samples 2, 3, 4 and 5 in Group I and in samples 3, 4, 5 in Group II elevated markedly compared to control levels. Plasma glucose levels of samples 4 and 5 in group I and II were significantly increased. Plasma GH levels were not different between the groups. We concluded that, surgical stress response is not depressed by sevoflurane anesthesia combined mth thoracic epidural analgesia with low and single döşe bupivacaine.

Keywords:

Anesthetics, Inhalation, Analgesia, Epidural, Bupivacaine,

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