A.Günay ÜLKÜ, Aysun POSTACI, Özlem FINDIKSAÇAN, Dilşen ÖRNEK, İsmail AYTAÇ, Nermin GÖĞÜŞ

The effect of circadian rhythm on vecuronium induced neuromuscular block

Amaç: Bu çalışma standart doz vecuronyum bromidle sağlanan nöromüskiiler blok süresine siıkadiyen ritmin etkisini değerlendirmeyi amaçladı. Materyal-Metod: Etik komite onamı alındıktan sonra ASA l-ll sınıfı, cerrahi operasyon geçirecek ve operasyon süresi 60 dakikadan kısa beklenmeyen 104 hastayı çalışmaya seçtik. Anestezi indiiksiyonu 2-2 J mg kg ' propofol. 0.1 mg kg ' vekuronyum bromur ile. anestezi idamesi ise %l-2 konsantrasyonda sevofluran + %50 N20 + % 0 02 ile sağlandı. Hastalar vekiironyumun uygulama zamanı açısından; öğleden önce (saat 06:00-12:00) 26 kişi Grup l (sabah), öğleden sonra (saat 12:00-18.00) 26 kişi Grup II (öğlen), akşam (saat 18:00-24:00) 26 kişi Grup III ve gece (saat 24:00-06:00) 26 kişi Grup IV olmak üzere 4 gruba ayrıldı. Nöromüskiiler blokaj süreleri TOF-Watch aleti kullanılarak tekli uyarı "single twitch" (ST) şekli ile değerlendirildi. Bulgular: Elektif ve/veya acil cerrahi gerektiren 50 si kadın ve 54 ii erkek, yaşları 18-65 arasında toplam 104 hasta istatistiksel değerlendirildi. Sabah grubundan l hasta ve gece grubundan 3 hasta (toplam 4 hasta) ST %25 e ulaşmadan cerrahi bittiği için çalışma dışı bırakıldı. Nöromüskiiler iletiyle ilgili ST ilk düşme zamanı. ST maximum düşme zamanı. ST'e ilk yanıt süresi, ST %10 ve %25 derlenme süreleri açısından dört grup açısından gruplar arasında anlamlı fark tespit edilmedi. Sonuç: Günün farklı saatlerinde standart indiiksiyon dozunda uygulanan vekuronyum bromiirün nöromüskiiler blok süresini etkilemediği sonucuna vardık.

Veküronyuma bağlı nöromusküler blokaj üzerine sirkadiyen ritmin etkisi

Objective: This study aimed to analyze the effect of the circadian rhythm on the neuromuscular block duration induced by a standard dose of vecuronium bromide. Methods: After ethical committee approval, we enrolled 104 ASA class I-II patients who were to have a surgical operation with an expected duration not less than 60 minutes into the study. Anesthesia induction was provided with 2-2.5 mg kg-1 propofol, 0.1 mg kg-1 vecuronium bromide, and the maintenance of anesthesia with sevoflurane + 50% N2 O + 50% O2 in 1-2% concentration. According to the application time of the vecuronium, the patients were divided into four groups: Group I (n=26) who had anesthesia in the forenoon (06:00- 12:00 a.m.) (in the morning), Group II (n=26) who had anesthesia in the afternoon (12:00-18:00 p.m.) (in the afternoon), Group III (n=26) who had anesthesia in the evening (18:00- 24:00) and Group IV (n=26) who had anesthesia at night (24:00- 06:00). The neuromuscular block time was measured using single twitch (ST) mode of TOF- Watch apparatus. Results: A total of 104 patients, 50 women and 54 men, aged between18 - 65 years who had elective and/or emergency surgery were evaluated statistically in this study. One patient in the morning group and three patients in the evening group were excluded (four patients in total) because surgery ended before reaching ST 25%. A significant difference was not observed among four groups in terms of ST first lag time, ST maximum lag time, first response time to ST, ST 10% and 25% recovery times related to the neuromuscular conduction. Conclusion: We concluded that the standard induction dose of vecuronium bromide applied in the different hours of the day did not affect the neuromuscular block duration.

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