Umut GÖK, Sibel BARIŞ, İ. Serhat KOCAMANOĞLU, FUNDA GÖK, Ayla TÜR

Tiroidektomi yapılacak hastalarda propranolol ve diazepam premedikasyonlarının karşılaştırılması

Amaç: Bu çalışmadaki amacımız, tiroidektomi planlanan hastalarda, 40 ve 60 mg propranolol premedikasyonlarının preoperatif anksiyeteye, entübasyona karşı gelişen hemodinamik yanıtlara ve postoperatif titremeye karşı etkilerini diazepam ve plasebo premedikasyonları ile karşılaştırmalı olarak değerlendirmektir. Gereç ve Yöntem: Çalışmaya toksik guatr nedeni ile operasyonu planlanan 85 ASA I-II yetişkin hasta alındı. Hastalara operasyondan önceki gece ve operasyondan 2 saat önce peroral 60 mg propranolol (Grup P60), 40 mg propranolol (Grup P40), 10 mg diazepam (Grup D) ya da plasebo (Grup P) premedikasy onları randomize çift kör olarak uygulandı. Hastaların hastaneye yatışında Durumluk-Sürekli Kaygı Envanteri (STAI-1 ve STAI-2), preoperatif bekleme odasında ve postoperatif 6. saatte STAI-1 ile anksiyete değerlendirmeleri yapıldı. Perioperatif kalp atım hızı (KAH), ortalama arteriyel basınç (OAB), periferik oksijen satürasyon(Sp02) değerleri, vücut sıcaklıkları, titreme, remifentanil ve meperidin tüketimleri kaydedildi. Bulgular: Grup P60 ve P40'da preoperatif ve postoperatif STAI-1 skoru, Grup D ve P'ye göre daha düşüktü (p

Comparison of propranolol and diazepam premedications in patients undergoing thyroidectomy

Aim: The aim of this study was to determine the effects of 40 and 60 mg propranolol premedications on preoperative anxiety, hemodynamic stress responses to intubation and postoperative shivering compared to with diazepam or placebo in patients undergoing thyroidectomy. Materials and Methods: 85 ASA I-II adult patients undergoing thyroidectomy were enrolled into the study. The patients received one of the following peroral premedications the night before surgery and. 2 hour preoperatively; 60 mg propranolol (Group P60), 40 mg propranolol (Group P40), 10 mg diazepam (Group D) and placebo (Group P). Preoperative anxiety was measured on admission via State-Trait Anxiety inventory (STAI-1 and STAI-2) at the preoperative room and six hour after surgery using STAI-1. Perioperative heart rate (HR), mean arterial presure (MAP), peripheral oxygen saturation, body temperatures, shivering, meperidin, remifentanil consumption were recorded. Results: Preoperative, postoperative STAI-1 scores in the Group P60 and Group P40 were lower than the Group D, Group P (p<0.01). There were no differences MAP and HR after intubation in the Group P60 and Group P40 while significant increments in the Group D and Group P (p<0.05). Intraoperatively and early postoperatively analgesic consumption in Group D and Group P were higher compared to Group P60 and Group P40 (p<0.001). There were significant reduction in postoperative shivering incidence in the Group P60 and Group P40 compared to Group D and Group P (p<0.05). Conclusion: We concluded that peroral propranolol premedication was beneficial and 40 and 60 mg propranolol premedications had similar effects in patients undergoing thyroid surgery.

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1.Lichtor JL, Zacny JP. Psychological preparation and preoperative medication. In: Miller RD. Miller's Anesthesia (4th edition). Philadelphia, Pennsylvania: Elsevier Churchill Livingstone Inc, 1994: 893-1137.
2.Stoelting RK, Miller RD. Preoperative medication. In: Stoelting RK, Miller RD. Basics of Anesthesia. (4th edition). Philadelphia, Pennsylvania: Elsevier Churchill Livingstone Inc, 2000: 119-30.
3.Roizen MF, Fleisher LA. Anesthesic Implications of Concurrent Diseases. In: Miller RD. Miller's Anesthesia (6th edition). Philadelphia, Pennsylvania: Elsevier Churchill Livingstone Inc, 2005: 1017-50.
4.Richard N, Wissler MD. Endocrine Disorders. In: Chestnut DH. Chesnut's Obstetric Anesthesia (2th edition). St Louis, Missori: Mosby Inc, 1999: 820-3.
5.Imamoğlu K. Tiroidin benign hastalıkları. Sayek İ. Temel cerrahi (2. baskı). Ankara: Güneş kitabevi 1994: 1187-98.
6.James IM, Griffith DN, Pearson RM, Newbury P. Effect of oxprenolol on stage-fright in musicians. Lancet 1977; 2: 952-4.
7.Dyck JB, Chung F. A comparison of propranolol and diazepam for preoperative anxiolysis. Can J Anaesth 1991; 38: 704-9.
8.Stoelting RK, Miller RD. Airway management and tracheal intubation. In Stoelting RK, Miller RD. Basics of Anesthesia (4th edition). Philadelphia, Pennsylvania: Elsevier Churchill Livingstone Inc, 2000: 148-67.
9.Mathews S, Al Mulla A, Varghese PK, Radim K, Mumtaz S. Postanesthetic shivering- a new look at tramadol. Anaesthesia 2002; 57: 394-8.
10.Gönüllü M, Turan ED, Erdem LK. Anestezi uygulanacak hastalarda anksiyete düzeyinin araştırılması. Türk Anest Rean Cem. 1986; 14: 110-3.
11.Aydemir Ö, Köroğlu E. Psikiyatride kullanılan klinik ölçekler. Hacettepe Taş Kitabevi, Ankara 2000; 153-63.
12.Crossley AW, Mahajan RP. The intensity of postoperative shivering is unrelated to axillary temperature. Anaesthesia 1994; 49: 205-7.
13.Bacuzzi A, Dionigi G, Del Bosco A, et al. Anaesthesia for thyroid surgery: perioperative management. Int J Surg 2008; 6: S82-5.
14.Stoelting RK, Miller RD. Endocrine and nutritional disease. In: Stoelting RK, Miller RD. Basics of Anesthesia (4th edition). Philadelphia, Pennsylvania: Elsevier Churchill Livingstone Inc, 2000: 307-20.
15.Carabine UA, Milligan KR, Moore JA. Adrenerjic modulation of preoperative anxiety: a comparison of temazepam, clonidine, and timolol. Anesth Analg 1991; 73: 633-7.
16.Wikinski S, Lombardo M, Medina JH, Rubio MC. Lack of anxiolytic effect of diazepam in pre-anaesthetic medication. Br J Anaesth 1994; 72: 694-6.
17.Jakobsson J, Rane K, Ryberg G. Oral premedication one hour before minor gynaecological surgery- does it have any effect? A comparison between ketobemidone, lorazepam, propranolol and placebo. Acta Anaesthesiol Scand 1995; 39: 359-63.
18.Lucchelli PE, Cattaneo AD, Zattoni J. Effect of capsule colour and order of administration of hypnotic treatments. Eur J Clin Pharmacol 1978; 13:153-5.
19.Waal HJ. Propranolol-induced depression. Br Med J 1967; 2: 50.
20.Fourneret P, Desombre H, de Villard R, Revol O. Interest of propranolol in the treatment of school refusal anxiety: about three clinical observations. Encephale 2001; 27: 578-84.
21.Coloma M, Chiu JW, White PF, Armbruster SC. The use of es-molol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg 2001; 92: 352-7.
22.Wallace A, Layug B, Tateo I, et al. Prophylactic atenolol reduces postoperative myocardial ischemia. Anesthesiology 1998; 88: 7-17.
23.Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996; 335: 1713-20.
24.Andrzejowski J, Francis G. The efficacy of lidocaine administered via the LITA tracheal tube in attenuating extubation response in beta-blocked patients following craniotomy. Anaesthesia 2002; 57: 399-401.
25.Stanley TH, de Lange S, Boscoe MJ, Brujin N. The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease. Can Anaesth Soc J 1982; 29: 319-24.
26.Chia YY, Chan MH, Ko NH, Liu K. Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth 2004; 93: 799-805.
27.Moss J, Glick D. The Autonomic Nervous System. In Miller RD. Miller's Anesthesia (6th edition). Philadelphia, Pennsylvania: Elsevier Churchill Livingstone Inc, 2005: 617-77.