Trakeal entübasyona hemodinamik yanıt: lidokain, esmolol ve fentanilin karşılaştırılması

Amaç: Bu çalışmada, normotansif hastalarda laringoskopi ve endotrakeal entübasyona bağlı gelişen olumsuz hemodinamik değişikliklerin giderilmesinde intravenöz ve plasebo kontrollü olarak lidokain, esmolol ve fentanilin etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: ASA /-//, 18-70 yaşları arasında elektif ürolojik operasyon planlanan 80 olgu rastgele 4 grup oluşturularak çalışmaya alındı. Operasyon öncesi premedikasyon uygulanmadı. Ameliyathanede standart monitörizasyon uygulandı. Grup P'ye (Plasebo) 1 ml kg' serum fizyolojik (n=20), Grup L'ye lidokain 1,5 mg kg'1 (n=20), Grup E'ye esmolol 1,5 mg kg' (n-20), Grup F'ye 2 jug kg' fentanil (n=20) iv bolus olarak uygulandı. Tiyopental-Na 6 mg kg'' ve roküronyum 0,8 mg kg'1 2 dk sonra iv uygulandı. Indüksiyonu takiben 2 dk sonra laringoskopi ve endotrakeal entübasyon gerçekleştirildi. Entübasyon kalite skorlaması kaydedildi. Entübasyon sonrası %50 oksijen, %50 N20, %2 sevofluran ile anestezi idamesi sağlandı. Hastaların bazal, indüksiyon öncesi, entübasyon öncesi, entübasyon sonrası 1., 2., 3., 4. ve 5. dakikadaki kalp atım hızı (KAH) , ortalama, diyastolik ve sistolik arter basınçları (sırasıyla O AB , DAB ve S AB) kaydedildi. Bulgular: Çalışmamızda indüksiyon sonrası 2.dk (T3) - entübasyon sonrası 1 .dk (T4) dönemleri arasında OAB'nın lidokain grubunda (83,90±8,19 - 114,05±7,58) fentanil grubuna (86,20±9,76 - 105,05±11,81) göre istatistiksel olarak daha fazla arttığı gözlendi. T3-T4 dönemlerinde SAB'nın, esmolol (115,80±12,71 - 143,65±13,79) ve fentanil gruplarında (113,45±12,46 -139,80±15,49), plasebo (114,80±8,5 -154,50±10,08) ve lidokain grubuna (107,35±8,98 -150,40±12,41) göre istatistiksel olarak daha az yükseldiği gözlendi. Kalp atım hızlarının da istatistiksel anlamlı olarak indüksiyon sonrası (T3) ile indüksiyon öncesi (T2) arasında esmolol (p = 0,007) ve fentanil (p = 0,002) gruplarında plasebo grubuna göre daha az yükseldiği gözlendi. Sonuç: Normotansif ve kalp hastalığı olmayan hastalarda; uyguladığımız doz ve zamanlama ile esmolol ve fentanilin endotrakeal entübasyon ve laringoskopiye bağlı gelişen hipertansiyonu ve taşikardiyi önlemede etkin olduğu görülmüştür.

The hemodynamic response to tracheal intubation: comparison of lidocaine, esmolol and fentanyl

Objectives: In this study we aimed to evaluate the effects of placebo controlled intravenous lidocaine, esmolol andfentanyl which are used to improve the negative haemodynamic changes related to laryngoscopy and endotracheal intubation in normotensive patients. Material and Method: 80 patients aged between 18-70 ASA I-II who would underwent elective urologic surgery were randomized into four groups. No premedication agent was administered. Standart monitorization was applied in the operating room. In Group Pplacebo 1 ml kg' isotonic saline (n=20), Group L lidocaine 1.5 mg kg' (n=20), Group E esmolol 1.5 mg kg' (n=20), Group F fehtanyl 2 jig kg' (n=20) iv bolus were administered. Two minutes after these medications thiopental-sodium 6 mg kg ' and ro-curonium 0.8 mg kg'1 were administered. Two minutes after the anestesia induction, laryngoscopy and endotracheal intubation yvas applied. Intubation quality score was also recorded. Anaestesia was maintained with %50 02 ,%50 N20 and %2 Sevoflurane. Patient's heart rate (HR), mean, diastolic, and sistolic arterial pressure (MAP, DAP, SAP) values were recorded at basal time, before induction, and Is', 2"d, 3rd, 4"', and 5"' minutes after induction. Results: In the study, the increment of MAP value in lidocaine group (83.90±8.19 to 114.05+ 7.58) were significantly higher than fentanyl group (86.20±9.76 to 105.05±11.81) in T3(after induction)-T4(after intubation) period. The increment of SAP value in.esmolol (U5.80±12J1 vs 143.65±13.79) andfentanyl groups (113.45±12.46 to 139.80±15.49) were significantly lower than plasebo (114.80±8.5 to 154.50±10.08) and lidocaine groups (107.35±8.98 vs 150.40±12.41) in this period. The increment of heart rate in fentanyl and esmolol groups were lower than plasebo in T3(after induction)-T2(before induction) period. Conclusion: In our study fentanyl and esmolol are effective medications for tachycardia and hypertension related to laryngoscopy and endotracheal intubation in normotensive patients.

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Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
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