Elif KUTLU, Ahmet TOPAL, Jale Bengi ÇELİK

Üç farklı genel anestezi yaklaşımının QT ve QTc aralığı üzerine etkilerinin karşılaştırılması

Amaç: QT aralığında uzama ciddi kardiyak aritmiler, polimorfik ventriküler taşikardi ve ventriküler fibrilasyon ile sonuçlanabilir. Bu çalışma da üç farklı genel anestezi protokolünün QT ve QTc aralığı üzerine etkilerinin araştırılması amaçlandı. Yöntem: Jinekolojik ve ürolojik operasyon geçirecek ASA I-II risk grubundan 60 hasta rasgele 3 eşit gruba ayrıldı. Tüm grup- lara genel anestezi indüksiyonu propofol ve fentanil ile ve trakeal entübasyon ise rokuronyum ile sağlandı. Anestezi idamesinde Grup I’de (n=20), propofol-remifentanil, Grup II’de (n=20) desfluran ve remifentanil, Grup III’te (n=20) desfluran ve % 40 O2+N2O karışımı kullanıldı. ‹ndüksiyon öncesi, indüksiyondan sonraki 5., 15., 45. dakikalarda ve postoperatif dönemde 3 derivas- yonlu EKG kaydı yapıldı. Aynı dönemlerde Grup II ve Grup III’te MAK değerleri ve tüm gruplarda oksijen saturasyonu (SpO2), sistolik (SAB), diastolik (DAB) ve ortalama arter basınçları (OAB) kaydedildi. Kalp hızı ile düzeltilmiş QT aralığı Bazett formülü kullanılarak hesaplandı. Ki-kare veya Unpaired Student t testi üç grubun demografik verilerini karşılaştırmada kullanıldı. Üç gruptan elde edilen verilerin istatiksel analizinde tek yönlü varyans analizi ve t testi kullanıldı. Her grup içinde farklı zamanlarda yapılan ölçümlerin bazal değerle karşılaştırılmasında ANOVA ve paired t testi kullanıldı. p0.05). Grup I’de bazal QT ve QTc değerleri ile 5.,15., 45. dakikalar ve postoperatif ölçümler benzerdi (p>0.05). Grup II ve III’te QT ve QTc değerleri 15. ve 45. dakikalarda bazal değere göre uzamıştı ve bu uzama her grup için istatistiksel olarak anlamlı idi (p

Anahtar Kelimeler:

Propofol, Anestezi, genel, Entübasyon, Kalp hızı, Anestezi, Varyans analizi

Comparison of the effects of three different general anesthesia methods on QT and QTc intervals

Objective: Prolongation of the QT interval may result in grave cardiac arrhythmias, polymorphic ventricular tachycardia and ventricular fibrillation. The aim of this study was to assess the influence of three different general anesthesia protocols on QT and QTc intervals. Method: Sixty ASA I-II patients undergoing gynecological and urological operations were randomly allocated into three groups. Anesthesia was induced with propofol, fentanyl and tracheal intubation was facilitated by rocuronium in all groups. Anesthesia was maintained in Group I (n=20) with propofol and remifentanil, in Group II (n=20) with desfluran and remifentanil, in Group III (n=20) with desfluran and 40% O2+60% N2O. Three lead electrocardiogram recordings were taken before induction, 5, 15, 45 minutes after induction and postoperative period. MAC values in Group II and Group III and oxygen saturation (SpO2), systolic (SAB), diastolic (DAB) and mean (OAB) arterial pressure in all groups were recorded at the same time. Heart rate and corrected QT interval were evaluated by using Bazett’s formula. Chi-Square or unpaired Student t-test were used for comparison of demographic data between the three groups. One -way analysis of variance and t-test were used for comparison of data between the three groups. For each group, measurements which were made at the different times were evaluated with control values by ANOVA and paired t-test. p<0.05 was considered as statistically significant. Results: There was no statistically significant difference in the baseline QT and QTc values of the groups (p>0.05). In Group I, there were not any statistical differences between basal QT and QTc values and the 5th , 15th , 45th minutes and postoperative measurements. In Group II and III, QT and QTc values were longer at 15th and 45th minutes compared with basal values and this prolongation was statically significant for each group (p<0.05). When the three groups were compared for QT and QTc interval prolongation, 15th , 45th minutes and postoperative measurements of QT and QTc interval were significantly longer in Group II and III than Group I (p<0.05). Arrhythmia was observed 5 cases in Group III and this was statistically significant when compared with Group I and II (p<0.05). In 3 cases in Group III, tachicardia was observed and was statistically significant when compared with group I (p<0.05). Conclusion: In this study, we concluded that desfluran and N2O or desfluran and remifentanil prolongs the QT and QTc interval but propofol and remifentanil do not prolong QT and QTc interval.

Keywords:

Propofol, Anesthesia, General, Intubation, Heart Rate, Anesthesia, Analysis of Variance,

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