Necla Dereli, Zehra Baykal, Münire Babayiğit, Handan Güleç, Hakan Buluş, Eyüp Horasanlı

Bir grup laparoskopik kolesistektomi hastasında intraoperatif esmolol infüzyonunun postoperatif stres yanıt üzerine etkisi

Amaç: Çalışmada esmololün intraoperatif anestezik- postoperatif analjezik gereksinimi, postoperatif kortizol ve prolaktin düzeylerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya 60 hasta dahil edilmiştir. Çalışma grupları şu şekilde dizayn edildi; 1: Esmolol infüzyonuna propofol ve remifentanil eklendi, 2: Sadece propofol ve remifentanil, 3: Esmolol infüzyonuna desfluran ve remifentanil eklendi, 4: Sadece desfluran ve remifentanil kullanıldı. Ameliyat öncesi ve sonrası kortizol ve prolaktin seviyeleri ölçüldü.Bulgular: Analjezik gereksinimi tüm gruplar içinde grup 1'de anlamlı olarak düşüktü ve grup 4 ile karşılaştırıldığında grup 3'te düşük bulundu. Kalp hızı esmolol gruplarında (grup 1 ve 3) kontrol gruplarına göre anlamlı olarak daha düşüktü. Prolaktin düzeyleri bütün gruplarda preoperatif değerlere göre postoperatif dönemde anlamlı yüksek bulundu. Ameliyat öncesi seviyelere ile karşılaştırıldığında postoperatif kortizol düzeylerinde grup 1de anlamlı bir azalma gözlendi. Sonuç: Laparoskopik kolesistektomi hastalarında anestezi yönetiminde adjuvan esmolol kullanımı herhangi bir hemodinamik instabiliteye neden olmadan anestezik - analjezik gereksinimini azaltıp postoperatif kortizol yanıtı baskılarken ameliyat sonrası prolaktin yanıtı üzerinde önemli bir etkisi yoktur.

Anahtar Kelimeler:

Esmolol, postoperatif stres yanıt, kortizol

Effect of intraoperative esmolol infusion on postoperative stress response in a group of laparoscopic cholecystectomy patients

Purpose: We aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postroperative cortisol and prolactin levels. Material and Methods: Sixty patients have been included. Study groups were as follows; 1: Esmolol infusion was added to propofol and remifentanil, 2: Only propofol and remifentanil, 3: Esmolol infusion was added to desflurane and remifentanil, 4: Only desflurane and remifentanil was used. Preoperative and postoperative cortisol and prolactin levels were measured. Results: Analgesic requirements were significantly lower in group 1 and was lower in group 3 compared to group 4 (p: 0.005). Heart rates were significantly lower in esmolol groups (group 1 and 3) compared to their controls (p: 0.001) . Prolactin levels significantly increased postoperatively in all groups compared to preoperative levels (p: 0.005 – 0.001). There was no significant difference between study groups in means of postoperative prolactin (p: 0.478). We observed a significant decrease in cortisol levels postoperatively in group 1 compared to preoperative levels (p: 0.037). Conclusion: Using adjuvant esmolol during anesthetic maintenance of laparoscopic cholecystectomy patients decreases anesthetic – analgesic requirements without causing any hemodynamic instability, and supresses postoperative cortisol response but does not have any significant effect on postoperative prolactin response.

Keywords:

Esmolol, postoperative stress response, cortisol,

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