Evin SÜMER, Ebru BİRİCİK, Yasemin GÜNEŞ, Murat GÜNDÜZ, Murat ILGINEL

Kraniyotomilerde endotrakeal ekstübasyona bağlı gelişen hemodinamik yanıtın kontrolünde lidokain-lidokain ve lidokain - esmolol etkinliğinin karşılaştırılması

Amaç: Kraniyotomi operasyonlarında ekstübasyon sırasında gelişebilecek istenmeyen hemodinamik değişiklikleri ortadan kaldırmak için, çalışmamızda lidokain+lidokain, lidokain+esmolol etkisini karşılaştırmayı amaçladık.Gereç ve Yöntem: Kraniyotomi uygulanacak ASA I-III grubu 60 hasta çalışmaya dahil edildi. Anestezi idamesi ise sevofluran-remifentanil kombinasyonu ile sağlandı. Postoperatif analjezi 2 mg kg-1 intravenöz tramadol ile sağlandı. Ameliyat bitimine 10 dakika kala hemodinamik parametreler kaydedildikten sonra tüm hastalara 1mg kg-1 bolus lidokain intravenöz yapıldı. Hastalar rastgele iki gruba ayrılarak Grup I’ de (grup Lidokain+Lidokain) 0,025mg kg sa-1 lidokain, Grup II’ de (grup Lidokain+Esmolol) 50 µg kg dk-1 esmolol infüzyonu başlandı. Hastaların lidokain ve esmolol infüzyonları sonrası 1.-5. ve 10. dakikada, hemodinamik parametreleri kaydedildi. Bulgular: Grup I’ de preoperatif döneme göre ekstübasyon sonrasında hemodinamik değişikliklerde anlamlı artış gözlendi. Grup II’ de esmolol infüzyonu sonrası 10. dakika ve ekstübasyon sonrasındaki hemodinamik değişikliklerde preoperatif döneme göre anlamlı artış belirlendi. Grup II’ de ekstübasyon zamanı, göz açma, sözel yanıt, oryantasyon süresi grup I’ den anlamlı olarak daha yüksekti.Sonuç: Kraniyotomi uygulanan olgularda ekstübasyon öncesinde uygulanan lidokain+lidokain infüzyonunun lidokain+esmolol infüzyonuna göre ekstübasyon sırası ve sonrasında daha stabil bir hemodinami sağladığı, ekstübasyon süresinin daha kısa olduğu kanısına varıldı.

Anahtar Kelimeler:

Lidokain, esmolol, ekstübasyon

Comparison of lidocaine-lidocaine and lidocaine-esmolol efficiency in control of haemodynamic response to endotracheal extubation craniotomies

Purpose: In this study, we aimed to compare efficiency of lidocaine+lidocaine and lidocaine+esmolol combinations on elimination of undesirable hemodynamic changes during extubation.Materials and Methods: 60 patients ASA I-III scheduled for craniotomy were included in this study. Anaesthesia maintenance was provided with sevoflurane-remifentanil and 2 mg kg -1 tramadol for postoperative pain. Lidocaine İV bolus 1 mg kg-1 was administered to the patients 10 minutes before the end of operation in both groups. Lidocaine İV infusion 0.025 mg kg h-1 and Esmolol İV infusion 50 mcg kg min-1 was administered to Group I (Lidocain+Lidocain) and II (Lidocain+Esmolol) respectively. Haemodynamic parameters were recorded at 1, 5 and 10 minutes after lidokain and esmolol infusions. Results: There was a statistically significiant increase for haemodynamic changes after extubation when compared preoperative period in group I. There was a statistically significant increase for haemodynamic changes at 10 minutes after esmolol administration and extubation when compared preoperative period in group II. Extubation, eye opening, verbal response and orientation time in Group II were significantly longer than in Group I.Conclusion: Lidocaine bolus- lidocaine infusion which administered before extubation provided more stable hemodynamics and shorter extubation time than lidocaine bolus-esmolol infusion in patients who undergoing craniotomy.

Keywords:

Lidocain, esmolol, extubation,

PDF

___

1. Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg. 1995;80:149-72.
2. Lowrie A, Johnston PL, Fell D, Robinson SL. Cardiovascular and plasma catecholamine responses at tracheal extubation. Br J Anaesth. 1992;68:261-3.
3. Hamaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of the response by lidocaine. Anesthesiology. 2000;93:95-103.
4. Morgan EG, Mikhail MS, Murray MJ. Airway Management. In: Clinical Anesthesiology. 3 rd Edition. New York, McGraw-Hill, 2002;59-85.
5. Lowrie A, Johnson PL, Fell D, Robinson W. Cardiovascular and plazma catecholamine responses at tracheal extubation. Br J Anaesth. 1992;68:261-63.
6. Kurian SM, Evans R, Fernandes NO, Sherry KM. The Effect of an infusion of esmolol on the incidence of myocardial ischaemia during tracheal extubation following coronary artery surgery. Anaesthesia. 2001;56:1163-8.
7. Dyson A, Isaac PA, Pennant JH, Giesecke AH, Lipton JM. Esmolol attenuates cardiovascular responses to extubation. Anesth Analg. 1990;71:675-8.
8. Davies R, Mcloone M. Anaesthesia for neurosurgery. Anaesthesia and Intensive Care Medicine. 2007;8:427-30.
9. Nishina K, Mikawa K, Maekawa N, Obara H. Fentanyl attenuates cardiovascular responses to tracheal extubation. Acta Anaesthesiol Scand. 1995;39:85-9.
10. Gong Z. Luo A. Effect of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Chin Med Sci J. 1999;14:189-92.
11. Stoelting RK. Circulatory changes during direct laryngoscopy with or without prior lidocaine. Anesthesiology. 1977;47:381-4.
12. Lowenthal DT. Porter RS. Saris SD, Bies CM, Slegowski MB, Staudacher A. Clinical pharmacology, pharmacodynamics, and interactions with esmolol. Am J Cardiol. 1985;56:14-18.
13. Gray RJ, Bateman TM, Czer LS, Conklin C, Matloff JM. Use of esmolol in hypertension after cardiac surgery. Am J Cardiol. 1985;56:49-56.
14. Asouhidou I, Trikoupi A. Esmolol reduces anesthetics reuirements thereby facilitating early extubation; a prospective controlled study in patients undergoing intracranial surgery. BMC Anesthesiol. 2015;15:172.
15. Gibson BE, Black S, Maass L, Cucchiara RF. Esmolol for the control of hypertension after neurologic surgery. Clin Pharmacol Ther. 1988;44:650-3.
16. Bidwai AV, Rogers CR, Stanley TH. Blood pressure and pulse-rate responses to endotacheal extubation with and without prior injection of lidocaine. Anesthesiology. 1979;51:171-3.
17. Mikawa K, Nishina K, Takao Y, Shiga M, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: comparison of verapamil, lidocaine and verapamil lidocaine combination. Anesth Analg. 1997;85:1005–10.
18. Wallin G, Cassuto J, Hogstrom S, Linden I, Faxen A, Rimback G et al. Effects of lidocaine infusion on the sympathetic response to abdominal surgery. Anesth Analg. 1987;66:1008-13.
19. Fujii Y, Saitoh Y, Takahashis S, Toyooka H. Combined diltiazem and lidocaine reduces cardiovascular responses to tracheal extubation and aneshesia emergence in hypertensive patiens. Can J. Anesth. 1999;46:952-6.
20. Akarca D, Kavak GÖ, Tüfek A, Çelik F, Karaman H, Yıldırım ZB et al. Endotrakeal ekstübasyona bağlı gelişen hemodinamik yanıtın kontrolünde deksmedetomidin, esmolol ve lidokainin etkinliğinin karşılaştırılması. Fırat Tıp Dergisi. 2011;16:110-4.
21. Güneş Y, Türktan M, Erman T. Özcengiz D. Comparison of dexmedetomidine, remifentanil, and esmolol for the control of hypertension during tracheal extubation and emergence from anesthesia after a craniotomy. Neurosurg Q. 2013;23:294–98.
22. Alkaya M.A, Saraçoğlu K.T, Pehlivan G, Eti Z, Yılmaz F. Kraniotomi sonrası trakeal ekstübasyona hemodinamik yanıtın önlenmesinde esmololün etkisi. Turk J Anaesth Reanim. 2014;42:86-90.
23. Lim SH, Chin NM, Tai HY, Wong M, Lin K. Prophylactic esmolol infusion for the control of cardiovascular responses to extubation after intracranial surgery. Ann Acad Med Singapore. 2000; 29:447-51.
24. Dereli N. Tutal ZB. Effect of intraoperative esmolol infusion on anesthetic, analgesic requirements and postoperative nausea-vomiting in a group of laparoscopic cholecystectomy patients. Rev Bras Anestesiol. 2015; 65:141-6.
25. Harless M, Depp C, Collins S, Hewer I. Role of Esmolol in perioperative analgesia and anesthesia: a literature review. AANA J. 2015;83:167-77.
26. Davidson EM, Doursout MF, Szmuk P, Chelly JE. Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats. Can J Anesth. 2001;48:59-64.
27. Yasui Y, Masaki E, Kato F. Esmolol modulates inhibitory neurotransmission in the substantia gelatinosa of the spinal trigeminal nucleus of the rat. BMC Anesthesiol. 2011;11:15-24.
28. Hashemi SJ. Heidari SM. Rahavi A. Lidocaine administration before tracheal extubation cannot reduce post-operative cognition disorders in elderly patients. Adv Biomed Res. 2013;2:81.