Levobupivakain ve bupivakainin kardiyotoksisite-sinin B-type natriüretik peptid ile karşılaştırılması

Amaç: Lokal anestezikler, sinir hücre membranlarındaki iyon kanalları üzerinden oluşturdukları etkileri, uyarılabilir diğer dokularda da oluşturduklarından kardiyovasküler sistem için de potansiyel toksik olarak kabul edilmektedirler.Bu çalışmada, levobupivakain ve bupivakainin kombine spinal-epidural anestezi ve analjezideki kardiyotoksisite etkilerini B-type natriüretik peptid (BNP) protein düzeyiyle saptamayı amaçladık. Yöntem: Bu prospektif, randomize, çift kör çalışmada 25-70 yaşları arasında American Society of Anesthesiologists (ASA) I-III sınıfında olan ve total diz artroplastisi cerrahisi uygulanan toplam 30 hasta dahil edildi. Hastalar Grup I (n = 15) Levobupivakain and in Grup II (n = 15) Bupivakain olacak şekilde randomize edildi ve kombine spinal-epidural anestezi uygulandı. Hastaların ameliyat sırasındaki takipleri sistolik arteriyal basınç (SAB), diastolik arteriyal basınç (DAB), ortalama arteriyal basınç (OAB) ve kalp atım hızı (KAH) ve ameliyat sonrası takipleri ise 0. dakika ve 1., 6.,12., 24. saatlerde SAB, DAB, KH, vizüel analog skala (VAS) değerleri izlenerek yapıldı. Spinal anestezi sonrası 5. dakika, Duyusal blok Torakal 10 düzeyinde ve ameliyat sonrası 24. saat BNP düzeyleri ölçüldü. Bulgular: Postoperatif 12. ve 24. saatteki VAS değerlerinde levobupivakain grubu lehine istatistiksel olarak anlamlı fark bulundu (p0.05). Sonuç: Levobupivakain ve bupivakainin hem spinal anestezi hem de epidural analjezi için eşit dozlarda kullanımında intraoperatif ve postoperatif BNP düzeylerinde benzer sonuçlara ulaşılmıştır.

Comparison of cardiotoxicity of levobupivacaine and bupivacaine with the brain natriuretic peptide

Objective: Local anesthetics are also considered to be potentially toxic to the cardiovascular system since they act on ionchannels in nerve cell membranes as well as in other tissues that can be stimulated.In this study we aimed to comparecardiotoxicity levels of both drugs with brain natriuretic peptide (BNP) protein level in patients undergoing combinedspinal epidural anesthesia and postoperative analgesia when given bupivacaine and levobupivacaine at equipotent doses.Method: In this prospective, randomized, double-blind study a total of 30 patients, aged 25-70 years, who were includedin the American Society of Anesthesiologists (ASA) I-III risk class and underwent total knee arthroplasty surgery, wereincluded in the study. Patients were randomized as Group I (n = 15) Levobupivacaine and Group II (n = 15) bupivacaineand combined spinal-epidural anesthesia was administered. The operation follow-up of patients were evaluated with thesystolic arterial pressure (SAB), the diastolic arterial pressure (DAB), the mean arterial pressure (MAP) and the heart rate(HR), and postoperative follow-up with SAB, DAB, KH, visual analogue scale (VAS) values were monitored at zerominute, 1st, 6th, 12th and 24th hour. BNP levels were measured at 5th minute after spinal anesthesia, sensory block atthoracal level 10 and post-operative 24th hour.Results: A statistically significant difference was found in the VAS values measured at postoperative 12th hour and 24thhour in favor of levobupivacaine group (p 0.05).Conclusions: Similar results were obtained in intraoperative and postoperative BNP levels when using levobupivacaineand bupivacaine in equal doses for both spinal anesthesia and epidural analgesia.

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