Berna Kaya UĞUR, Murat SUCU, Gülseren KARSLI, Fatma Yılmaz COŞKUN, Veysel İ. DÜZEN, Mete Gürol UĞUR

Comparison of ventricular repolarization parameters including Tp-e, Tp-e/QTc, JTc and JTd during low-flow and high-flow desflurane anesthesia in gynecologic laparoscopic surgery

Objectives: Low-flow anesthesia (LFA) gained reasonable popularity as it provides many advantages including physiological, ecological, economical issues. Desflurane is a preferable anesthetic in low-flow anesthesia practice however, the relation between QTc, QTd, and QTcd prolongation and management of anesthesia with desflurane has been previously demonstrated. We aimed to compare the effects of low-flow (LFA) and high-flow (HFA) desflurane anesthesia on hemodynamic changes and ventricular repolarization markers in gynecologic laparoscopy.Methods: 58 patients were randomized into group L (LFA, n=30) and group H (HFA, n=28). ECG was recorded before anesthesia and 60th minute of anesthesia in both groups.Results: JTc-0 values were lower than JTc-1 values within both group L and H (p=0.001 for both groups). JTcd-0 and JTd-1 values were lower than JTcd-1 within group H (p=0.042 and 0.002, respectively). QTc-0 values were lower than QTc-1 within both group L and group H (p=0.001 and 0.002, respectively). QTcd-0 values were lower than QTcd-1 within group H (p=0.021). QTd-0 values were lower than QTd-1 within-group H (p=0.026). Tpe-0 and Tpe-1 values were lower in group L (p=0.001 and 0.002 respectively). Also, JTc-0 values were lower than JTc-1 values within both group L and H (p=0.021 and 0.027, respectively). Tpe/QTc-1 ratio was significantly lower in group L (p= 0.010). The difference between Tpe/QTc-0 and Tpe/QTc-1 ratios within group H was significant (p=0.028).Conclusion: Our study showed that there was no significant difference between LFA and HFA in terms of ECG repolarization markers, which may predict the possibility of torsadogenity.

Jinekolojik Laparoskopik Cerrahide Düşük ve Yüksek Akımlı Desfluran Anestezisinin Tp-e,Tpe/QTc, JTc ve JTd gibi ventriküler repolarizasyon parametrelerine etkisinin karşılaştırılması

Amaçlar: Düşük akımlı anestezi (DAA) fizyolojik, ekolojik, ekonomik konular dahil olmak üzere birçok avantajları nedeniyle son yıllarda popülerlik kazanmıştır. Desfluran, DAA uygulamasında tercih edilen bir anesteziktir, ancak desfluran ile anestezide QTc, QTd ve QTcd uzaması daha önceki çalışmalarda gösterilmişti. Çalışmamızda jinekolojik laparoskopide düşük akımlı ve yüksek akımlı (HFA) desfluran anestezisinin hemodinamik değişiklikler ve ventriküler repolarizasyon belirteçleri üzerindeki etkilerini karşılaştırmayı amaçladık. Yöntemler: 58 hasta grup L (LFA, n = 30) ve grup H (HFA, n = 28) olarak randomize edildi. Her iki grupta da anestezi öncesi ve 60. dakika anestezi EKG çekildi. Bulgular: JTc-0 değerleri hem grup L hem de H içinde JTc-1 değerlerinden düşüktü (her iki grup için p = 0,001). Grup H içinde JTcd-0 ve JTd-1 değerleri JTcd-1'den düşüktü (sırasıyla p = 0.042 ve 0.002). QTc-0 değerleri hem grup L hem de grup H'de QTc-1'den düşüktü (sırasıyla p = 0.001 ve 0.002). Grup H içinde QTcd-0 değerleri QTcd-1'den daha düşüktü (p = 0.021). QTd-0 değerleri, grup H içinde QTd-1'den düşüktü (p = 0.026). Grup L'de Tpe-0 ve Tpe-1 değerleri daha düşüktü (sırasıyla p = 0,001 ve 0,002). Ayrıca, hem L hem de H grubunda JTc-0 değerleri JTc-1 değerlerinden daha düşüktü (sırasıyla p = 0.021 ve 0.027). Grup L'de Tpe / QTc-1 oranı anlamlı olarak daha düşüktü (p = 0,010). Grup H içinde Tpe / QTc-0 ve Tpe / QTc-1 oranları arasındaki fark anlamlıydı (p = 0,028). Sonuç: Çalışmamızda, DAA ve YAA arasında EKG repolarizasyon belirteçleri ve torsadojenite riski arasında anlamlı bir fark olmadığı sonucuna varıldı.

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