Kerem İNANOĞLU, BUKET ÇAĞLA ÖZBAKIŞ AKKURT, Murat KARCIOĞLU, Selim TURHANOĞLU

Diz protezi operasyonlarında anestezi yönteminin hemodinami üzerine etkileri

Amaç: Diz protezi ameliyatlarında spinal ve genel anestezi yöntemlerinin metil metakrilat uygulaması, turnike şişirilmesi ve turnike indirilmesi sırasındaki hemodinamik değişiklikler üzerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Total diz protezi cerrahisi yapılacak olan ASA I/II grubu 38 hasta randomize olarak sevofluran bazlı genel anestezi (n=20) ve 3 mL %0.5 levobupivakainin intratekal olarak uygulandığı spinal anestezi (n=18) grubu olmak üzere iki gruba ayrıldı. Tüm hastalara radial arter kateterizasyonu yapıldıktan sonra kardiyak output, arteriyel kan basınçları ve kalp atım hızı anestezi indüksiyonu veya spinal anestezi öncesi, entübasyon veya spinal anestezi sonrası 5, 10, 15. dakikalarda, turnike öncesi, turnike sonrası, kemik çimento öncesi ve sonrası 1, 3, 5, 10. dakikalarda ve turnike indirildikten 1 dakika sonra ölçülerek kaydedildi. Bulgular: Spinal anestezi ve genel anestezi grubunda turnike uygulaması kardiyak outputta ve kan basıncında anestezi öncesi değerlerine göre anlamlı olarak artışa sebep oldu. Kemik çimentosu uygulaması ve turnike çözülmesi her iki grupta kardiyak outputu ve kan basıncını düşürdü, ancak gruplar arası anlamlı bir farklılık bulunamadı. Sonuç: Turnike ve kemik çimentosu uygulanan diz protezi operasyonlarında uygulanan anestezi yöntemlerinin hemodinamik açıdan birbirinden farklı olmadığı sonucuna vardık.

The effect of anesthetic technique on hemodynamic parametres in total knee surgery

Objective: To compare the effects of spinal and general anaesthesia on hemodynamic variations during tourniquet application and cementation in patients undergoing total knee surgery. Materials and Methods: 38 ASA physical status I/II patients undergoing total knee surgery were randomized into two groups as spinal anesthesia group (n=18) where 3 mL of 0.5% levobupivacaine injected intrathecally and sevoflurane based general anesthesia group (n=20). Radial artery catheterization was performed in all of the patients and cardiac output, invasive arterial pressure and heart rate were measured and recorded before anesthesia indication or spinal blockade, at 5 th, 10 th, and 15 th min following endotracheal intubation or spinal blockade, just before and after tourniquet inflation, just before and at 1 st, 3 rd, 5 th, and 10 th min following bone cement placement, and at 1st min after tourniquet deflation. Results: Tourniquet application caused a significant increase in the blood pressure and cardiac output when compared to the values recorded before anesthesia in both groups. Sementation and deflation of the tourniquet caused decrease in blood pressure in both groups, but there was no significant difference between two groups. Conclusion: We concluded that total knee surgery with sementation and tourniquet application did not affect hemodynamic parameters in both spinal and general anesthesia groups.

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