Osman BULUT, Nuh KILIÇ, Büşra KİBAR, Zeynep Bilgen ŞEN, L. Didem KOXACI, Cahit Gürsel BELLEK

Tavşanlarda İzofluran, Sevofluran, Propofol-Fentanil, Medetomidin-MidazolamKetamin ve Ksilazin-Ketamin ile Oluşturulan Uzun Süreli Anestezinin Akut Faz Proteinleri ve Kardiyak Troponin I Konsantrasyonları Üzerine Etkisi

Bu çalışmada, kalp üzerine olumsuz etkileri bilinen enjektabl anestezik kombinasyonlardan medetomidin-ketamin-midazolam ve ksilazin-ketamin ile kardiyoprotektif etkileri bilinen inhalasyon anesteziklerinden izofluran ve sevofluran ile enjektable anesteziklerden propofol-fentanil kombinasyonlarının kalp üzerindeki olası yan etkilerinin göstergesi olan kardiyak troponin I ve Creaktif (CRP) proteinin düzeylerinin karşılaştırmalı olarak araştırılması amaçlanmıştır. Hayvan materyalini 15 erkek ve 15 dişi olmak üzere toplam 30 adet erişkin Yeni Zelanda tavşanı oluşturdu. Tavşanlar altışarlı 5 gruba ayrıldı. Bu amaçla 1. gruptaki tavşanlara izofluran ile 4 saatlik anestezi sağlandı. 2. gruptaki hayvanlara ise 1. gruptakiyle aynı prosedür sevofluran kullanılarak uygulandı. 3. gruptaki hayvanlara ise başlangıçta midazolam, medetomidine and fentanyl i.m. uygulanarak takiben ek doz uygulaması ile toplam 4 saatlik bir anestezi oluşturuldu. 4. gruptaki hayvanlara ise fentanil ve propofol ile indüksiyonunu takiben genel anestezinin idamesi propofol ve fentanil ile toplam 4 saatlik bir anestezi sağlandı. Son gruptaki hayvanlara ksilazin ile premedike edilerek ketamine ile 4 saatlik anestezi oluşturuldu. Ayrıca her tavşan için anestezi öncesi, sırası ve sonrasında refleksler, kalp atım sayısı, solunum sayısı ve biyokimyasal (CRP and cTn-I) parametreler kayıt edildi. 5. grup ve 3. grup kombinasyonları major cerrahi prosedürler için uygun bulunurken 1. grup ve 2. grup anestezi protokolleri ise minor cerrahi prosedürler için daha uygun bulundu. Kalp atım sayısında 2. grupta ve 3. grupta başlangıç değerlerine göre azalma istatiksel olarak anlamlı bulundu. CRP ve cTn-I değerlerinde, gruplar arasında ve başlangıç değerlerine göre istatiksel olarak analizleri yapıldı; ancak anlamlı bir fark belirlenmedi. Sonuç olarak, kardiyak troponinler uzun süreli anesteziye bağlı oluşabilecek akut miyokardiyal hasarın erken belirlenmesinde kullanılabileceği kanısına varılmıştır.

Effect(s) of Long-Term Anaesthesia Induced by Isoflurane, Sevoflurane, Propofol-Fentanyl, Medetomidin-MidozolamKetamine or Xylazine-Ketamine Combinations on the Acut Phase Proteins and Cardiac Troponins Levels in Rabbits

The aim of this study was to determine the effect(s) of long-time anesthesia generated byisoflurane, sevoflurane, propofol-fentanyl, medetomidine-midozolam-ketamine or xylazine-ketaminecombinations on hemodynamic parameters, serum cardiac troponin-I, and C-reactive proteinconcentrations in rabbits. The study was performed on 30 New Zeland rabbits. Rabbits weredivided into 5 groups. In group 1, induction was performed with isoflurane, and anesthesia lastedfor four hours. In group 2, the same procedure in group 1 was applied using sevoflurane instead. Ingroup 3, midazolam, medetomidine and ketamine were administered intramuscularly. Anaesthesiaprotocols lasted for four hours with additional injections. In group 4, anaesthesia was induced withfentanyl and propofol and maintained with fentanyl and propofol) for four hours. In group 5, xylazinewere used for premedication. General anesthesia was performed with ketamine. Four houranesthesia was maintained. The reflexes between induction and recovery time were evaluated.Haemodynamic and respiratory variables were recorded. Blood samples were analyzed forbiochemical parameters (CRP and cTn-I).While group 5 or group 3 protocols provided analgesia for major surgical approaches, group 1 andgroup 2 anaesthetics were enough for minor surgical approaches. In group 2 and group 3, heartrates decreased compared to pre-induction. When we measured the CRP and cTn-I serum levelsbefore, during and after 6, 12 and 24 hours of induction, no significant change in values observedin between the groups. In conclusion, cardiac troponins could be used to detect acute myocardialdamage associated with anesthesia both experimental and clinical studies.

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