Semra DEMİRBİLEK, Ahmet KÖROĞLU, Hale BORAZAN, M. Hacer ÜLGER, M. Özcan ERSOY

Orta kulak cerrahisinde dexmedetomidin ile kontrollü hipotansiyon

Amaç: Ortakulak cerrahisinde, deksmedetomidin ve nitrogliserinin intraoperatif kontrollü hipotansiyon, cerrahi alan kalitesi, karaciğer ve böbrek fonksiyonları üzerine etkilerinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Olgular, tiyopental 5-7 $mu$g. $kg^{-1}$, fentanil 1 $mu$g. $kg^{-1}$ ve vekuronyum 0.1 $mu$g. $kg^{-1}$ ile anestezi indüksiyonundan sonra iki gruba ayrıldı: Deksmedetomidin grubunda (n=20), deksmedetomidin 1$mu$g. $kg^{-1}$ yükleme dozunu (10 dk'da) takiben 0.1-0.7 $mu$g.$kg^{-1}$; nitrogliserin grubunda (n=20), nitrogliserin 0.25-1 $mu$g.$kg^{-1}$.$dk^{-1}$ infüzyon olarak uygulandı. İlaç dozları ortalama arter basıncı (OAB) 65-75 mmHg olacak şekilde ayarlandı. Anestezi idamesinde, %4-6 desfluran ve % 60 $O_2$ hava karışımı kullanıldı. Kontrollü hipotansiyon süresince arteriyel kan gazı, operasyondan önce ve sonra, postoperatif 3. günde AST, ALT, BUN, kreatinin değerleri için kan alındı. Bulgular: Kontrollü hipotansiyondan 15 dk ve ekstübasyondan sonra OAB ve KH, nitrogliserin grubunda (95.15 ±16.88 ve 96.10 ± 22.76) deksmedetomidin grubuna (84.90 ± 14.26 ve 82.65 ± 18.82) göre daha yüksekti. Deksmedetomidin grubunda, kontrollü hipotansiyondan 15 dk sonra OAB'ı indüksiyon öncesine göre düşüktü. Nitrogliserin grubunda ise ekstübasyondan sonraki OAB ve KH indüksiyon öncesine göre anlamlı yüksekti. Nitrogliserin grubunda, iki olguda refleks taşikardi gözlendi. Deksmedetomidin grubunda, üç olguda bradikardi gelişti. Cerrahi alan kalite skoru, deksmedetomidin grubunda (0.1+0.31) nitrogliserin grubuna (0.65 ± 0.67) göre düşüktü (p

Controlled hypotension with dexmedetomidine for middle ear surgery

Aim: To compare the effect of dexmedetomidine on providing controlled hypotension and surgical field quality, liver and kidney function in middle ear microsurgery, with nitroglycerine. Material and Method: Patients were divided into two groups after anesthetic induction with thiopental (5-7 $mu$g. $kg^{-1}$), fentanyl (1 $mu$g. $kg^{-1}$ and vecuronium (0.1 $mu$g. $kg^{-1}$). In dexmedetomidine group (n=20), following the loading dose of 1 $mu$g. $kg^{-1}$ (10 min), infusion was applied with a dose of 0.1-0.7 $mu$g.$kg^{-1}$;1. In nitroglycerine group (n=20), infusion of nitroglycerine was applied with a dose of 0.25-1 ug.kg^.min"1. Drug doses were titrated to maintain the mean arterial pressure (MAP) at 65-75 mmHg. Anesthesia was maintained with 4-6 % desflurane and 60% oxygen-air mixture. During controlled hypotension, arterial blood gas analysis was examined. For the measurement of AST, ALT, BUN and creatinine, blood samples were obtained before and after surgery and on postoperative third day. Results: Fifteen minutes after controlled hypotension and immediately after the extubation, MAP and HR were higher in nitroglycerine group (95.15 ±16.88 and 96.10 ± 22.76, respectively) when compared with dexmedetomidine group (84.90 + 14.26 and 82.65 + 18.82, respectively). In dexmedetomidine group, 15 min after controlled hypotension, MAP was higher compared to the value previous to induction (p

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