Ferda YILMAZ İNAL, Hayrettin DAŞKAYA, Yavuz GÜN, Taner ÇİFTÇİ, Sinan UZMAN, Mehmet TOPTAŞ, Mustafa DEMİR

Comparison of the hemodynamic effects of etomidate between hypertensive and normotensive patients

Amaç: Etomidat ile anestezi indüksiyonunun hipertansif ve normotansif hastalarda hemodinamik etkilerini karşılaştırmayı amaçladık. Yöntemler: Etik komite onayı ve hastaların yazılı ve sözlü onamları alındıktan sonra genel anestezi altında çeşitli elektif cerrahi girişim uygulanacak olan 40 ardışık ASA I-II hasta çalışmaya alındı. Hastalar rastgele 2 gruba ayrıldı: Grup H (Hipertnasif hastalar), Grup N (Normotansif hastalar). Hastalar anestezi indüksiyonundan önce fentanil ve midazolam ile premedike edildi. Anestezi indüksiyonu etomidat 0.3 mg/kg ve rokuornyum 0.6 mg/kg ile yapıldı. Arteriyal basınçlar ve kalp hızı şu zamanlarda ölçüldü: kontrol, entübasyon öncesi ve entübasyondan 1, 3, 5 dakika sonra. Grup ayrımından habersiz bir anestezist tarafından miyoklonik hareketler ve hemodinamik parametreler kaydedildi.Bulgular: Hemodinamik parametreler tüm dönemlerde hipertansif hastalarda daha yüksekti fakat kabul edilebilir klinik sınırlar içindeydi.Sonuç: Ne hipertansif ne de normotansif hastalarda anestezi indüksiyonunda etomidatla hemodinamik instabilite yoktu.

Hipertansif ve normotansif hastalarda etomidatın hemodinamik etkilerinin karşılaştırılması

Objective: Comparison of the hemodynamic effect of etomidate induction in normotensive and hypertensive patients.Methods: Forty ASA 1-2 patients were included. After informed consent were obtained, patients were divided into two group; Group H: Hypertensive patients, Group N: Normotensive patients. Fentanile and midazolam were administrated for premedication. Anesthesia induction was performed by etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg. Arterial pressures and heart rates were measured at certain intervals: control, pre-intubation and 1, 3 and 5 min post-intubation. Myoclonic movements and hemodynamic parameters were noted by an anesthetist who was masked to the groups.Results: Hemodynamic parameters were higher in hypertensive patients but were in clinically tolerable limits.Conclusion: No hemodynamic instability was observed in anesthesia induction with etomidate in neither hypertensive nor normotensive patients.

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Joint National Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Institutes of Health, 2003.
Hanada S, Kawakami H, Goto T, Morita S. Hyper- tension and anesthesia. Curr Opin Anaesthesiol 2006;19:315-319.
Hassan MA, Prys-Roberts C. Anesthesia and chronic hypertension. Middle East J Anesthesiol 1991;11:119- 146.
Barash PG, Cullen BF, Stoelting RK. Clinical Anesthe- sia, 5th Ed; Philadelphia; Lippincott Williams & Wilkins, 2006; p. 344-345.
Doenicke A. Etomidate, a new intravenous hypnotic. Acta Anaesthesiol Belg 1974;25:307-315.
Wolfson AB. Harwood-Nuss' Clinical Practice of Emer- gency Medicine, 4th Ed; Portland; Lippincott Williams & Wilins, 2005; p. 1150-1153.
Gooding JM, Weng JT, Smith RA, et al. Cardiovascular and pulmonary response following etomidate induc- tion of anesthesia in patients with demonstrated car- diac disease. Anesth Analg 1979;058:40-41.
Forbes AM, Dally FG. Acute hypertension during in- duction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth 1970;42:618-624.
Onat A. Risk factors and cardiovascular disease in Tur- key. Atherosclerosis 2001;156:1-10
Singh R, Choudhury M, Kapoor PM, Kiran U. A ran- domized trial of anesthetic induction agents in pa- tients with coronary artery disease and left ventricular dysfunction. Ann Card Anaesth 2010;13:217-223.
Zhang GH, Sun L. Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic in- duction. Chin Med J 2009;122:2330-2334.