İ̇smail, İlknur YORULMAZ, Onur ÖZLÜ, Derya, Fatih AKCAN, Pelin

Septorinoplasti ameliyatlarında trigeminokardiyak refleks, QT, QTc ve anestezi ilişkisi

Amaç: Trigeminokardiak refleks trigeminal sinirin uyarılması sonucu gelişen hipotansiyon, bradikardi, gastrik hipermotilite veya asistoli ile karakterize bir refleksdir. Genel ve lokal anestezi altında yapılan septorinoplasti operasyonları sırasında trigeminokardiyak refleks gelişebildiği gözlenmiştir. Retrospektif çalışmamızda genel anestezi altında yapılan septorinoplasti operasyonlarında birincil olarak cerrahi olarak refleksin uyarıldığı düşünülen periyodlarda trigeminokardiyak refleks gelişimi araştırılmıştır. İkincil olarak da farklı inhalasyon anestezik ajanların bu refleksin ortaya çıkışında etkisi araştırılmıştır. Yöntem: 01/ Ocak/2016- 30/Kasım/2016 tarihleri arasında opere edilmiş septorinoplasti vakalarının anestezi notları ve Datex Ohmeda icentral merkezi monitör kayıtları ve MİA-MED Hastane Bilgi Yönetim Sistemi yazılımı üzerinden retrospektif olarak incelenerek saptandı. İndüksiyon, lokal anestezi uygulaması, cerrahi insizyon, insizyon sütürasyonu başlangıcı ve ekstübasyondan 5 dakika sonra değerleri kayıtlardan saptandı. Kriterlere uyan 60 hastada 2 farklı inhalasyon anestezik madde uygulandığı tespit edilerek grup sevofluran ve grup desfluran olarak 2 ayrı grupta analizler yapıldı ve QT, QTc ve Trigeminokardiyak refleks gelişimi araştırıldı. Bulgular: Gruplar arasında fark olmamasına rağmen bazal değerler ile diğer periyodlar karşılaştırıldığında TKR gelişiminin ve QT, QTc uzmanlarının en fazla sınırlı uyuşturma uygulaması, cerrahi insizyon, insizyon sütürasyonu periyotlarında izlendiği saptandı. (p<0,001) Sonuç: En fazla sevofluran grubunda olmak üzere kullanılan inhalasyon anestezik ajanların özellikle trigeminal sinirin maksimal uyarıldığı periyodlarda kümülatif etki yaratarak TKR gelişiminde kolaylaştırıcı bir rol oynadığını düşünmekteyiz.

Anahtar Kelimeler:

Trigeminokardiyak refleks, QT intervali, QTc, electrokardiyogram, anestezi, septorinoplasti

Relationship between trigeminocardiac reflex, QT, QTc and anesthesia in septorhinoplasty surgeries

Objective: Trigeminocardiac reflex is a reflex characterized by hypotension, bradycardia, gastric hypermotility or asystole that develops as a result of stimulation of the trigeminal nerve. In our retrospective study, in septorhinoplasty operations performed under general anesthesia, trigeminocardiac reflex development was investigated primarily during the periods where the reflex was surgically stimulated. Secondly, the effect of different inhalation anesthetic agents on the emergence of this reflex was investigated. Method: Anesthesia notes and Datex Ohmeda icentral central monitor records of septorhinoplasty cases operated between 01 / January / 2016 - 30 / November / 2016 were retrospectively examined and detected through the Hospital Information Management System software. Induction, application of local anesthesia, surgical incision, initiation of incision suturing and 5 minutes after extubation were recorded from the records. It was determined that two different inhalation anesthetics were administered in 60 patients who met the criteria, and analyzes were performed in 2 separate groups as group sevoflurane and group desflurane, and the development of QT, QTc and Trigeminocardiac reflex was investigated. Results: Although there was no difference between the groups, when the basal values were compared with the other periods, it was found that the development of TKR and QT and QTc experts were mostly observed in the periods of local anesthesia, surgical incision and incision suturing. (p <0.001) Conclusion: We think that the inhalation anesthetic agents used mostly in the sevoflurane group play a facilitating role in the development of TKR, especially by creating a cumulative effect during periods when the trigeminal nerve is maximally stimulated.

Keywords:

Trigeminocardiac reflex, QT interval, QTc, electrocardiogram, anesthesia, septorhinoplasty surgery,

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez