Mustafa OĞURLU, Bakiye UĞUR, Erdal GEZER, Feray GÜRSOY

ENDOTRAKEAL ENTÜBASYON SIRASINDA OLUŞAN HEMODİNAMİK DEGİŞİKLİKLERE ESMOLOLÜN ETKİSİ

Amaç:Çalışmamızın amacı laringoskopi ve endotrakeal entübasyona yanıt olarak oluşan taşikardi vehipertansiyonu baskılamada, bir beta bloker olan esmolol'ün etkilerini araştırmaktır.Gereç ve yöntem:Çalışma prospektif, randomize, tek kör olarak düzenlendi,ASAI-II, 20-50 yaş arası 60 olgu 2gruba ayrılarak yapıldı. Grup Esmolol'e (Grup E) esmolol (Brevibloc®) 1.5 mg/kg, Grup Kontrol'e (Grup K) %5dekstroz 5 cc, laringoskopi ve entübasyondan 2 dakika önce İ.V bolus verildi. Preoperatif, indüksiyondan sonra,entübasyonun ardından ve 1., 3., 5., 7., 10. dakikalarda kalp atım hızı (KAH), ortalama arter basıncı (OAB) ve hızbasınç ürünü (RPP) değerleri kaydedildi.Bulgular:Grup K'da KAH bazal değeri ile karşılaştırıldığında; indüksiyondan sonra ,5., 7., 10. dk'da anlamlıdüşme, entübasyondan sonra ise anlamlı yükselme, Grup E'de ise; indüksiyondan sonra, 3., 5., 7., 10. dk'daanlamlı düşme saptandı (P<0.05). Grup K'da OAB bazal değeri ile karşılaştırıldığında; indüksiyondan sonra, 5.,7., 10. dk'da anlamlı düşme, entübasyondan sonra ve 1. dk'da anlamlı yükselme, Grup E'de indüksiyondan sonrave 3., 5., 7., 10. dk'da anlamlı düşme, entübasyondan sonra ise anlamlı yükselme saptandı (P<0.05). Grup K'daRPP bazal değeri ile karşılaştırıldığında; indüksiyondan sonra, 5., 7., 10. dk'da anlamlı düşme, entübasyondansonra ve 1. dakikada ise anlamlı yükselme, Grup E'de ise; indüksiyondan sonra ve 3., 5., 7., 10., dk'da anlamlıdüşme saptandı (P<0.05). Gruplar arasında Grup E'de indüksiyondan ve entübasyondan hemen sonra ve 1.dakikada KAH ve RPPbakımından anlamlı düşme gözlendi (P<0.05).Sonuç:Çalışmamızda esmololün bu dozda laringoskopi ve endotrakeal entübasyon sırasında oluşan taşikardi veRPP'yi baskılamada etkili, hipertansiyonu baskılamada yetersiz olduğunu gözlemledik

Anahtar Kelimeler:

Esmolol, endotrakeal entübasyon, hemodinami

Effects of Esmolol on Hemodynamic Responses to Endotracheal Intubation

Objective: To evaluate the efficacy of esmolol in modifying hemodynamic response to laryngoscopy and endotracheal intubation. Materials and methods: ASA I-II 60 subjects, aged between 20-50 years, were included in this prospective, randomized and single-blind study. Patients were divided into two groups. Group Esmolol(Group E) and Group Control (Group C) received IV bolus of esmolol 1.5 mg/kg and %5 dextrose 5 cc respectively, 2 minutes before laryngoscopy and intubation. We recorded heart rates (HR), mean arterial pressures (MAP), and rate pressure products (RPP) preoperatively, after induction and intubation and in 1st, 3rd, 5th, 7th, and 10th minutes after intubation. Results: In Group C, HR decreased after induction in 5th, 7th, and 10th minutes, whereas it increased after intubation. In Group E, HR decreased after induction, in 3rd, 5th, 7th, and 10th minutes (P<0.05). In Group C, MAP decreased after induction, in 5th, 7th, and 10th minutes, while it increased after intubation and in the first minute. In Group E, MAPdecreased after induction, in 3rd, 5th, 7th, and 10th minutes, but increased after intubation (P<0.05). In Group C, RPP decreased after induction, at 5th, 7th, and 10th minutes, however it increased in the first minute. In Group E, RPP decreased after induction, in 3rd, 5th, 7th, and 10th minutes (P<0.05). When we compared the two groups, HR and RPPdecreased in Group E immediately after induction and intubation and in the first minute. Conclusion: This dose of esmolol was effective in controlling the tachycardia and RPP, but it was ineffective in controlling the hypertensive response to laryngoscopy and endotracheal intubation.

Keywords:

Esmolol, endotracheal intubation, hemodynamic,

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