Bakan Nurten AKPOLAT, Tülin GÜMÜŞ, Ülkü AYPAR, Elif BAŞGÜL, MERAL KANBAK, Kemal ERDEM

İzofluran ve halotan anestezisi altında fruktoz ve glukoz solüsyonlarının akut metabolik etkilerinin karşılaştırmalı olarak incelenmesi

Cerrahi gibi stres hallerinde glukoz kullanımı azalabilir. Fruktoz solüsyonu cerrahi esnasında glukoz solüsyonuna alternatif olabilir. Bu çalışmanın amacı, izofluran ve halotan anestezisi altında fruktoz ve glukoz infüzyonlarının akut metabolik etkilerini karşılaştırmaktır. Elektif cerrahi girişim geçirecek ASA (Amerikan Anestezi Cemiyeti risk gruplandırması) I-II grubundan 60 olgu seçildi. Olgular 2 gruba ayrıldı; İzofluran (Grup I) ve Halotan (Grup II). İzofluran ve halotan grupları kendi içinde iki alt gruba ayrıldı: a.fruktoz grubu, b.dekstroz (glukoz) grubu. %5 fruktoz veya dekstroz infüzyonu uygulamasından önce bazal kan örnekleri alındı. Anestezi idamesinde izofluran (%1) ile O2-N2O (%67.7-33.3) veya halotan (%0.6) ile O2-N2O (%67.7-33.3) kullanıldı.Hastaların serum glukoz, laktik asit (LA), pirüvik asit (PA), sodyum, potasyum, klor, kreatinin ve kan üre nitrojen (BUN) düzeyleri anesteziden önce ve anestezinin başlangıcından itibaren 30. ve 60. dakikalarda ölçüldü. Serum glukoz düzeyi, her iki grupta da anlamlı derecede arttı, fakat bu artış dekstroz solüsyonu alan hastalarda daha fazlaydı. Fruktoz solüsyonu alan grupta serum LA ve PA düzeyleri anlamlı derecede arttı ve bikarbonat düzeyleri anlamlı derecede azaldı. Bu sonuçlar, fruktoz solüsyonunun glukoz solüsyonuna alternatif bir karbonhidrat olacağını telkin etmektedir, fakat bu solüsyon laktik asidoz riski olan hastalarda dikkatle kullanılmalıdır.

Anahtar Kelimeler:

Asidoz, laktik, Anestezi, genel, Fruktoz, Glukoz, Halotan, İzofluran, Metabolizma

The comparison of the acute metabolic effects of fructose and glucose solutions under isofluorane or halothane anaesthesia

Glucose utilization may impair during stress such as surgery. Fructose solution may be an alternative to glucose solution during surgery. The aim of this study is to evaluate acute metabolic effects of fructose and glucose infusions under isofluorane and halothane anaesthesia. Sixty ASA (American Society of Anesthesiologists Physical Status Classification) I-II patients undergoing elective surgery were selected. The patients were divided into two groups: isofluorane (group I) or halothane (group II). Isofluorane and halothane groups were further divided into two more subgroups: a.Fructose infusion, b.Dextrose(glucose) infusion group. Basal blood samples were drawn before the administration of 5% dextrose or fructose infusions. Maintenance of anaesthesia were isofluorane (1%) in O2-N2O (67.7-33.3%) and halothane (0.6%) in O2-N2O (67.7-33.3%) in groups I and II, respectively. Serum glucose, lactic acid (LA), piruvic acid (PA), bicarbonate, sodium, potassium, chloride, creatinine and blood urea nitrogen (BUN) levels were measured before the anaesthesia and at 30th and 60th minutes after the beginning of anaesthesia. Serum glucose levels were increased significantly in both groups, but the increament was more marked in the patients who received dextrose solution. Serum LA and PA levels increased and bicarbonate levels decreased significantly in the patients who received fructose solution. These results suggest that fructose solution may be an alternative carbohydrate to glucose solution, but it must be used cautiously in patients at the risk of lactic acidosis.

Keywords:

Acidosis, Lactic, Anesthesia, General, Fructose, Glucose, Halothane, Isoflurane, Metabolism,

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