İlknur YORULMAZ, Gökçe AKMAN KÖSE, Yavuz DEMİRARAN, Şengül CANGÜR

Farklı Anestezik Ajanların Rejyonel İntravenöz Anestezi Yapılan Hastalarda Elektrokardiyografik Değişiklikler Üzerine Etkisi

Amaç: Çalışmamızda lidokain ve lidokain+ ketamine ile intravenöz rejyonel anestezi (İVRA) uygulanan hastalardaki elektrokardiyografik değişiklikleri karşılaştırmayı amaçladık.Materyal ve Metot: Çalışmamız prospektif, gözlemsel, randomize ve çift kör olarak yapıldı. İVRA altında kol ve önkol operasyonu geçirecek ASA I -II statüsünde 18-60 yaş arası 70 hasta çalışmaya alındı. Çift kaflı turnike opere edilecek ekstremiteye yerleştirildi. Hastalar randomize ve olarak 2 gruba ayrıldı. Group 1: % 0,5 Lidokain+Ketamin 0,8 mg/kg; 40 ml. Group 2: % 0,5 Lidokain 40 ml olarak belirlendi. Enjeksiyondan 20 dakika sonra distal kaf şişirilerek proksimal kaf 3 dakikada bir 50 mmHg hızda indirildi. Zaman periyodları turnike indirilmesinin başlamasından itibaren 0, 5, 10, 15, 30, 45, 60. dakika ve turnike indirilmesinden 10 dakika sonra olarak belirlendi. İnvaziv olmayan kan basıncı değerleri, kalp atım hızı, puls oksimetre değerleri kaydedildi. Elektrokardiyografik kayıtlar alınarak PR, RR, QT intervalleri, QTc değerleri kaydedildi.Bulgular: Lidokain+ketamin grubunda QT basal değerleri QT5. dk, QT10. dk, QT15. dk , QT30. dk, QT45. dk, QT60. dk ve QTtur10 değerlerinden düşük bulundu. QTc bazal değerleri grup lidokain + ketamin QTctur10 değerlerinden daha düşük bulundu (p <0.001).Sonuç: Lidokain grubunda belirgin bir değişiklik gözlenmedi. Turnike indirilmesinden sonra lidokain+ketamin grubunda QT, QTc değerlerinde ve özellikle noninvaziv kan basıncı değerlerinde belirgin artış gözlendi.

Anahtar Kelimeler:

Elektrokardiyogram, İVRA, ketamin, lidokain

Effect of Different Anesthetic Agents Management on Electrocardiographic Changes of Patients Operated under Regional Intravenous Anesthesia

Objective: We compared cardiac effects, electrocardiographic changes by intravenous regional anesthesia (IVRA) with lidocaine and lidocaine + ketamine.

Keywords:

Electrocardiogram, IVRA, ketamine, lidocaine,

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