Ebru KARAKOÇ, İlkay CEYLAN, Belkıs TANRIVERDİ

Kardiovasküler Cerrahi Anestezisinde Ekstrakorporeal Dolaşımda Sevofluran ve Desfluran Kullanımının BIS Monitorizasyonu ile Değerlendirilmesi

Kardiyovasküler cerrahide anestezi sırasında farkındalık diğer cerrahilere göre 5 kat fazladır. Kalp akciğer pompası kullanımı yetersiz anestezi derinliğine sebep olabilir. Çalışmamaızda sevofloran ve desfloran ile uygulanan kardiak anestezide BİS eşliğinde farkındalık ve anestezi derinliğini belirlemeyi amaçladık. Prospektif ve randomize olarak tasarladığımız çalışmamız koroner arter ve kalp kapak cerrahisi geçirecek 60 kişi dahil edildi. Rastgele 2 gruba ayrılan hastalara sevofloran ve desfloran ile inhalasyon anestezisi ile analjezi için sabit doz remifentanil infuzyonu uygulandı. Hemodinamik veriler ve BİS değerleri kaydedildi. Kolay hatırlanabilmesi nedeniyle tanıdık ses olan köpek havlaması ekstrakorporeal dolaşım boyunca hastalara dinletildi. Post operatif 2. günde farkındalık ve uyanıklık için hastalarla görüşme yapıldı ve kaydedildi. Elde edilen veriler SPSS ile incelendi. Hastalarda benzer hemodinamik veriler ve BİS değerleri olduğu görüldü. Hastalarda farkındalık ve uyanıklığa rastlanılmadı.Kardiyovasküler anestezi uygulamasında anestezi derinliğinin hemodinamik veriler ile belirlenmesinin BİS ile korele olmasına rağmen anestezinin daha derin seviyeye doğru kaydığı görüldü. Bu nedenle BİS ile anestezi derinliğinin güvenli şekilde belirlenebileceği kanısına varıldı.

Anahtar Kelimeler:

farkındalık, BİS monitorizasyonu, kardiyopulmoner bypas

Evaluation of BIS Monitorization Using Sevoflurane Versus Desflurane During Extracorporeal Circulation in Cardiovascular Surgery Anesthesia

The risk of awareness in cardiac surgery is 5 times higher than in other surgeries. The use of cardiopulmonary bypass pump may lead to inadequate anesthesia depth. In this study we aimed to evaluate the awareness and the depth of anesthesia with BIS monitorization in cardiovascular anesthesia. This study was designed as a propective randomised controled trial. Sixty patients who underwent coronary artery bypass grafting and heart valve surgery were included in the study. The patients were divided into 2 groups randomly. Maintenance of anesthesia provided by 2-4% sevoflurane to Group 1 and 5-8% desflurane to Group 2 including extracorporeal circulation period. Anesthesia depth adjusted according to hemodynamic and clinical values. Patients in both groups were followed with BIS monitoring. In all study groups, fixed dose of remifentanil infusion was initiated following induction of anesthesia. Patients hemodynamic data, BIS measurements were recorded during the operation. Considering the ease of recognitions and recall, from the beginning of extracorporeal circulation, the dog barking was constantly listened with earphones by patients to assess alertness and awareness. On the second postoperative day, patients were asked whether they remember anything about operation and dog barking. The obtained data were evaluated with SPSS package program. Similar hemodynamic data and BIS measurements were obtained in both groups in our study. Postoperative awareness and remembrance were not found in either group. In cardiovascular surgery, it was observed that the depth of anesthesia determined by hemodynamic data is correlated with BIS, but shifted to deeper levels of anesthesia. Although complications were not seen in the patients, it was concluded that the adjusting the level of anesthesia with BIS could be safer.

Keywords:

Awareness, BIS monitorization, cardiopulmonary bypass,

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