Levent BİRİNCİOĞLU, Ayşegül ÖZGÖK, Çiğdem GÜÇLÜ YILDIRIM, Senem KORUK, Dilek KAZANCI, Gülsevim SAYDAM, Omaç TÜFEKÇİOĞLU, Özcan ERDEMLİ

A comparison of total intravenous anesthesia, sevoflurane, and isoflurane anesthesia for preconditioning in cardiac surgery

Amaç: Bu çalışmada fentanil bazlı total intravenöz anestezi (TİVA), sevofluran ve izofluranın miyokardiyal koruyucu etkileri karşılaştırıldı. Çalışma planı: Etik komite onayı alındıktan sonra kardiyopulmoner baypas (KPB) ile açık kalp cerrahisi planlanan 57 hasta üç gruba ayrıldı. Standart indüksiyon sonrası grup 1’de (TİVA grup; n=17) fentanil-midazolam-pankuronyum ile grup 2’de (Sevo grup; n=20) 1 MAC sevofluran ile grup 3’de (Iso grup; n=20) 1 MAC izofluran ile idame yapıldı. Ameliyat öncesi dönemde ve ameliyat sonrası üçüncü günde sol ventrikül fonksiyonları ve kardiyak skorlar transtorasik ekokardiyografi ile değerlendirildi. Kardiyak troponin I (cTnI) ve kreatin kinaz MB fraksiyonu (CKMB) KPB’den önce ve KPB’den sonraki altıncı saatte, birinci, ikinci ve üçüncü günlerde ölçüldü. Laktat ölçümü için kan örnekleri, KPB öncesi ve sonrası ve klempin kaldırılışını takiben arteriyel hattan ve retrograd kanülden alındı. Bulgular: Demografik parametreler her üç grupta benzer idi. Kardiyopulmoner baypas sonrası kardiyak indeks ve debi her üç grupta da artış gösterdi. Kardiyopulmoner baypas öncesi CKMB ve cTnI seviyeleri gruplar arasında benzer iken, KPB sonrası altıncı saatte bu değerler tüm gruplarda artış gösterdi. İstatistiksel olarak gruplar arasında anlamlı fark olmasa da bu artış TİVA grubunda en yüksekti. Klempin alınmasını takiben retrograd kanülden alınan kan örneklerinde laktat seviyesi tüm gruplarda yükseldi. Sonuç: Sonuç olarak, bütün grupların önkoşullama potansiyeli olduğundan, miyokardiyal koruma açısından fentanil bazlı TİVA ve volatil anestezik grupları arasında istatistiksel olarak anlamlı bir fark bulamasak da volatil anestezik gruplarının fentanil bazlı TİVA grubuna göre daha kardiyoprotektif olduğunu söyleyebiliriz.

Kardiyak cerrahide önkoşullama için total intravenöz anestezi, sevofluran ve izofluran anestezilerinin karşılaştırılması

Background: In this study we compared the myocardial protective effects of fentanyl-based total intravenous anesthesia (TIVA), sevoflurane and isoflurane. Methods: After ethic committee approval, 57 patients who were scheduled to undergo open heart surgery using cardiopulmonary bypass (CPB) were randomized into three groups. Following standard induction, group 1 (TIVA group; n=17) received fentanyl-midazolam-pancuronium, group 2 (Sevo group; n=20) received 1 MAC sevoflurane and group 3 (Iso group; n=20) received 1 MAC isoflurane for maintenance. During preoperative period and on postoperative third day, left ventricle functions and cardiac scores were evaluated by transthoracic echocardiography. Cardiac troponin I (cTnI) and creatine kinase MB fraction (CKMB) were measured before CPB and at sixth hour, day one, two and three following CPB. For lactate measurement, blood samples were collected from arterial line and retrograde cannula before and after CPB and following declamping. Results: Demographic parameters were similar among three groups. Cardiac index and output increased in all three groups after CPB. Creatine kinase MB fraction and cTnI levels were similar among groups before CPB, those levels increased in all groups at sixth hour after CPB. Although there was not a statistically significant difference among the groups, this increase was the highest in TIVA group. After declamping, the lactate levels collected from retrograde cannula increased in all groups. Conclusion: As a result, as all the groups have preconditioning potential, although we did not find a significant difference between fentanyl-based TIVA group and volatile anesthetics in terms of myocardial protection, we could say that volatile anesthetics are more cardioprotective, compared to fentanylbased TIVA group.

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