Nihan YAPICI, Zuhal AYKAÇ, Ceren KÖKSAL, Zeliha TUNCEL, Türkan KUDİSOĞLU, Yasemin ALTUNTAŞ

Kalp cerrahisinde propofol ve desfluran ile oluşturulan önkoşullamanın miyokard korunması üzerine etkilerinin karşılaştırılması

Amaç: Bu çalışmada, koroner arter baypas greft (KABG) cerrahisi uygulanan hastalarda anestezi süresince verilen propofol ve desfluranın hemodinamik parametreler ve miyokardın koruması üzerine etkileri karşılaştırıldı. Çalışma planı: Temmuz 2011 - Ekim 2011 tarihleri arasında kliniğimizde elektif KABG cerrahisi planlanan 60 hasta çalışmaya alındı. Hastalar desfluran grubu (n=30) ve propofol grubu (n=30) olmak üzere iki gruba ayrıldı. Anestezi indüksiyonundan sonra, ameliyat süresince desfluran %0.5-2 minimal alveoler konsantrasyonda ve propofol 1.5-4 mg/kg/sa. dozlarında verildi. Ayrıca her iki gruba 8-10 μg/kg/sa. fentanil infüzyonu uygulandı. İndüksiyonu takiben Ioc-View ile bilinçsizlik indeks düzeyleri cerrahi anestezik seviyede (40-60) olacak şekilde izlendi. Kardiyopulmoner baypas sırasında, desfluran %0.2-2 minimal alveoler konsantrasyonda, propofol infüzyonu 1 mg/kg/sa. dozunda devam etti. Ameliyat öncesi dönemde ve ameliyat sonrası 0, 6, 12, 18. ve 24. saatlerde troponin I, beyin natriüretik peptid (BNP), kreatin kinaz (CK), kreatin kinaz kas ve beyin (CK-MB) örnekleri alındı. Hemodinamik parametreler kaydedildi.Bulgular: Troponin I, CK, CK-MB ve BNP gibi miyokard hücre hasar belirteçlerinin düzeyleri, desfluran grubuna kıyasla, propofol grubunda daha yüksek idi.Sonuç: Çalışmamızda KABG cerrahisi uygulanan hastalara ameliyat süresince verilen propofol ve desfluran, yeterli anestezi düzeyi ve hemodinamik stabilite sağladı. Desfluranın iskemi riski yüksek olan hastalarda kullanımının daha yararlı olacağı kanısına varıldı.

A comparison of preconditioning effects of propofol and desflurane on myocardial protection in cardiac surgery

Background: This study aims to compare the effects of propofol and desflurane on hemodynamic parameters and myocardial protection in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Sixty patients who were scheduled for elective CABG surgery between July 2011 and October 2011 were included. The patients were divided into two groups as desflurane group (n=30) and propofol group (n=30). After anesthesia induction, desflurane was given at minimum 0.5 to 2% alveolar concentration and propofol was given at 1.5-4 mg/kg/h during surgery. Both groups also received 8-10 μg/kg/hours fentanyl infusion. Following induction, the unconsciousness level was determined by the loc-View at the surgical anaesthetic level (40-60). During cardiopulmonary bypass, desflurane at minimum 0.2 to 2% alveolar concentration and propofol at 1 mg/kg/h were maintained. Troponin I, brain natriuretic peptide (BNP), creatine kinase (CK) and creatine kinase muscle and brain (CK-MB) samples were collected at preoperative period and postoperative 0, 6, 12, 18 and 24 hours. Hemodynamic data were recorded.Results: The levels of troponin I, CK, CK-MB, and BNP levels which were the markers of myocardial damage were higher in the propofol group, compared to the desflurane group.Conclusion: Our study showed that propofol and desflurane provided adequate level of anesthesia and hemodynamic stability during surgery in patients undergoing CABG surgery. We concluded that desflurane would be more useful for patients having a high risk of ischemia.

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