Hakkı ÜNLÜGENÇ, Yasemin GÜNEŞ, Tayfun GÜLER, Ahmet DENKER, Mehmet ÖZALEVLİ

Desfluran ve sevofluran anestezisi sırasında sisatrakuryum ile atrakuryumun oluşturduğu nöromüsküler blokun karşılaştırılması

Çalışmamızda desfluran ve sevofluran anestezisi sırasında sisatrakuryumun oluşturduğu nöromüsküler bloğun atrakuryumun oluşturduğu nöromüsküler blok ile karşılaştırılması amaçlandı. Fakültemiz etik kurul onayı alınarak elektif ortopedi, plastik veya laparaskopik cerrahi uygulanan 80 erişkin olgu çalışma kapsamına alındı. Anestezi indüksiyonu, tüm olgularda inlravenöz IV 5 mg/kg tiyopenton sodyum, idamesi ise % 4-6 desfluran + % 66 N2O + % 34 O2 veya % 1-2 sevofluran + % 66 N2O + % 34 O2 ile sağlandı. Olgular rasgele 4 eşit gruba ayrıldı. Grup I'de desfluran+atrakuryum (0.5 mg/kg) (Grup DA), grup II'de desfluran+sisatrakuryum (0.1 mg/kg) (Grup DS), grup lll'de sevofluran+atrakuryum (0.5 mg/kg) (Grup SA) ve grup IV'de ise sevofluran+sisatrakuryum (0.1 mg/kg) (Grup SS) uygulandı. Nöromüsküler bloğa ait etkinin başlama zamanı (T95), maksimum etki süresi, (Tmax), klinik etki süresi (T25), derlenme indeksi (T75-T25) ve spontan derlenme süreleri (T4/T1= % 70) ölçülerek kaydedildi. Sisatrakuryumun uygulandığı gruplarda T95 süresinin grup SS'de grup DS'ye göre uzun (p=0.046), T25 ve T4/T1 = % 70 sürelerinin ise kısa olduğu belirlendi (p=0.006 ve p=0.011). Atraküryumun uygulandığı gruplarda T95 ve T max sürelerinin grup SA'da grup DA'ya göre uzun (p=0.018 ve p=0.019), T25 ve T4/T1 = % 70 sürelerinin ise kısa olduğu belirlendi (p=0.00 vep=0.00). Sonuç olarak gerek desfluran gerekse sevofluran anestezisinde, sisatrakuryumun oluşturduğu nöromüsküler bloğa ait etki başlama ve maksimum etki sürelerinin atrakuryuma göre daha uzun olduğu, sevofluran anestezisi uygulanan olgulara kıyasla desfluran anestezisi uygulanan olgularda sisatrakuryum ve atrakuryumun etki başlama sürelerinin daha kısa, klinik etki sürelerinin ise daha uzun olduğu kanısına varıldı.

Comparison of cisatracurium and atracurium-induced neuromuscular block during desflurane and sevoflurane anaesthesia

In this study, cisatracurium-induced and atracurium-induced neuromuscular blocks were compared during desflurane and sevoflurane anaesthesia. Following faculty ethic committee approval, 80 adult patients undergoing elective orthopaedic, laparascopic or plastic surgery were accepted to study. Anaesthesia was induced with thiopentone sodium (5 mg/kg) and maintained either with 4-6 % desflurane or 1.5-2 % sevoflurane in a mixture of 66 % nitrous oxide and 34 % oxygen in all patients. The patients were assigned randomly four groups. To group I desflurane+atracurium (0.5 mg/kg) (Group DA), to group II desflurane+cisatracurium (0.1 mg/kg) (Group DS), to group III sevofliirane+atracurium (0.5 mg/kg) (Group SA), and to group IV sevoflurane+cisatracurium (0.1 mg/kg) (Group SC) were applied. The onset time (T95), onset maximum block (Tmax), clinical duration (T25 ), recovery index (T75-T25), spontaneous recovery time (T4/T1=% 70) and endotracheal intubation conditions were assessed. In cisatracurium groups; T95 values were found shorter (p=0.046) in group DS than in group SC whereas T25 and T4/T1 =% 70 values were found longer (p=0.06 and p=0.011). In atracurium groups; T95 and Tmax values were found shorter (p=0.018 and p=0.019) in group DA than in group SA whereas T25$ and T4/T1=% 70 values were found longer (p=0.00 and p=0.00). In conclusion; onset of action and onset of maximum block was longer in cisatracurium groups than atracurium groups during desflurane and sevoflurane anaesthesia. The onset of action of cisatracurium and atracurium was shorter with desflurane than did sevoflurane whereas clinical duration of action was longer.

PDF

___

1. Kisor DF, S eh m itli VD: Clinical pharmacokinetics of cisatracurium besilate. Clin Pharmacokinet 1999; 36:27-40. 2. YVulf H, Kahl M, Ledowski T: Augmentation of the neuro- muscular blocking effects of cisatracurium during desflurane, sevoflurane, isoflurane or total IV anaesthesia. Br J Anaesth 1998; 80:308-12. 3. Miller RD, Eğer El II, Way W, Stevens WC, Dolan WM: Comparative neuromuscular effects of forane and halothane alone and in combination with d-tubocurarine in man. Anesthesiology 1971; 35:38-42. 4. Rupp SM, Miller RD, Gencarelli PJ: Vecurqnium induced neuromuscular blockade during enflurane. isoflurane and halothane anesthesia in humans. Anesthesiology 1984; 60:102-5. 5. Magorian T, Flannery KB, Miller RD: Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology 1993; 79:913-8. 6. Belmont MR, Lien CA, Quessy S et al: The clinical neuro¬ muscular pharmacology of 51W98 in patients receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1995: 82:1139-45. 7. Bowman WC, Rodger IW, Houston J, et al: Structure: action relationships among some desacetoxy analogues of pan- curonium and vecuronium in anesthetized cat. Anesthesiology 1988; 69:57-62. 8. Law Min JC, Bekavac I, Clavinovic MI, et al: Iontophoretic study of speed of action of various muscle relaxants. Anesthesiology 1992; 77:351-6. 9. Mellinghof H, Radbruch L, Diefenbach C, Buzello W: A comparison of cisatracurium and atracurium: Onset of neuromus- cıılar block after bolus injection and recovery after subsequent infusion. Anesth Analg 1996; 83:1072-5. 10. Ornstein E, Lien CA, Matteo RS, Ostapkovich ND, Diaz J, Wolf KB: Pharmacodynamics and pharmacokinetics of cisatracurium in geriatric surgical patients. Anesthesiology 1996; 84:520-5. 11. Bryson HM, Faulds D: Cisatracurium besilate. A review of its pharmacology and clinical potential in anaesthetic practice. Drugs 1997; 53:848-66. 12. Mellinghoff H, Diefenbach C: The clinical pharmacology of cisatracurium. Anaesthesist 1997; 46:481-5. 13. Boyd AH, Eastwood NB, Parker CJR, Hunter JM: Pharmacodynamics of the 1R cis-l'R cisisomer of atracuri- um(51W89) in health and chronic renal failure. Br J Anaesth 1995:74:400-4. 14. Smith CE, van Miert MM, Parker CJ, Hunter JM: A comparison of the infusion pharmacokinetics and pharmacody¬ namics of cisatracurium, the IR-cis l'R-cis isomer of atracurium, with atracurium besylate in healthy patients. Anaesthesia 1997; 52:833-41. 15. Strum DP, Eger El: Partition coefficients for sevoflurane in human blood, saline, and olive oil. Anesth Analg 1987; 66:654-6. 16. Yasuda N, Targ AG, Eger El: Solubility of 1-653, sevoflu¬ rane. isoflurane, and halothane in human tissues. Anesth Analg 1989; 69:370-3.
17. Wiilf H, Kah! M, Ledowski T; Augmentation of the neuro- muscular blocking effects of cisatracurium during desfhirane, sevoflurane, isoflurane or total IV anaesthesia. Br J Anaesth 1998; 80:308-12. 18. Hendrickx JFA, Soetens M, Van der Donck A, Meeuwis H, Smolders F, De Wolf AM: Uptake of desflurane and isoflu¬ rane during closed-circuit anesthesia with spontaneous and con¬ trolled mechanical ventilation. Anesth Analg 1997; 84:413-8 19. Carroll MT, Mirakhur RK, Lowry D, Glover P, Kerr CJ: A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium. Anaesthesia 1998; 53:744-8. 20. Hemmerling TM, Schuettler J, Sehwilden H: Desfhirane reduces the effective therapeutic infusion rate (ETI) of cisatracurium more than isoflurane, sevoflurane, or propofol Can J Anaesth 2001; 48:532-7. 21. Ghouri AF, White PF: Comparative effects of desfhirane and isoflurane on vecuronium-induced neuromuscular blockade. JClin Anesth 1992; 4:34-8. 22. Gan TJ, Quill TJ, Pressley C, Parrillo S, Glass PSA: A comparison of mivacurium dosage requirements during isoflu¬ rane and desflurane anesthesia. J Clin Anesth 1996; 8:301-6. 23. Zhou TJ, Çoloma M, White PF, et al: Spontaneous recov¬ ery profile of rapacuronium during desflurane, sevoflurane, or propofol anesthesia for outpatient laparoscopy. Anesth Analg 2000; 91:596-600. 24. Bluestein LS, Stinson LW Jr, Lennon RL, Quessy SN, Wilson RM: Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesth 1996; 43:925-31.