Epidural klonidinin total intravenöz anestezi ile kombinasyonunun intraoperatif hemodinami ve postoperatif analjezi üzerine etkileri

Bu çalışmada, elektif açık kolesistektomi olacak hastalarda, epidural klonidin ile total intra venöz anestezi (TİVA) kombinasyonun; TİVA’da kullanılan ajanların dozlarına, uyanma süresine, peroperatif hemodinamik parametreler üzerine etkileri ile postoperatif dönemde epidural klonidinin oluşturduğu analjezinin süresi, niteliği ve sedatif etkilerini araştırmayı amaçladık. Araştırmaya epidural kataterden klonidin (2 μg kg-1) veya % 0.9 NaCl uygulanmasına göre 20’şer olguluk 2 grup olmak üzere 40 hasta rastgele seçilerek alındı. Çalışma protokolüne göre, standart TİVA uygulandı. Çalışmamızda noninvaziv yöntemle ortalama arteriyel basınç ve kalp atım hızı preoperatif 30 dk, intraoperatif 1 saat belirli zamanlarda değerlendirildi. Postoperatif ağrının niteliği; vizüel anolog skala (VAS) ile sedasyon ise sedasyon skalası kullanılarak belirlendi. İlk analjezik uygulanması VAS≥4 olduğu zaman epidural yoldan meperidin uygulanarak standardize edildi. İlk analjezik uygulanana kadar geçen süre belirlenerek epidural klonidinin analjezi süresi saptandı. Sonuç olarak bu dozda epidural klonidinin; TİVA’da kullandığımız ilaçların dozlarına ve uyanma süresine etkisinin olmadığı, ancak TİVA’nın hemodinamik yan etkilerini hafif derecede belirlendi. Epidural klonidin ile postoperatif ağrıdaki azalmanın yetersiz ve kısa süreli olması nedeniyle diğer epidural analjeziklerle kombine kullanılmasının daha iyi analjezi sağlayacağı düşüncesine varıldı.

Effects of the combination of epidural clonidine and total intravenous anesthesia on both intraoperative haemodynamics and postoperative analgesia

This study aimed to assess the effects of epidural clonidine combined with total intra venous anesthesia (TIVA) on drug consumption, recovery time from anesthesia, peroperative haemodynamics and in postoperative period, the effects of epidural clonidine on sedation, and duration and quality of analgesia in patients undergoing elective open cholecystectomy surgery. The study included 40 patients. Patients were randomly allocated into two equal groups to receive clonidine (2 μg kg-1) or saline solutions through an epidural catheter. Standardized TIVA technique was used in accordance with the study protocol. Heart rate and non-invasive blood pressure were evaluated at certain intervals, preoperatively for 30 mins and intraoperatively for 1 hr. Postoperatively, pain intensity and sedation were assessed using a Visual Analog Scale (VAS) and Sedation Scale respectively. First pain medication was standardized and treated with epidural meperidine 30 mg for a pain VAS score ≥4. Duration of epidural clonidine analgesia was defined as the time between the administration of clonidine and onset of pain at the surgical site. It can be concluded that this dose of epidural clonidine combined with TIVA does not have any effects on the intraoperative requirement of anesthetic drugs and the time required for recovery from anesthesia. However, epidural clonidine results in a decrease in the hemodynamic parameters during TIVA. The results of the study have also confirmed that the combination of clonidine and other epidural analgesics produces more potent postoperative analgesia than when used individually since reductions in postoperative pain with epidural clonidine alone are small and short-lived.

Kaynakça

1. Dabu-Bondoc SM. Regional anesthesia and perioperative outcome: what is new ? Curr Opin Anaesthesiol 2004;17: 435-9.

2. Demirbilek S, Ganidağli S, Aksoy N, Becerik C, Baysal Z. The effects of remifentanil and alfentanil-based total intravenous anesthesia (TIVA) on the endocrine response to abdominal hysterectomy. J Clin Anesth 2004;16:358-63.

3. Camu F, Kay B: Why total intravenous anaesthesia (TİVA) ? In: Total Intravenous Anaesthesia, 2nd ed. (ed): B. Kay. Elsevier Company, Amsterdam, 1991; pp1-14.

4. Ferrante FM. α2-Agonists. In: Postoperative Pain Management, 1st ed. (eds): FM Ferrante, TR VadeBoncour. Churchill Livingstone, New York, Chap.31, pp 641-650, 1993.

5. Novak-Jankoviĉ V, Paver-E&rcircen V, Bovill JG, Ihan A, Osredkar J. Effect of epidural and intravenous clonidine on the neuro-endocrine and immune stress response in patients undergoing lung surgery. Eur J Anaesthesiol 2000; 17:50-6.

6. Maroof M, Khan RM, Bhatti TH. Clonidine premedication for induced hypotension with total intravenous anaesthesia for middle ear microsurgery. Can J Anaesth 1994; 41:164-5.

7. Higuchi H, Adachi Y, Arimura S, Ogata M, Satoh T. Oral clonidine premedication reduces the awakening concentration of propofol. Anesth Analg 2002; 94: 609-14.

8. Filos KS, Goudas LC, Patroni O, Polyzou V. Intrathecal clonidine as a sole analgesic for pain relief after cesarean section. Anesthesiology 1992; 77: 267-74.

9. Liu N, Bonnet F, Delaunay L, Kermarec N, D'Honneur G. Partial reversal of the effects of extradural clonidine by oral yohimbine in postoperative patients. Br J Anaesth 1993;70: 515-8.

10. Huntoon M, Eisenach JC, Boese P. Epidural clonidine after cesarean section. Appropriate dose and effect of prior local anesthetic. Anesthesiology 1992;76: 187-93.

11. Çicek M, Koroglu A, Demirbilek S, Teksan H, Ersoy MO. Comparison of propofol-alfentanil and propofol-remifentanil anaesthesia in percutaneous nephrolithotripsy. Eur J Anaesthesiol 2005;22: 683-8.

12. Tong C, Eisenach JC. α2-adrenergic agonists. In: Anesthesiology Clinics of North America,1st ed. (ed): E Ornstein. W.B. Saunders Company, Philadelphia, pp 49-64, 1994.

13. Carabine UA, Milligan KR, Mulholland D, Moore J. Extradural clonidine infusions for analgesia after total hip replacement. Br J Anaesth 1992;68: 338-43.

14. Eisenach JC, Rauck RL, Buzzanell C, Lysak SZ. Epidural clonidine analgesia for intractable cancer pain: phase I. Anesthesiology 1989;71:647-52.

15. Tramèr MR, Moore RA, McQuay HJ. Propofol and bradycardia: causation, frequency and severity. Br J Anaesth 1997;78: 642-51.

16. Rucquoi M, Camu F. Haemodynamic effects of continuous infusion anaesthesia and sedation. In: Total Intravenous Anaesthesia, 2nd ed. (ed): B. Kay. Elsevier Science Publishing Company, Amsterdam, 1991; pp: 151-74.

17. van Leeuwen L, Zuurmond WW, Deen L, Helmers HJ. Total intravenous anaesthesia with propofol, alfentanil, and oxygen-air: three different dosage schemes. Can J Anaesth. 1990;37: 282-6.

18. De Kock M, Gautier P, Pavlopoulou A, Jonniaux M, Lavand'homme P. Epidural clonidine or bupivacaine as the sole analgesic agent during and after abdominal surgery: a comparative study. Anesthesiology 1999;90: 1354-62.

19. van Essen EJ, Bovill JG, Ploeger EJ. Extradural clonidine does not potentiate analgesia produced by extradural morphine after meniscectomy. Br J Anaesth 1991;66: 237-41.

20. Gordh T. Epidural clonidine for treatment of postoperative pain after thoracotomy: a double blind placebo controlled study. Acta Anaesthesiol Scand 1988;32: 702-9.

21. Bonnet F, Boico O, Rostaing S, Saada M, Loriferne JF, Touboul C, et al. Postoperative analgesia with extradural clonidine. Br J Anaesth 1989;63: 465-9.

22. Eisenach J, Detweiler D, Hood D. Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 1993;78: 277-87.

Kaynak Göster

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  • ISSN: 1300-2317
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018

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