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.

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Yeni Tıp Dergisi-Cover
  • ISSN: 1300-2317
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2018
  • Yayıncı: -
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