Publication: Kraniotomi sonrası ekstübasyona bağlı hemodinamik yanıtın baskılanmasında esmolol etkisinin araştırılması
Abstract
Çalışmamızda; elektif kraniotomi uygulanacak olgularda ekstübasyondan önce yapılan esmolol infüzyonunu kontrol grubu ile karşılaştırdık. Marmara Üniversitesi Tıp Fakültesi Etik Kurulu onayı ile operasyona alınacak hastaların sözlü ve yazılı izinleri alınarak, elektif kraniotomi planlanan ASA I-II grubu, 20 - 65 yaş arası, 30 hasta çalışmaya dahil edildi. Hastalar Grup I (Esmolol, n=15) ve Grup II (Plasebo, n=15) olarak rasgele iki gruba ayrıldı. Hastalara premedikasyon uygulanmadı. Ameliyat masasına alınan hastalara EKG, kan basıncı ve oksijen satürasyonu monitörizasyonu uygulandı. 5-7 mg/ kg tiyopental sodyum ve 0.1 mg/ kg vekuronyum bromid i.v. enjeksiyonu ile sağlanan indüksiyon ve endotrakeal entübasyon sonrasında anestezi, 1 MAC sevofluran ve %50 02 içinde %50 hava ve 0,25 mcg/ kg/ dk remifentanil i.v. infüzyonu ile sürdürüldü. Genel anestezi uygulaması süresince sistolik, diyastolik, ortalama arter basıncı, kalp atım sayısı, tidal sonu karbondioksit parsiyel basıncı, osijen satürasyonu ve kas gevşekliği düzeyi monitörize edildi. Ameliyat bittiğinde anestezik ajan uygulamaları sonlandırılarak hastaya %100 oksijen solutudu. Nöromusküler blok 0,03 mg/ kg neostigmin ve 0,01 mg/ kg atropin i.v. ile sonlandırıldı. Ekstübasyondan 5 dakika önce hastalara, uygulayıcı dışında bir anestezi doktoru tarafından hazırlanan 50 ml içinde 2 mg/ kg/ 10dk esmolol veya 50 ml/ 10dk SF infüzyonu yapıldı. Hastanın spontan solunumu yeterli olduğunda, orofaringeal sekresyonlar aspire edilerek ekstübeasyon yapıldı. Ekstübasyon kalitesi 5’li skala ile değerlendirildi. (1= öksürük yok, solunum rahat, 2= oldukça yumuşak, hafif öksürük, 3= orta derecede öksürük, 4= şiddetli öksürük ve zorlu solunum, 5= laringospazm, şiddetli öksürük ve zorlu solunum). Hastalarda infüzyon öncesi, infüzyondan 1 dk sonra, ekstübasyon sırasında, ekstübasyondan 1, 3, 5, 10 dakika sonra kalp atım sayısı, SAB, DAB, OAB değerleri kaydedildi. Kontrol grubundaki hastaların sistolik, diyastolik, ortalama arter basıncı ve kalp atım sayısı değerlerinde tüm ölçüm zamanlarında istatistiksel fark bulunmadı (p>0.05). Esmolol grubundaki hastalarda sistolik, diyastolik, ortalama arter basıncı ve kalp atım sayısı değerleri açısından ilaç enjeksiyonu öncesi ve sonrası ölçüm zamanları arasında belirgin azalma saptandı (p<0.05). İki grup verilerinin karşılaştırılması sonucunda sistolik, diyastolik,ortalama arter basıncı ve kalp atım sayısı değerlerinin ekstübasyon sonrası dönem ölçümlerinde esmolol grubunda belirgin olarak düşük bulundu (p<0.05). Sonuç olarak; ekstübasyon sırasında kafa içi basıncının yükselmesine neden olabilecek hipertansiyon ve taşikardinin ekstübasyon öncesinde esmolol kullanılması ile önlenebileceği kanısına vardık.
In our study we compared the effects of esmolol infusion administered before extubation in patients undergoing elective craniotomy with control group. After the approval of Marmara University Medical Faculty Ethics Board and patients’ written consent, 30 patients between ages of 20-65 years with ASA I-II group, undergoing elective craniotomy, were included in the study. Patients were randomized into two groups as Group I (Esmolol, n=15) and Group II (Placebo, n=15). No premedication was administered. In all patients monitorization included ECG, invasive blood pressure and peripheric oxygen saturation. Anesthesia was induced with 5-7 mg/ kg thiopental sodium and 0.1 mg/ kg vecuronium bromide i.v. and was maintained with 1 MAC sevofluran in oxygen-air mixture (50:50) and 0,25 μg/ kg/ min remifentanil i.v. infusion. During general anesthesia systolic, diastolic and mean arterial pressure, heart rate, end-tidal CO2 pressure, oxygen saturation and muscle relaxation was monitorized. At the end of the operation patient inhaled 100 % oxygen after the cessation of anesthetic agents. For reversal of muscle relaxation 0,03 mg/ kg neostigmine and 0,01 mg/ kg atropine i.v. was administered. Five minutes before extubation 2 mg/ kg/ 10 min esmolol in 50 ml or 50 ml/ 10 min SP infusion were administered by another anesthetist. When the patient had spontaneous breathing, extubation was performed by aspirating oropharyngeal secretions. The quality of extubation was evaluated with a 5 point scale (1= no cough, breathing smooth, 2= very smooth, mild cough, 3= moderate cough, 4= severe cough and forced breathing, 5= laryngospasm, severe cough and forced breathing). Heat rate, SBP, DBP, MBP values were recorded in patients before infusion, 1 minute after infusion, during extubation and 1, 3, 5, 10 minutes after extubation. In the control group no statistical difference was obtained in systolic, diastolic, mean arterial pressure and heart rate in any measurement times (p>0.05). In esmolol group, systolic, diastolic, mean arterial pressure and heart rate decreased significantly after esmolol injection (p<0.05). Mean systolic, diastolic, mean arterial pressure and heart rate were found to be significantly lower in esmolol group than control group after extubation period (p<0.05). We concluded that hypertension and tachycardia which could cause an increase in cerebral pressure during extubation, could be prevented by using iv esmolol before extubation.
In our study we compared the effects of esmolol infusion administered before extubation in patients undergoing elective craniotomy with control group. After the approval of Marmara University Medical Faculty Ethics Board and patients’ written consent, 30 patients between ages of 20-65 years with ASA I-II group, undergoing elective craniotomy, were included in the study. Patients were randomized into two groups as Group I (Esmolol, n=15) and Group II (Placebo, n=15). No premedication was administered. In all patients monitorization included ECG, invasive blood pressure and peripheric oxygen saturation. Anesthesia was induced with 5-7 mg/ kg thiopental sodium and 0.1 mg/ kg vecuronium bromide i.v. and was maintained with 1 MAC sevofluran in oxygen-air mixture (50:50) and 0,25 μg/ kg/ min remifentanil i.v. infusion. During general anesthesia systolic, diastolic and mean arterial pressure, heart rate, end-tidal CO2 pressure, oxygen saturation and muscle relaxation was monitorized. At the end of the operation patient inhaled 100 % oxygen after the cessation of anesthetic agents. For reversal of muscle relaxation 0,03 mg/ kg neostigmine and 0,01 mg/ kg atropine i.v. was administered. Five minutes before extubation 2 mg/ kg/ 10 min esmolol in 50 ml or 50 ml/ 10 min SP infusion were administered by another anesthetist. When the patient had spontaneous breathing, extubation was performed by aspirating oropharyngeal secretions. The quality of extubation was evaluated with a 5 point scale (1= no cough, breathing smooth, 2= very smooth, mild cough, 3= moderate cough, 4= severe cough and forced breathing, 5= laryngospasm, severe cough and forced breathing). Heat rate, SBP, DBP, MBP values were recorded in patients before infusion, 1 minute after infusion, during extubation and 1, 3, 5, 10 minutes after extubation. In the control group no statistical difference was obtained in systolic, diastolic, mean arterial pressure and heart rate in any measurement times (p>0.05). In esmolol group, systolic, diastolic, mean arterial pressure and heart rate decreased significantly after esmolol injection (p<0.05). Mean systolic, diastolic, mean arterial pressure and heart rate were found to be significantly lower in esmolol group than control group after extubation period (p<0.05). We concluded that hypertension and tachycardia which could cause an increase in cerebral pressure during extubation, could be prevented by using iv esmolol before extubation.