Publication: Kraniotomi sonrası trakeal ekstübasyona hemodinamik yanıtın önlenmesinde esmololün etkisi
Abstract
AMAÇ: Çalışmanın amacı; elektif kraniotomilerde ekstübasyondan önce uygulanan esmolol infüzyonunun hemodinamik yanıt üzerine etkilerinin araştırılmasıdır. YÖNTEMLER: Marmara Üniversitesi Tıp Fakültesi Etik kurul onayı ve yazılı hasta onamları sonrası, elektif kraniotomi ameliyatı geçirecek, 20-65 yaş arası 30 hasta, Esmolol Grubu (n=15) ve Kontrol Grubu (n=15) olmak üzere iki gruba ayrıldı. Anestezi indüksiyonu 5-7 mg kg-1 tiyopental sodyum, 0,1 mg kg-1 vekuronyum bromid ve 1µg kg-1 remifentanil i.v. ile sağlandı. Endotrakeal entübasyon sonrasında anestezi, 1 MAK sevofluran ve %50 02 içinde %50 hava ve 0,25 µg kg-1 dk-1 remifentanil infüzyonu ile sürdürüldü. Ameliyat bitiminde anestetik ajan uygulamaları sonlandırılarak, hastalara %100 oksijen solutuldu. Ekstübasyondan 5 dakika önce, uygulayıcı dışında bir anestezi doktoru tarafından hazırlanan 50 mL içinde 2 mg kg-1 esmolol veya 50 mL %0,9 NaCl solüsyonu 10 dakikada uygulandı. Ekstübasyon kalitesi 5 puanlı skala ile değerlendirildi. Hastaların infüzyon öncesi, infüzyondan 1 dk sonra, ekstübasyon sırasında, ekstübasyondan 1, 3, 5, 10 dakika sonra kalp atım hızı, sistolik, diyastolik ve ortalama arter basıncı değerleri kaydedildi. BULGULAR: Esmolol grubunda sistolik, diyastolik, ortalama arter basıncı ve kalp atım hızı değerleri açısından ilaç enjeksiyonu öncesi ve sonrası ölçüm zamanları arasında belirgin azalma saptandı (p<0,05). İki grup verilerinin karşılaştırılmasında ise, sistolik, diyastolik, ortalama arter basıncı ve kalp atım hızı değerleri ekstübasyon sonrası ölçümlerde esmolol grubunda belirgin olarak düşük bulundu (p<0,05). Ekstübasyon skoru 1 olan hastaların oranı esmolol grubunda belirgin olarak yüksek bulundu (p<0,05). SONUÇ: Kraniotomi geçiren hastalarda ekstübasyon sırasında oluşabilecek hipertansiyon ve taşikardinin önlenmesinde, ekstübasyon öncesinde 2 mg kg-1 iv esmolol uygulamasının etkili olduğu kanısına varıldı.
OBJECTIVE: The aim of this study was to evaluate the effects of esmolol infusion on prevention of hemodynamic responses to tracheal extubation, in patients undergoing elective craniotomy. METHODS: With Marmara University, Medical School Ethics Committee approval and patients written consent, thirty patients aged between 20-65 years, undergoing elective craniotomy were randomized into two groups as Group Esmolol (n=15) and Group Control (n=15). Anaesthesia was induced with 5-7 mg kg-1 thiopental sodium, 1µg kg-1 remifentanil and 0.1 mg kg-1 vecuronium bromide iv, and was maintained with 1 MAC sevoflurane in oxygen-air mixture (50: 50) and 0.25 &#956;g kg-1 min-1 remifentanil infusion. At the end of the operation patients inhaled 100% oxygen after the discontinuation of anaesthetic agents. Five minutes before extubation in Group Esmolol 2 mg kg-1 esmolol in 50 mL was infused over 10 min (0.2 µg kg-1 min-1) and in Group Control 50 mL saline was infused over 10 min. The quality of extubation was evaluated with a 5 point scale. Heat rate, systolic, diastolic and mean arterial pressure were recorded before infusion, 1 min after infusion, during extubation and at 1, 3, 5, 10 min after extubation. RESULTS: In esmolol group, systolic, diastolic, mean arterial pressures and heart rate decreased significantly after esmolol infusion and were significantly lower than control group after extubation (p<0.05). The ratio of patients with an extubation score 1 was significantly higher in the esmolol group than the control group (p<0.05). CONCLUSION: We concluded that 2 mg kg-1 esmolol infusion before extubation can prevent hypertension and tachycardia caused by extubation in patients undergoing elective craniotomy.
OBJECTIVE: The aim of this study was to evaluate the effects of esmolol infusion on prevention of hemodynamic responses to tracheal extubation, in patients undergoing elective craniotomy. METHODS: With Marmara University, Medical School Ethics Committee approval and patients written consent, thirty patients aged between 20-65 years, undergoing elective craniotomy were randomized into two groups as Group Esmolol (n=15) and Group Control (n=15). Anaesthesia was induced with 5-7 mg kg-1 thiopental sodium, 1µg kg-1 remifentanil and 0.1 mg kg-1 vecuronium bromide iv, and was maintained with 1 MAC sevoflurane in oxygen-air mixture (50: 50) and 0.25 &#956;g kg-1 min-1 remifentanil infusion. At the end of the operation patients inhaled 100% oxygen after the discontinuation of anaesthetic agents. Five minutes before extubation in Group Esmolol 2 mg kg-1 esmolol in 50 mL was infused over 10 min (0.2 µg kg-1 min-1) and in Group Control 50 mL saline was infused over 10 min. The quality of extubation was evaluated with a 5 point scale. Heat rate, systolic, diastolic and mean arterial pressure were recorded before infusion, 1 min after infusion, during extubation and at 1, 3, 5, 10 min after extubation. RESULTS: In esmolol group, systolic, diastolic, mean arterial pressures and heart rate decreased significantly after esmolol infusion and were significantly lower than control group after extubation (p<0.05). The ratio of patients with an extubation score 1 was significantly higher in the esmolol group than the control group (p<0.05). CONCLUSION: We concluded that 2 mg kg-1 esmolol infusion before extubation can prevent hypertension and tachycardia caused by extubation in patients undergoing elective craniotomy.