Yaşlı hastalarda çimentolu kalça protezi operasyonlarında spinal ve epidural anestezi uygulaması sonrası intraoperatif hemodinami ve santral sıcaklık değişikliklerinin karşılaştırılması
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Date
2011
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Trakya Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Trakya Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı'nda yaptığımız çalışmamızda yaşlı hastalarda çimentolu kalça protezi uygulanan operasyonlarda levobupivakain veya bupivakain ile spinal ve epidural anestezi uygulamasının intraoperatif hemodinamiye ve vücut sıcaklığına etkisi araştırılmıştır. Etik kurul onayı ve olguların izinleri alındıktan sonra çimento kullanılarak kalça protezi operasyonu yapılacak, 60 yaş üzeri, `American Society of Anesthesiologists' risk sınıflaması I-III grubunda olan, sipinal ve epidural anestezi uygulanacak 100 olgu çalışma kapsamına alınmıştır. Hastalar rastgele dört gruba ayrılmıştır; Grup I'e spinal anestezi ile 3 ml % 0,5 levobupivakain, Grup II'e spinal anestezi ile 3 ml % 0,5 bupivakain, Grup III'e epidural anestezi kateteri ile 15 ml % 0,5 levobupivakain, Grup IV'e epidural anestezi kateteri ile 15 ml % 0,5 bupivakain uygulanmıştır. Hastaların rejyonel blok öncesi ve sonrası, çimento öncesi, başlangıcı ve sonrası hemodinamik değerleri kaydedildi. Hastaların rejyonel blok sonrası, çimento başlangıcı ve sonrası ölçülen sistolik ve diastolik arter basıncı ortalamaları karşılaştırıldıklarında klinik olarak normal sınırlarda özellikle epidural levobupivakain verilen gruplarda azalma gözlenmiştir. Çimento başlangıcı ve sonrası ölçülen kalp atım hızı değerleri gruplar arasında karşılaştırıldıklarında anlamlı fakat klinik olarak normal sınırlarda farklılık saptanmıştır. Rejyonel blok sonrası 25. dk, 60. dk, 120. dk'larda vücut sıcaklığı değerlerinde ise gruplar arasında anlamlı fakat klinik olarak normal sınırlarda değişiklik saptandı. Ölçülen oksijen saturasyonu değerlerinde ise gruplar arasında anlamlı farklılık saptanmadı. Çalışmamızda elde ettiğimiz sonuçlara göre, levobupivakain veya bupivakain ile uygulanan epidural ve spinal anestezi yaşlı hastaların klinik özelliklerine uygun seçildiğinde hemodinamide anestezi tekniğinden bağımsız ve klinik olarak önemsiz, tedavi gerektirmeyen kısa süreli geçici değişiklikler meydana gelmektedir.
Abstract
Our scientific research that we conducted in Trakya University Faculty of Medicine Department of Anesthesiology and Reanimation, the effects of levobupivacaine, bupivacaine and spinal, epidural anesthesia applications to intra-operative hemodynamics and body temperature has been analyzed in the cemented hip prosthesis operations that in old patients. After taking approval of ethics committee and permission of the cases, hip prosthesis operation will performed by using cement. Hundred cases that spinal and epidural anesthesia will be applied, being in I-III group of American Society of Anesthesiologists risk classification and over 60 years old have been included in the scope of this research. The patients have been divided into four groups randomly. Spinal anesthesia and 3 ml 0,5% levobupivacaine to Group 1, Spinal anesthesia and 3 ml 0,5% bupivacaine to Group 2, epidural anesthesia and 15 ml 0,5% levobupivacaine to Group 3, epidural anesthesia catheter and 15 ml 0,5% bupivacaine to Group 4 have been applied. The hemodynamic values of the patients before and after regional block, before, beginning and after cement have been recorded. When the systolic arterial pressure and diastolic arterial pressure averages of patients that were measured after regional block and in the beginning of cement and after cement are compared, it has been observed that there is a decrease especially in the groups that epidural levobupivacaine was given clinically under normal conditions though this is significant among the groups. It has been detected that there is clinically difference under normal conditions though this is significant among the groups when the heart rate values, measured at the beginning of cement and after cement, are compared. It has been also detected that there is clinically difference under normal conditions in body temperature values in 25, 60, 120 minutes after regional block though this is significant among the groups. Any significant difference has not been detected in the measured oxygen saturation values among the groups. According to the results of our research, , when epidural and spinal anesthesia, applied with levobupivacaine or bupivacaine, chosen appropriately to the clinical features of geriatric patients, it has been understood that in hemodynamic there has been short-term temporary changes that do not need treatment, free from anesthesia technique and clinically insignificant.
Abstract
Our scientific research that we conducted in Trakya University Faculty of Medicine Department of Anesthesiology and Reanimation, the effects of levobupivacaine, bupivacaine and spinal, epidural anesthesia applications to intra-operative hemodynamics and body temperature has been analyzed in the cemented hip prosthesis operations that in old patients. After taking approval of ethics committee and permission of the cases, hip prosthesis operation will performed by using cement. Hundred cases that spinal and epidural anesthesia will be applied, being in I-III group of American Society of Anesthesiologists risk classification and over 60 years old have been included in the scope of this research. The patients have been divided into four groups randomly. Spinal anesthesia and 3 ml 0,5% levobupivacaine to Group 1, Spinal anesthesia and 3 ml 0,5% bupivacaine to Group 2, epidural anesthesia and 15 ml 0,5% levobupivacaine to Group 3, epidural anesthesia catheter and 15 ml 0,5% bupivacaine to Group 4 have been applied. The hemodynamic values of the patients before and after regional block, before, beginning and after cement have been recorded. When the systolic arterial pressure and diastolic arterial pressure averages of patients that were measured after regional block and in the beginning of cement and after cement are compared, it has been observed that there is a decrease especially in the groups that epidural levobupivacaine was given clinically under normal conditions though this is significant among the groups. It has been detected that there is clinically difference under normal conditions though this is significant among the groups when the heart rate values, measured at the beginning of cement and after cement, are compared. It has been also detected that there is clinically difference under normal conditions in body temperature values in 25, 60, 120 minutes after regional block though this is significant among the groups. Any significant difference has not been detected in the measured oxygen saturation values among the groups. According to the results of our research, , when epidural and spinal anesthesia, applied with levobupivacaine or bupivacaine, chosen appropriately to the clinical features of geriatric patients, it has been understood that in hemodynamic there has been short-term temporary changes that do not need treatment, free from anesthesia technique and clinically insignificant.
Description
Tıpta Uzmanlık Tezi
Keywords
Anestezi Teknikleri, Anestezikler, Lokal, Kemik Çimentoları, Anesthesia Techniques, Anesthetics, Local, Bone Cements
