Hipotansif ve normotansif anestezinin QTc intervali ve QT dispersiyonu üzerine etkileri
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Tarih
2011
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Trakya Üniversitesi Tıp Fakültesi Hastanesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı'nda yaptığımız çalışmamızda hipotansif ve normotansif anestezinin QTc intervali ve QT dispersiyonu üzerine etkileri araştırılmıştır. Etik kurul onayı ve olguların onamları alındıktan sonra 3 saatten kısa normotansif veya hipotansif anestezi uygulanarak, kulak burun boğaz, plastik ve rekonstriktif cerrahi ameliyatı yapılacak, 18-65 yaş arası, "American Society of Anesthesiologists" risk sınıflaması I-II grubunda olan 100 olgu çalışma kapsamına alınmıştır. Operasyon sırasında normotansif düzeylerde hemodinami sağlanan Grup I (n=50)' e ortalama arter basıncı 70-90 mmHg arasında olacak şekilde anestezi idamesi sağlandı. Cerrahi prosedür gereği kontrollü hipotansiyon uygulanan Grup II (n=50)'de kontrollü hipotansiyon oluşturularak ortalama arter basıncı 55?65 mmHg düzeyinde tutuldu. Tüm olguların intraoperatif ve postoperatif 60. dakikaya kadar hemodinami takipleri yapıldı. 30. ve 60. dakikalarda elektrokardiyografi monitörizasyonu yapılarak kaydedildi. Olguların elektrokardiyografi kaydı okunarak değerlendirildi. QT aralığının hıza göre düzeltilmesinde Bazzette formülü kullanıldı. Hastaların anestezi indüksiyonu öncesi ve sonrası, entübasyon sonrası ve ekstübasyon sonrası ölçülen kalp atım hızı, sistolik arter basıcı, diastolik arter basıncı, ortalama arter basıncı ortalamaları gruplar arasında karşılaştırıldıklarında, özellikle hipotansif anestezi uygulanan grupta azalma gözlenmesine rağmen klinik olarak normal sınırlarda saptandı. Postoperatif 30. ve 60.dakikalarda ölçülen QT ve QTcd gruplar arasında karşılaştırıldıklarında anlamlı farklılık saptanmadı. Grup içi postoperatif 30. ve 60.dakikalardaki QT ve QTcd değerleri operasyon öncesi değerlerle karşılaştırıldıklarında hipotansif anestezi uygulanan grupta azalma gözlenmesine rağmen klinik olarak normal sınırlarda saptandı. Çalışmamızda elde ettiğimiz sonuçlara göre, hastaların klinik özelliklerine uygun hemodinami normal sınırlarda sağlandığı sürece hipotansif ve normotansif anestezinin postoperatif QTc intervali ve QT dispersiyonu üzerine etkisi bulunamamıştır. Anahtar kelimeler: Hipotansif anestezi, QT dispersiyonu, düzeltilmiş QT intervali
Abstract
In our study conducted at the Department of Anesthesiology and Reanimation in Trakya University Medical Faculty Hospital, the effects of hypotensive and normotensive anesthesia on QTc interval and QT dispersion were investigated. After Ethics Committee approval and obtaining permissions for cases, 100 patients between 18-65 years of age who are in I-II group according to American Society of Anesthesiologists risk classification and would undergo ear nose throat, plastic and reconstructive surgery by applying normotensive and hypotensive anesthesia less than 3 hours were included in the study. Maintenance of anesthesia, mean arterial pressure to be between 70-90 mmHg, is achieved to Group I (n = 50) that is provided hemodynamics in normotensive levels during the operation. Group II (n = 50) to which controlled hypotension is applied due to the surgical procedure is held at the mean arterial pressure to be 55-65 mmHg at the level by maintaining controlled hypotension. Intraoperative and postoperative hemodynamics monitoring till 60 minute was done in all cases. Electrocardiography monitoring at 30th and 60th minute was held and enlisted. Electrocardiography records of cases were read and assessed. Bazzette formula was used for correction of QT interval according to speed. When averages of heart rate speed, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure of patients that were measured before and after induction of anesthesia, after intubation and after extubation were compared between the groups, although reduction was observed particularly in the group applied hypothensive anesthesia, they were clinically ascertained in normal ranges. There was no significant difference fixed when they were compared between the QT and QTcd groups measured at postoperative 30th and 60th minutes. When the QT and QTcd measures at postoperative 30th and 60th minutes in the group were compared between the pre-operation measures, they were fixed in normal ranges although reduction was observed in hypotensive anesthesia group. According to the results we've obtained in our study, as long as hemodynamics, proper to patients' clinical characteristics, was provided in the normal range, there was no effect of hypotensive and normotensive anesthesia on postoperative QTc interval and QT dispersion detected. Key words: hypotensive anesthesia, QT dispersion, corrected QT interval.
Abstract
In our study conducted at the Department of Anesthesiology and Reanimation in Trakya University Medical Faculty Hospital, the effects of hypotensive and normotensive anesthesia on QTc interval and QT dispersion were investigated. After Ethics Committee approval and obtaining permissions for cases, 100 patients between 18-65 years of age who are in I-II group according to American Society of Anesthesiologists risk classification and would undergo ear nose throat, plastic and reconstructive surgery by applying normotensive and hypotensive anesthesia less than 3 hours were included in the study. Maintenance of anesthesia, mean arterial pressure to be between 70-90 mmHg, is achieved to Group I (n = 50) that is provided hemodynamics in normotensive levels during the operation. Group II (n = 50) to which controlled hypotension is applied due to the surgical procedure is held at the mean arterial pressure to be 55-65 mmHg at the level by maintaining controlled hypotension. Intraoperative and postoperative hemodynamics monitoring till 60 minute was done in all cases. Electrocardiography monitoring at 30th and 60th minute was held and enlisted. Electrocardiography records of cases were read and assessed. Bazzette formula was used for correction of QT interval according to speed. When averages of heart rate speed, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure of patients that were measured before and after induction of anesthesia, after intubation and after extubation were compared between the groups, although reduction was observed particularly in the group applied hypothensive anesthesia, they were clinically ascertained in normal ranges. There was no significant difference fixed when they were compared between the QT and QTcd groups measured at postoperative 30th and 60th minutes. When the QT and QTcd measures at postoperative 30th and 60th minutes in the group were compared between the pre-operation measures, they were fixed in normal ranges although reduction was observed in hypotensive anesthesia group. According to the results we've obtained in our study, as long as hemodynamics, proper to patients' clinical characteristics, was provided in the normal range, there was no effect of hypotensive and normotensive anesthesia on postoperative QTc interval and QT dispersion detected. Key words: hypotensive anesthesia, QT dispersion, corrected QT interval.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Hipotansif Anestezi, QT Dispersiyonu, Düzeltilmiş QT İntervali, Hypotensive Anesthesia, QT Dispersion, Corrected QT İnterval
