Genel anestezi altında major abdominal cerrahi uygulanan olgularda torasik epidural analjezinin hemodinami, derlenme ve postoperatif analjezi üzerine etkileri
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2007
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info:eu-repo/semantics/openAccess
Özet
Çalışmamızda, major abdominal cerrahide genel anestezi ve genel anestezi + torasik epidural analjezi uygulamasının intraoperatif ve postoperatif hemodinami, derlenme, analjezik tüketimi ile postoperatif yan etki profili ve hasta taburcu olma kriterlerine olan etkilerini karşılaştırmayı amaçladık. ASA I-III grubundan 46 olgu rastgele iki gruba ayrıldı. Her iki gruba da GA indüksiyonundan önce postoperatif ağrı kontrolü amacıyla oturur pozisyonda steril bir teknikle T9-11 seviyesinden torasik epidural kateter takıldı. Tüm olgulara indüksiyon amacıyla iv olarak 2-2.5 mg/kg propofol ve 0.1-0.15mg/kg sisatrakurium uygulandı. Anestezi idamesi ise sevofluran ile birlikte % 50 N2O + % 50 O2 ile sağlandı. Grup I'e torasik epidural kateterden cilt kapatılırken 2mg/ml ropivakain 10 ml bolus olarak verildi ve postoperatif ağrı kontrolü amacıyla torasik epidural kateterden HKA sağlandı. Grup II'ye ise torasik epidural kateter takılması sonrası 2mg/ml'lik ropivakain solüsyonundan 4-6 ml/saat kontinü infüzyon başlatıldı ve postoperatif ağrı kontrolü amacıyla torasik epidural kateterden HKA sağlandı. Operasyon boyunca tüketilen sevofluran miktarı ile kullanılan fentanil miktarı kayıt edildi. Ekstübasyon, göz açma, verbal uyarıya yanıt süresi (dk) kaydedildi. Derlenme 5., 10., 15. dklarda Aldrete skorları ile izlendi. Her iki grupta postoperatif dönemde analjezi epidural kateterden ropivakain (2 mg/ml) bolus 10 ml, 30 dk. kilitli kalma süresi protokolü ile HKA uygulandı ve olguların ilk ağrı duyduğu zaman kaydedildi. Her iki grubun demografik verileri ile anestezi ve operasyon süreleri benzerdi (p>0.05). Grup II'de cilt insizyonuna hemodinamik yanıt alınmadı, intraoperatif hemodinamik takipleri Grup I'e göre daha stabildi ve intraoperatif tüketilen opioid miktarı düşük bulundu 76 (p<0.05). Olguların postoperatif dönemde bakılan VAS değerleri, HKA de istek/alım oranı, yürüyebilme, sözlü uyarı ile göz açma ve verbal yanıt süreleri açısından Grup II'de anlamlı düşük bulundu (p<0.05). Olguların ekstübasyon süreleri ile hasta memnuniyeti, wilson sedasyon skalası ve postoperatif bulantı-kusma açısından fark bulunmadı (p>0.05). Sonuç olarak major abdominal cerrahi planlanan olgularda, genel anesteziye ek olarak kullanılan torasik epidural analjezinin hemodinamik stabilizasyon sağlaması ile düşük opioid ve sevofluran tüketimine, erken derlenme kriterlerine, düşük yan etki profiline ek olarak postoperatif erken mobilizasyon sağlaması nedeniyle tercih edilebilir bir yöntem olduğu kanısına vardık. Anahtar kelimeler: Torasik epidural analjezi, Genel anestezi, abdominal cerrahi, intraoperatif ve postoperatif hemodinami, postoperatif analjezi
The aim of this study is to investigate the effects of general anesthesia alone and general anesthesia combined with thorasic epidural analgesia on intraoperative and post operative hemodymamics, recovery, the consumption of analgesia and the profile of postoperative side effects and the externalisation criterias of patients. Fourtysix cases fitting between American Society of Anesthesiologists I-III criterias randomly divided into two groups. Before the induction of GA a thorasic epidural catheter was inserted at T9-11 level for postoperative control of pain to all of the cases in both groups. All cases were treated with 2-2.5 mg/kg propofol and 0.1-0.15 mg/kg cisatracurium for induction. The continuation of anesthesia is managed with 50 % N2O + 50 % O2 combined with sevoflurane. Group I was given a 10 ml bolus dose of 2 mg/ml ropivacaine and post operative analgesia was admitted with patient controlled analgesia device via thorasic epidural catheter. Where as in group II after the insertion of thorasic epidural catheter a 4-6 ml/hour continued infusion of 2 mg/ml ropivacaine solution was started and post operative pain control was again managed via thorasic epidural patient controlled analghesia. The consumed propofol and fentanyl doses perioperatively were recorded. The times of extubation, opening of eyes and response to verbal stimuli were recorded in minutes. Recovery was monitored in 5th, 10th and 15th minutes with Aldrete scores. In both of the groups analgesia were managed with 10 ml bolus of ropivacaine (2 mg/ml), depending on 30 minute locked protocol, via patient controlled analghesia device and the time of the first sensible pain were recorded. The demographic data and the time of anesthesia were similar in two groups (p>0.05). In group II no hemodynamic response were seen to incision of the skin, the intraoperative hemodynamic parameters were more stable according to group I and the consumption of perioperative opioids were less (p<0.05). The postoperative visual analogue scale values, delivery/demand ratio of patient controlled analghesia, walking, eyes opening with verbal stimuli and verbal response were significantly lower in group II (p<0.05). There were no significant difference between the groups on the extubation times and patient comfortability, wilson sedation scale and postoperative nausia and vomitting (p>0.05). As a result we found that especially in the cases who are candidates for major abdominal surgery, thorasic epidural analgesia combined with general anesthesia is useful in stabilising hemodynamic parameters peroperatively and reducing the consumption of opioids and anesthesia agents, and has positive effects on early recovery criterias, lower side effects, and enhances early mobilisation. Key words: Thorasic epidural analghesia, general anesthesia, abdominal surgery, intraoperative and post operative hemodymamics, postoperative analgesia
The aim of this study is to investigate the effects of general anesthesia alone and general anesthesia combined with thorasic epidural analgesia on intraoperative and post operative hemodymamics, recovery, the consumption of analgesia and the profile of postoperative side effects and the externalisation criterias of patients. Fourtysix cases fitting between American Society of Anesthesiologists I-III criterias randomly divided into two groups. Before the induction of GA a thorasic epidural catheter was inserted at T9-11 level for postoperative control of pain to all of the cases in both groups. All cases were treated with 2-2.5 mg/kg propofol and 0.1-0.15 mg/kg cisatracurium for induction. The continuation of anesthesia is managed with 50 % N2O + 50 % O2 combined with sevoflurane. Group I was given a 10 ml bolus dose of 2 mg/ml ropivacaine and post operative analgesia was admitted with patient controlled analgesia device via thorasic epidural catheter. Where as in group II after the insertion of thorasic epidural catheter a 4-6 ml/hour continued infusion of 2 mg/ml ropivacaine solution was started and post operative pain control was again managed via thorasic epidural patient controlled analghesia. The consumed propofol and fentanyl doses perioperatively were recorded. The times of extubation, opening of eyes and response to verbal stimuli were recorded in minutes. Recovery was monitored in 5th, 10th and 15th minutes with Aldrete scores. In both of the groups analgesia were managed with 10 ml bolus of ropivacaine (2 mg/ml), depending on 30 minute locked protocol, via patient controlled analghesia device and the time of the first sensible pain were recorded. The demographic data and the time of anesthesia were similar in two groups (p>0.05). In group II no hemodynamic response were seen to incision of the skin, the intraoperative hemodynamic parameters were more stable according to group I and the consumption of perioperative opioids were less (p<0.05). The postoperative visual analogue scale values, delivery/demand ratio of patient controlled analghesia, walking, eyes opening with verbal stimuli and verbal response were significantly lower in group II (p<0.05). There were no significant difference between the groups on the extubation times and patient comfortability, wilson sedation scale and postoperative nausia and vomitting (p>0.05). As a result we found that especially in the cases who are candidates for major abdominal surgery, thorasic epidural analgesia combined with general anesthesia is useful in stabilising hemodynamic parameters peroperatively and reducing the consumption of opioids and anesthesia agents, and has positive effects on early recovery criterias, lower side effects, and enhances early mobilisation. Key words: Thorasic epidural analghesia, general anesthesia, abdominal surgery, intraoperative and post operative hemodymamics, postoperative analgesia
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
