Akademik Veri Yönetim Sistemi
Tezin Türü: Tıpta Uzmanlık
Tezin Yürütüldüğü Kurum: Ankara Üniversitesi, Tıp Fakültesi, Türkiye
Tezin Onay Tarihi: 2011
Tezin Dili: Türkçe
Öğrenci: DEVRİM TANIL KURT
Danışman: NESLİHAN ALKIŞ
Özet:Beta-adrenerjik reseptör blokerleri, anestezi inüksiyonuna, trakeal entübasyona ve cerrahi strese sempatomimetik yanıtı azaltmak için başarıyla kullanılmaktadırlar. Elektrokardiyografide (EKG) QT ve QTc ise kolay elde edilebilir, ucuz ve noninvaziv bir parametre olup ventriküler taşikardi ve fibrilasyon gibi ölümcül aritmiler yönünden bir gösterge olabilir. Çalısmamızda, koroner arter bypass cerrahisi (KABC) operasyonu planlanan olgularda, esmolol kullanımının hemodinamik değişkenler, EKG' de QT, QTc ve katekolaminler üzerine etkisini araştırmayı amaçladık.51 hasta prospektif randomize olarak plasebo ve kontrol olmak üzere iki gruba ayrıldı. Anestezi indüksiyonu öncesinde 0.5 mg/kg bolus esmololü takiben 100 mcg/kg/dk esmolol infüzyonu başlanırken kontrol grubunda (Grup K) serum fizyolojik uygulandı. Tüm hastalara indüksiyon sırasında etomidat 0.3 mg/kg ve fentanil 5 mcg/kg verildi. Olguların indüksiyon öncesi (T0), çalışma ilaçlarının infüzyonunun 5 dakika sonrası (T1), veküronyum verilmesinin 3 dakika sonrası (T2), entübasyondan 1 dakika (T3) ve 5 dakika sonrası (T4) , sternotomi öncesi (T5), sternotomiden 5 dakika sonrası (T6) kalp atım hızı, sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), ortalama kan basıncı (OKB), periferik oksijen satürasyonu (SpO2) değerleri kaydedildi.Gruplar arasında yas, cinsiyet, vücut kitle indeksi, cerrahi ve anestezi süreleri, katekolamin seviyeleri açısından istatistiksel olarak anlamlı bir fark saptanmazken, esmolol grubunda sistolik kan basıncı (SKB), ortalama kan basıncı (OKB), diyastolik kan basıncı (DKB) ve kalp atım hızı kontrol grubuna göre düşük olup istatistiksel olarak anlamlı fark bulundu. Esmolol grubunda,T1-T6 zaman dilimleri arasında ölçülen QTc değerleri, plasebo grubuna göre anlamlı olarak daha düşük bulundu (p<0,05).Sonuç olarak, etomidat ve fentanil ile indüksiyonu takiben yapılan trakeal entübasyon ve sternatomi, QTc aralığını uzatmaktadır. Esmolol infüzyonu QTc aralığındaki bu uzamayı azaltmakta ve daha iyi bir hemodinamik stabilizasyon sağlamaktadır.AbstractBeta-adrenergic blocking agents have been used successfully to attenuate the sympathomimetic responses to induction of anaesthesia, tracheal intubation and surgical stress. QT interval and QTc in electrocardiography (ECG) is an easily available, cheap and noninvazive parameter and may be an indicator by means of fatal arrhythmias such as ventricular tachycardia and fibrillation. In our study, we aimed to investigate the effect of Esmolol use on hemodynamic variables, catecholamines and QT, QTc in ECG in the CABG patients.Fifty one patients were prospectively randomised to either a plasebo group or the esmolol group. Esmolol was administered as a bolus 0.5 mg/kg, followed by an infusion at 100 mcg/kg/min. Salin was given to plasebo group. All patients received etomidate 0.3 mg/kg and fentanyl 5 mcg/kg. Hemodynamic data, oxygen saturation (SpO2) values of the cases were monitored and recorded at determined times. The ECG was recorded prior to induction of anaesthesia (T0), 5 min following the start of drug infusions (T1), 3 min following vecuronium (T2), 1 min (T3) and 5 min (T4) after intubation, before sternotomy (T5) and 5 min after sternotomy (T6).No significant difference was observed by means of age, sex, body mass index, surgery and anaesthesia times, catecholamine values between the groups; however systolic pressure, diastolic pressure, mean arterial pressure, heart rate were lower in the esmolol group compared to the control group and there were significant differences between them. In the esmolol group, QTc interval was significantly shorter at T1-T6 compared to the control group (p < 0.05).In conclusion, QTc interval increased following tracheal intubation during induction of anaesthesia using etomidate and fentanyl. Esmolol infusion of attenuated the QTc interval prolongation associated with tracheal intubation and surgical stress. It provided a better hemodynamic stabilization.Beta-adrenergic blocking agents have been used successfully to attenuate the sympathomimetic responses to induction of anaesthesia, tracheal intubation and surgical stress. QT interval and QTc in electrocardiography (ECG) is an easily available, cheap and noninvazive parameter and may be an indicator by means of fatal arrhythmias such as ventricular tachycardia and fibrillation. In our study, we aimed to investigate the effect of Esmolol use on hemodynamic variables, catecholamines and QT, QTc in ECG in the CABG patients.Fifty one patients were prospectively randomised to either a plasebo group or the esmolol group. Esmolol was administered as a bolus 0.5 mg/kg, followed by an infusion at 100 mcg/kg/min. Salin was given to plasebo group. All patients received etomidate 0.3 mg/kg and fentanyl 5 mcg/kg. Hemodynamic data, oxygen saturation (SpO2) values of the cases were monitored and recorded at determined times. The ECG was recorded prior to induction of anaesthesia (T0), 5 min following the start of drug infusions (T1), 3 min following vecuronium (T2), 1 min (T3) and 5 min (T4) after intubation, before sternotomy (T5) and 5 min after sternotomy (T6).No significant difference was observed by means of age, sex, body mass index, surgery and anaesthesia times, catecholamine values between the groups; however systolic pressure, diastolic pressure, mean arterial pressure, heart rate were lower in the esmolol group compared to the control group and there were significant differences between them. In the esmolol group, QTc interval was significantly shorter at T1-T6 compared to the control group (p < 0.05).In conclusion, QTc interval increased following tracheal intubation during induction of anaesthesia using etomidate and fentanyl. Esmolol infusion of attenuated the QTc interval prolongation associated with tracheal intubation and surgical stress. It provided a better hemodynamic stabilization.