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Orta Kulak Cerrahisinde Dexmedetomidin ile Kontrollü Hipotansiyon

Controlled Hypotension with Dexmedetomidine for Middle Ear Surgery

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2004

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Aim: To compare the effect of dexmedetomidine on providing controlled hypotension and surgical field quality, liver and kidney function in middle ear microsurgery, with nitroglycerine. Material and Method: Patients were divided into two groups after anesthetic induction with thiopental (5-7 mg. kg- 1), fentanyl (1 μg. kg-1), and vecuronium (0.1 mg. kg-1). In dexmedetomidine group (n=20), following the loading dose of 1 μg. kg-1 (10 min), infusion was applied with a dose of 0.1-0.7 μg.kg-1.h-1. In nitroglycerine group (n=20), infusion of nitroglycerine was applied with a dose of 0.25-1 μg.kg-1.min-1. Drug doses were titrated to maintain the mean arterial pressure (MAP) at 65-75 mmHg. Anesthesia was maintained with 4-6 % desflurane and 60% oxygenair mixture. During controlled hypotension, arterial blood gas analysis was examined. For the measurement of AST, ALT, BUN and creatinine, blood samples were obtained before and after surgery and on postoperative third day. Results: Fifteen minutes after controlled hypotension and immediately after the extubation, MAP and HR were higher in nitroglycerine group (95.15 ±16.88 and 96.10 ± 22.76, respectively) when compared with dexmedetomidine group (84.90 ± 14.26 and 82.65 ± 18.82, respectively). In dexmedetomidine group, 15 min after controlled hypotension, MAP was higher compared to the value previous to induction (p<0.05). In nitroglycerine group, MAP and HR were significantly higher compared to the value previous to the induction (p<0.05). Reflex tachycardia was observed in two patients in the nitroglycerine group. In dexmedetomidine group, bradycardia was observed in 3 patients during the loading dose. Surgical field quality score was lower in dexmedetomidine group (0.1 ± 0.31) compared to nitroglycerine group (0.65 ± 0.67) (p<0.05). In both groups, AST, ALT, BUN and creatinine were within normal limits. Conclusion: It was concluded that, in the middle ear microsurgery, dexmedetomidine was suitable for the controlled hypotension. Because, it provides hemodynamic stability and good surgical field visibility, and did not cause reflex tachycardia and rebound hypotension. In addition, it can be safely used, since it did not cause side effects on liver and kidney function tests.
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Abstract (Original Language): 
Amaç: Ortakulak cerrahisinde, deksmedetomidin ve nitrogliserinin intraoperatif kontrollü hipotansiyon, cerrahi alan kalitesi, karaciğer ve böbrek fonksiyonları üzerine etkilerinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Olgular, tiyopental 5-7 mg. kg-1, fentanil 1 μg. kg-1 ve vekuronyum 0.1 mg. kg-1 ile anestezi indüksiyonundan sonra iki gruba ayrıldı: Deksmedetomidin grubunda (n=20), deksmedetomidin 1μg. kg-1 yükleme dozunu (10 dk’da) takiben 0.1-0.7 μg.kg-1.s-1; nitrogliserin grubunda (n=20), nitrogliserin 0.25-1 μg.kg-1.dk-1 infüzyon olarak uygulandı. İlaç dozları ortalama arter basıncı (OAB) 65-75 mmHg olacak şekilde ayarlandı. Anestezi idamesinde, %4-6 desfluran ve % 60 O2-hava karışımı kullanıldı. Kontrollü hipotansiyon süresince arteriyel kan gazı, operasyondan önce ve sonra, postoperatif 3. günde AST, ALT, BUN, kreatinin değerleri için kan alındı. Bulgular: Kontrollü hipotansiyondan 15 dk ve ekstübasyondan sonra OAB ve KH, nitrogliserin grubunda (95.15 ±16.88 ve 96.10 ± 22.76) deksmedetomidin grubuna (84.90 ± 14.26 ve 82.65 ± 18.82) göre daha yüksekti. Deksmedetomidin grubunda, kontrollü hipotansiyondan 15 dk sonra OAB’ı indüksiyon öncesine göre düşüktü. Nitrogliserin grubunda ise ekstübasyondan sonraki OAB ve KH indüksiyon öncesine göre anlamlı yüksekti. Nitrogliserin grubunda, iki olguda refleks taşikardi gözlendi. Deksmedetomidin grubunda, üç olguda bradikardi gelişti. Cerrahi alan kalite skoru, deksmedetomidin grubunda (0.1±0.31) nitrogliserin grubuna (0.65 ± 0.67) göre düşüktü (p<0.05). Her iki grubun AST, ALT, BUN ve kreatinin değerleri normal sınırlardaydı. Sonuç: Deksmedetomidinin nitrogliserine göre daha stabil hemodinami ve iyi cerrahi görüş alanı sağlaması, refleks taşikardi ve rebound hipertansiyon oluşturmaması nedeniyle kontrollü hipotansiyon için uygun olduğu kanısına varıldı. Karaciğer ve böbrek fonksiyonlarına yan etkisinin olmaması güvenle kullanılabileceğini düşündürmektedir.
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  • 4
237-241
  • Turkish

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