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Serebral Anevrizma Cerrahisinde İzofluran ve TİVA Uygulamasının Hemodinami, Derlenme ve Erken Nörolojik Durum Üzerine Etkilerinin Karşılaştırılması

Comparison of the Effects of Isoflurane and TIVA on Hemodynamics, Recovery and Early Neurologic Status During Cerebral Aneurysm Surgery

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2007

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
The study was designed to compare the effects of isoflurane plus fentanyl and total intravenous anesthesia (TIVA) with propofol plus alfentanyl infusions used for anesthesia maintenance on hemodynamics, recovery, and early neurological status during cerebral aneurysm surgery. Study was performed in 90 patients who underwent elective cerebral aneurysm surgery. Anesthesia induction was performed in all patients via propofol, fentanyl, and vecuronium. Then, the patients were randomly assigned to receive either isoflurane (ETiso; end-tidal isoflurane concentration: 1.2), fentanyl (2 µg kg -1 ) (Group isoflurane, n=45) or propofol (6 mg kg -1 h -1 ), alfentanyl (35 µg kg -1 h -1 ) infusions (Group TIVA, n=45) for the maintenance of anesthesia. Both groups were ventilated with 50% air in O2. Mild hypothermia (34-36º C) had been applied until the aneurysm was clipped. Hemodynamic data were recorded in the different periods. Recovery was assessed by the time to response to command, and extubation and postoperative early neurological status. Changes in heart rate after pinhead-holder application were varied in the comparison between the two groups (p<0.05). Decrease in systolic arterial pressure after aneurysm clipping in group TIVA was higher (p<0.05). Recovery and physiological data were similar in both groups. It was concluded that, although similar recovery profile and neurological status were observed in both groups, peroperative hemodynamic stability was better by isoflurane, fentanyl during cerebral aneurysm surgery.
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Abstract (Original Language): 
Çalışma, serebral anevrizma cerrahisinde, anestezi idamesinde kullanılan izofluran, fentanil ile propofol, alfentanil infüzyonlarını içeren total intravenöz anestezinin (TİVA) hemodinami, derlenme ve erken nörolojik durum üzerine etkilerinin karşılaştırılması amacıyla planlandı. Çalışma elektif serebral anevrizma cerrahisi planlanan 90 hastada yapıldı. Tüm hastalarda, propofol, fentanil ve vekuronyum ile anestezi indüksiyonu uygulandı. Sonrasında, hastalar anestezi idamesi için izofluran (ETizo; soluk sonu izofluran konsantrasyonu: 1.2), fentanil (2 µg kg -1 ) (Grup izofluran, n=45) veya propofol (6 mg kg -1 sa -1 ), alfentanil (35 µg kg -1 sa -1 ) (Grup TİVA, n= 45) infüzyonu uygulaması için rastgele ayrıldılar. Her iki grup, oksijen içinde %50 hava ile ventile edildi. Anevrizma klipleninceye kadar ılımlı hipotermi (34-36º C) uygulandı. Hemodinamik veriler farklı dönemlerde kaydedildi. Derlenme, emirlere uyma, ekstübasyon zamanları ve erken nörolojik durumları değerlendirildi. İki grup arasında, çivili başlık yerleştirilmesi sonrası kalp hızında kaydedilen değişiklikler farklı bulundu (p<0.05). Anevrizma kliplenmesi sonrası sistolik arter basıncındaki azalma TİVA grubunda daha fazlaydı (p<0.05). Derlenme ve fizyolojik veriler her iki grupta benzerdi. Sonuç olarak, serebral anevrizma cerrahisinde her iki grupta benzer derlenme profili ve nörolojik durum gözlenmesine rağmen cerrahi dönemde hemodinamik stabilitenin izofluran ve fentanil ile daha iyi korunduğu görüldü.
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  • Turkish

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