Normal tiroid fonksiyonlu ve tiroid fonksiyon bozukluğu tanılı hastalarda monitörizasyon eşliğinde genel anestezi ihtiyacının gözlemlenmesi
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve amaç: Hipotiroidi, tiroid bezinin yetersiz hormon üretimi sonucu ortaya çıkan ve yaygın olarak görülen bir endokrin bozukluktur. Hipotiroidi hastalarında multimodal görüntüleme yöntemleriyle beyindeki yapısal ve fonksiyonel değişiklikler gösterilmiştir. Yapılan çalışmalar da tiroid hormonları ile GABAerjik sistem arasında karşılıklı bir düzenleme olduğunu desteklemektedir. Propofol, en sık kullanılan intravenöz indüksiyon ajanıdır ve GABA reseptörleri üzerinden etki eder. Çalışmamızda birincil amacımız hipotiroidi tanılı ve tedavisini almakta olan hastalar ile tiroid fonksiyonları normal olarak değerlendirilen hastaların bispektral indeks monitörizasyonu altında total intravenöz anestezide kullanılan propofol ve remifentanil tüketim miktarlarının karşılaştırılmasıdır. İkincil amacımız ise anestezi öncesi değerlendirilen tiroid hormon düzeyleri ve manyetik rezonans spektroskopik görüntülemede GABA metabolitinin değişikliklerin (ppm cinsinden ) saptanmasıdır. Gereç ve yöntem: Çalışmamıza ASA I-II statüsünde: Grup 1 (Kontrol grubu) (n=40) tiroid fonksiyon bozukluğu olmayan hastalar ve Grup 2 (Hipotiroid grubu) (n=40) hipotiroidi tanılı ve eksojen tiroid hormonu kullanan tiroid fonksiyon testleri normal aralıkta olan hastalar olmak üzere toplam 80 hasta dahil edildi. Hastalar preoperatif dönemde Montreal Değerlendirme Ölçeği ve Beck Anksiyete Ölçeği ile değerlendirildi. Operasyondan 1 gün önce tüm hastalara beyin MR incelemesi uygulandı. Hem non-invaziv görüntüleme yöntemi olması hem de tiroid bezi fonksiyon bozukluğu olan hastalarda beyin metabolitlerindeki değişiklikleri değerlendirmek için etkili bir yöntem olması nedeniyle MR spektroskopi görüntüleme yöntemi tercih edildi. Beyin metabolitleri incelemesinde NAA, Cr ve Glx pikleri tespit edildi bu spektrum içinde GABA'nın da olması nedeniyle değerler GABA'nın değişen konsantrasyonu olarak yorumlandı. Hastalar total intravenöz anestezi altında operasyona alındı. İndüksiyonda 2mg/kg propofol 0,5 mg/kg fentanil, 0,5 mg/kg roküronyum ile indüksiyon yapıldı. İdame bispektral indeks monitörizasyonu yapılarak değerler 40-60 arasında olacak şekilde 1-8 mg/kg/dk propofol infüzyonu, 0.5-2 mcg/kg/dk dozunda remifentanil infüzyonuyla sağlandı. Bulgular: Hipotiroidi tanılı hasta grubunda yaş ortalaması, kadın cinsiyet ve ASA II olma oranları kontrol grubuna göre istatistiksel olarak anlamlı yüksek bulundu (p değerleri sırasıyla; p<0,001, p<0,001, p=0,002). Çalışmaya dahil edilen hastalarda TSH düzeyi kontrol grubuna göre istatistiksel olarak anlamlı yüksek, T3 düzeyi ise kontrol grubuna göre istatistiksel olarak anlamlı düşük saptandı değerleri sırasıyla; p<0,001, p=0,020) Hipotiroidi tanılı hasta grubunda mid anterior singulat kortekste (mACC)(p<0,001)ve mid posterior singulat kortekste (mPCC) (p<0,001) GABA metabolit düzeyleri kontrol grubuna göre istatistiksel olarak anlamlı yüksek bulundu. Hasta ve kontrol gruplarında mACC ve mPCC' de ki GABA metabolitleri ile tiroit hormon düzeyleri arasında istatistiksel olarak anlamlı korelasyon saptanmadı (p>0,005). Kontrol grubu hastalarda propofol düzeyleri ile T4 arasında negatif yönde iyi derecede istatistiksel olarak anlamlı korelasyon tespit edildi (p<0,001). Kontrol grubu hastalarında mid posterior singulat korteks de bulunan GABA metaboliti düzeyi ile propofol düzeyleri arasında pozitif yönde düşük- orta düzeyde istatistiksel olarak anlamlı korelasyon tespit edildi (p=0,038). Sonuç: Çalışmamız, hem hipotiroidi tanılı hastalarda GABA reseptör tayinin yapılması hem de intraoperatif anestezik madde kullanımın karşılaştırılması açısından çok yönlü değerlendirme fırsatı veren literatürdeki ilk çalışmadır. Çalışmamızda hipotiroidi tanılı hastalarda serum TSH hormon seviyeleri ve beyinde ki anterior singulat kortekste ve posterior singulat kortekste GABA metabolit seviyeleri anlamlı yüksek saptanmıştır. Buna rağmen, propofol ve remifentanil kullanım miktarının anlamlı değişmediği gözlenmiştir. Sağlıklı grupta ise tiroid hormon seviyeleri ile propofol ve remifentanil kullanım miktarları arasında sıkı bir ilişki gözlenirken, eksojen tiroid hormonu kullanan hipotiroidi tanılı grupta bu ilişki gözlenmemiştir. Hipotiroidinin nörolojik etkilerinin karmaşıklığı ve bireyler arası farklılıklar nedeniyle etkilerinin tam olarak anlaşılması için daha çok çalışmaya ihtiyaç vardır.
Introduction and objective: Hypothyroidism is a common endocrine disorder resulting from insufficient hormone production by the thyroid gland. Structural and functional changes in the brain have been demonstrated in hypothyroid patients using multimodal imaging techniques. Studies have supported a reciprocal regulation between thyroid hormones and the GABAergic system. Propofol, the most commonly used intravenous induction agent, acts through GABA receptors. The primary objective of our study is to determine whether there is a distribution in the required propofol dose under total intravenous anesthesia, guided by variable bispectral index monitoring, in relation to thyroid hormone levels. Our secondary objective is to investigate whether there is a difference in the amount of the GABA metabolite in the anterior and posterior cortex regions on magnetic resonance spectroscopy imaging between patients with normal and abnormal thyroid function. Materials and Methods: A total of 80 patients with ASA I-II status were included in our study: Group 1, the Control group (n=40), consisted of patients without thyroid dysfunction, and Group 2, the Hypothyroid group (n=40), included patients diagnosed with hypothyroidism who were taking exogenous thyroid hormones and had thyroid function tests within normal ranges. Preoperatively, patients were assessed using the Montreal Cognitive Assessment Scale and the Beck Anxiety Inventory. Brain MRI scans were performed on all patients one day before surgery. Magnetic resonance spectroscopy imaging was chosen due to its non-invasive nature and its effectiveness in evaluating brain metabolite changes in patients with thyroid dysfunction. In examining brain metabolites, NAA, Cr, and Glx peaks were identified, which were interpreted as indicators of changing GABA concentrations. The patients were operated on using total intravenous anesthesia. Induction was made with 2 mg/kg propofol, 0.5 mg/kg fentanyl, and 0.5 mg/kg rocuronium. Maintenance bispectral index monitoring is performed with propofol infusion at a dose of 1-8 mg/kg/min and remifentanil infusion at a dose of 0.5-2 mcg/kg/min, with bispectral index monitoring values between 40-60. Results: In the patient group diagnosed with hypothyroidism, mean age, female gender and ASA II rates were found to be statistically significantly higher compared to the control group (p values; p<0.001, p<0.001, p=0.002, respectively). In the patients included in the study, TSH level was found to be statistically significantly higher compared to the control group, and T3 level was found to be statistically significantly lower compared to the control group (p values; p<0.001, p=0.020, respectively). In the patient group diagnosed with hypothyroidism, GABA metabolite levels in the mid anterior cingulate cortex (mACC) and mid posterior cingulate cortex (mPCC) were found to be statistically significantly higher compared to the control group (p<0.001, p<0.001). No statistically significant correlation was found between GABA metabolites in the mACC and mPCC and thyroid hormone levels in the patient and control groups (p>0.005). In the control group patients, a negative and good statistically significant correlation was detected between propofol levels and T4 (p<0.001). In the control group patients, a positive and low-moderate statistically significant correlation was detected between GABA metabolite levels in the mid posterior cingulate cortex and propofol levels (p=0.038). Conclusion: Our study is the first in the literature that provides a comprehensive evaluation of both the determination of GABA receptors in patients diagnosed with hypothyroidism and the comparison of intraoperative anesthetic drug usage. In our study, patients diagnosed with hypothyroidism were found to have significantly higher serum TSH hormone levels and GABA metabolite levels in the anterior cingulate cortex and posterior cingulate cortex of the brain. However, it was observed that the amount of propofol and remifentanil used did not change significantly. In the healthy group, a strong correlation was observed between thyroid hormone levels and the amounts of propofol and remifentanil used. In contrast, this correlation was not observed in the hypothyroid group using exogenous thyroid hormones. More studies are needed to fully understand the effects of hypothyroidism due to the complexity of its neurological effects and interindividual differences.
Introduction and objective: Hypothyroidism is a common endocrine disorder resulting from insufficient hormone production by the thyroid gland. Structural and functional changes in the brain have been demonstrated in hypothyroid patients using multimodal imaging techniques. Studies have supported a reciprocal regulation between thyroid hormones and the GABAergic system. Propofol, the most commonly used intravenous induction agent, acts through GABA receptors. The primary objective of our study is to determine whether there is a distribution in the required propofol dose under total intravenous anesthesia, guided by variable bispectral index monitoring, in relation to thyroid hormone levels. Our secondary objective is to investigate whether there is a difference in the amount of the GABA metabolite in the anterior and posterior cortex regions on magnetic resonance spectroscopy imaging between patients with normal and abnormal thyroid function. Materials and Methods: A total of 80 patients with ASA I-II status were included in our study: Group 1, the Control group (n=40), consisted of patients without thyroid dysfunction, and Group 2, the Hypothyroid group (n=40), included patients diagnosed with hypothyroidism who were taking exogenous thyroid hormones and had thyroid function tests within normal ranges. Preoperatively, patients were assessed using the Montreal Cognitive Assessment Scale and the Beck Anxiety Inventory. Brain MRI scans were performed on all patients one day before surgery. Magnetic resonance spectroscopy imaging was chosen due to its non-invasive nature and its effectiveness in evaluating brain metabolite changes in patients with thyroid dysfunction. In examining brain metabolites, NAA, Cr, and Glx peaks were identified, which were interpreted as indicators of changing GABA concentrations. The patients were operated on using total intravenous anesthesia. Induction was made with 2 mg/kg propofol, 0.5 mg/kg fentanyl, and 0.5 mg/kg rocuronium. Maintenance bispectral index monitoring is performed with propofol infusion at a dose of 1-8 mg/kg/min and remifentanil infusion at a dose of 0.5-2 mcg/kg/min, with bispectral index monitoring values between 40-60. Results: In the patient group diagnosed with hypothyroidism, mean age, female gender and ASA II rates were found to be statistically significantly higher compared to the control group (p values; p<0.001, p<0.001, p=0.002, respectively). In the patients included in the study, TSH level was found to be statistically significantly higher compared to the control group, and T3 level was found to be statistically significantly lower compared to the control group (p values; p<0.001, p=0.020, respectively). In the patient group diagnosed with hypothyroidism, GABA metabolite levels in the mid anterior cingulate cortex (mACC) and mid posterior cingulate cortex (mPCC) were found to be statistically significantly higher compared to the control group (p<0.001, p<0.001). No statistically significant correlation was found between GABA metabolites in the mACC and mPCC and thyroid hormone levels in the patient and control groups (p>0.005). In the control group patients, a negative and good statistically significant correlation was detected between propofol levels and T4 (p<0.001). In the control group patients, a positive and low-moderate statistically significant correlation was detected between GABA metabolite levels in the mid posterior cingulate cortex and propofol levels (p=0.038). Conclusion: Our study is the first in the literature that provides a comprehensive evaluation of both the determination of GABA receptors in patients diagnosed with hypothyroidism and the comparison of intraoperative anesthetic drug usage. In our study, patients diagnosed with hypothyroidism were found to have significantly higher serum TSH hormone levels and GABA metabolite levels in the anterior cingulate cortex and posterior cingulate cortex of the brain. However, it was observed that the amount of propofol and remifentanil used did not change significantly. In the healthy group, a strong correlation was observed between thyroid hormone levels and the amounts of propofol and remifentanil used. In contrast, this correlation was not observed in the hypothyroid group using exogenous thyroid hormones. More studies are needed to fully understand the effects of hypothyroidism due to the complexity of its neurological effects and interindividual differences.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation, Anestezi, GABA metaboliti, Hipotroidi, Propofol, Remifentanil, Manyetik Rezonans Spektroskopi, Anesthesia, GABA metabolite, Hypothyroidism, Propofol, Remifentanil, Magnetic Resonance Spectroscopy
