Sigara kullanımının nöromuskuler bloğun geri döndürülmesi üzerine etkisi
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Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmamızda nondepolarizan bir nöromuskuler bloker olan roküronyum bromürün antagonize edilmesinde kullanılan sugammadeksin sigara kullanan ve kullanmayan hastalarda etki şiddeti ve antagonize etme süresinin karşılaştırılması amaçlanmıştır. Materyal Metod: Prospektif olarak planlanan çalışmaya, elektif cerrahi geçirecek yaşları 18-60 arasında ASA 1-2 olan en az 10 yıldır günde 20 ve daha fazla sigara kullanan ve halen sigara içen 20 hasta ve hiç sigara kullanmamış 20 hasta dahil edildi. Tüm hastalara operasyondan 30 dakika önce 0.03 mg/kg midazolam intravenöz uygulanarak premedikasyonları sağlandı. ??Datex-Ohmeda S/5?? cihazı ile monitorizasyon uygulanarak, EKG, SpO2, TA, vücut sıcaklığı takibi yapıldı. İndüksiyonda 2 mg/kg propofol, 1 mcg/kg fentanil intravenöz uygulandı. Kirpik refleksi kaybından sonra, Datex-Ohmeda S/5 cihazının nöromuskuler monitorizasyon modülüne otomatik olarak supramaksimal uyarı yaptırıldı. Rokuronyum 0,6 mg/kg olacak şekilde intravenöz uygulandı. Kronometre kullanılarak TOF süreleri kaydedildi. T2i süresinde hasta ayni kişi tarafından entübe edildi. 5 dakika aralıklarla TOF değerleri ölçüldü. T2d süresi klinik etki süresi olarak kaydedildi. Operasyon esnasında TOF Count 2 değerine ulaştığında 0,15 mg/kg rokuronyum hastaya uygulandı. Anestezinin idamesi %50 O2 + %50 hava ve sevofluran % 2 ile sürdürüldü. Operasyon bitiminde son rokuronyum dozundan en az 15 dakika sonra sugammadeks 2 mg/kg yapıldı. TOF 0,7-0,8-0,9 değerlerine ulaşma süreleri kaydedildi. Bulgular: Çalışmamızda sigara içen grupta entübasyon süresi; 132,8±46,4 saniye iken sigara içmeyen grupta; 127,6±32,7 saniye olarak bulundu. Sigara içen grupta klinik etki süresi; 35,1±9,4 saniye iken içmeyen grupta; 36,3±12,8 olarak bulundu. Sigara içen grupta TOF 0,7 değerine ulaşma süresi; 153,3±54,7 saniye, içmeyen grupta; 125±67,2 saniye, içen grupta TOF 0,8 değerine ulaşma süresi; 178,4±58,8 saniye, içmeyen grupta; 146,6±72,6 saniye ve içen grupta TOF 0,9 değerine ulaşma süresi; 200,8±55,8 saniye, içmeyen grupta; 170,4±77,8 saniye olarak bulundu. Gruplar arasında entübasyon süresi, klinik etki süresi, TOF 0,7?e ulaşma süresi, TOF 0,8?e ulaşma süresi, TOF 0,9?a ulaşma süresi açısından istatistiksel anlamlılık bulunamadı. Sonuç: Biz çalışmamızın sonucunda, sigara içen grupta ve sigara içmeyen grupta TOF geri dönüş zamanlarımızda istatiksel olarak anlamlılık gözlemlemedik. Tüm vücut sistemleri üzerine olumsuz etkileri olan sigaranın sugammadeks kullanımı açısından değerlendirilmesi için farklı bakış açılarıyla ve daha geniş popülasyonlu çalışmalara ihtiyaç olduğunu düşünmekteyiz. ANAHTAR SÖZCÜKLER: Genel anestezi, sugammadeks, sigara, rokuronyum
Aim: In this study we aim to compare the time of antagonism and intensity of effect of sugammadex that is used for antagonism of rocuronium which is a non-depolarizing neuromuscular blocker on smokers and non-smokers. Material method: In the prospectively planned study, 20 smokers aged between 18-60 who were ASA 1-2 and have been smoking 20 or more cigarettes per day for at least 10 years and 20 non-smoker who were undergoing elective surgery were included. All patients were premedicated by being given 0.03 mg/kg midazolam ıv for 30 minutes before the surgery. EKG, SpO2, TA and heat of the body were monitorized by ``Datex-Ohmeda S/5??. 2 mg/kg propofol, 1 mcg/kg fentanyl ıv was given in induction. After the loss of lash reflexion, the neuromuscular monitorization module of Datex-Ohmeda S/5 was automotically made to give supramaximal warning. Intravenöz was applied by keeping Rocuronium 0,6 mg/kg. TOF times were recorded with timekeeper. During T2i, the patient was entubated by the same person. TOF amount was measured every 5 minutes. T2d time was recorded as the clinical effect time. During the operation when TOF level was 2, 0,15 mg/kg was applied to the patient. Anesthesia was kept with %50 O2 + %50 air and % 2 sevoflorane. At the end of the surgery, after applying last rocuronium doze at least 15 minutes later 2 mg/kg was applied. The time of TOF reaching 0,7-0,8-0,9 levels were recorded. Result: In our study the entubation time in smokers were 132,8 ± 46,4 whereas 127,6 ± 32,7 in non-smokers. The clinical effect time in smokers were 35,1 ± 9,4 and 36,3 ± 12,8 in non-smokers. The time of TOF reaching 0,7 level was 153,3 ± 54,7 in smokers and 125 ± 67,2 in non-smokers; the time of TOF reaching 0,8 level was 178,4 ± 58,8 in smokers and 146,6 ± 72,6 in non-smokers and the time of TOF reaching 0,9 level was 200,8 ± 55,8 in smokers and 170,4 ± 77,8 in non-smokers. The entubation time, clinical effect time, the time of TOF reaching 0,7-0,8-0,9 between the groups were statistically irrelevant. Conclusion: We didn?t observe statistically relevance in reversing times of TOF in smokers and non-smokers. We believe different point of views and studies with wider population are needed to evaluate smoking which has negative effects on the whole body system and usage of sugammadex.
Aim: In this study we aim to compare the time of antagonism and intensity of effect of sugammadex that is used for antagonism of rocuronium which is a non-depolarizing neuromuscular blocker on smokers and non-smokers. Material method: In the prospectively planned study, 20 smokers aged between 18-60 who were ASA 1-2 and have been smoking 20 or more cigarettes per day for at least 10 years and 20 non-smoker who were undergoing elective surgery were included. All patients were premedicated by being given 0.03 mg/kg midazolam ıv for 30 minutes before the surgery. EKG, SpO2, TA and heat of the body were monitorized by ``Datex-Ohmeda S/5??. 2 mg/kg propofol, 1 mcg/kg fentanyl ıv was given in induction. After the loss of lash reflexion, the neuromuscular monitorization module of Datex-Ohmeda S/5 was automotically made to give supramaximal warning. Intravenöz was applied by keeping Rocuronium 0,6 mg/kg. TOF times were recorded with timekeeper. During T2i, the patient was entubated by the same person. TOF amount was measured every 5 minutes. T2d time was recorded as the clinical effect time. During the operation when TOF level was 2, 0,15 mg/kg was applied to the patient. Anesthesia was kept with %50 O2 + %50 air and % 2 sevoflorane. At the end of the surgery, after applying last rocuronium doze at least 15 minutes later 2 mg/kg was applied. The time of TOF reaching 0,7-0,8-0,9 levels were recorded. Result: In our study the entubation time in smokers were 132,8 ± 46,4 whereas 127,6 ± 32,7 in non-smokers. The clinical effect time in smokers were 35,1 ± 9,4 and 36,3 ± 12,8 in non-smokers. The time of TOF reaching 0,7 level was 153,3 ± 54,7 in smokers and 125 ± 67,2 in non-smokers; the time of TOF reaching 0,8 level was 178,4 ± 58,8 in smokers and 146,6 ± 72,6 in non-smokers and the time of TOF reaching 0,9 level was 200,8 ± 55,8 in smokers and 170,4 ± 77,8 in non-smokers. The entubation time, clinical effect time, the time of TOF reaching 0,7-0,8-0,9 between the groups were statistically irrelevant. Conclusion: We didn?t observe statistically relevance in reversing times of TOF in smokers and non-smokers. We believe different point of views and studies with wider population are needed to evaluate smoking which has negative effects on the whole body system and usage of sugammadex.
Açıklama
YÖK Tez No: 340610
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation, Anestezi-genel, Anesthesia-general, Nöromusküler ajanlar, Neuromuscular agents, Nöromusküler blok ajanları, Neuromuscular blocking agents, Nöromusküler kavşak, Neuromuscular junction, Rokuronyum, Rocuronium, Sigara içme, Smoking, Sugammadeks, Suggamadex, General anesthesia, sugammadex, smoking, rocuronium
