Sigara Kullanımının Nöromuskuler Bloğun Geri Döndürülmesi Üzerine Etkisi
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Dosyalar
Tarih
2016
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Rokuronyum orta etki başlama süresine sahip, aminosteroid yapıda non depolarizan steroid kas gevşeticidir ve ideal kas gevşetici bulma çabaları sonucunda klinik amaçlı kullanılmaya başlanmıştır. Postoperatif kürarizasyon (PORC) non-depolarizan kas gevşeticilerin etkisinin uzaması sonucu ortaya çıkar. Bu önemli sorun günümüzde hala yaygındır ve hasta güvenliğini ciddi bir şekilde etkilemektedir. Literatür taramamızda sigara içiminin nöromuskuler bloğun etkisini ortadan kaldırmak ve PORC'dan kaçınmak için daha sık kıllanılan sugammadex üzerine etkisini araştıran bir çalışma bulunmamıştır. Bu çalışmanın amacı sigara kullanımının rokuronyum bromürü antagonize etmek için kullanılan sugammadexin etkinliği üzerine etkisini araştırmaktır. Yöntemler: Prospektif randomize çalışmaya ASA 1-2; son 10 yıldır sigara içen veya hiç içmeyen elektif cerrahi hazırlığı yapılan hastalar dahil edildi. Hastalara rutin vital bulgu monitorizasyonu ve nöromuskuler monitörizasyon uygulandı. Anestezi indüksiyonunda 2 mg kg-1 propofol, 1 mcg kg-1 fentanyl IV verildi. Kornea refleksi kaybolduktan sonra 0,6 mg kg-1 rokuronyum bromur IV uygulandı. Dörtlü uyarı (TOF) 2 düzeyine ulaşıldığında hastalar entübe edildi. İdame %50 O2 , %50 hava ve %2 sevoflurane ile sağlandı. TOF 2 olduğunda 0,5 mg kg-1 rokuronyum bromür uygulandı. Operasyon sonunda 2 mg kg-1 sugammadeks uygulandı. TOF değerinin 0,7-0,8-0,9 olma süreleri kaydedildi. Bulgular: Sigara içenlerde entübasyon süresi 132,846,4 sn, iç- meyenlerde 127,632,7 sn bulundu. Sugammadeks uygulandıktan sonar sigara içenlerde TOF 0,7 153,354,7 sn ile içmeyenlerde 12567,2 sn bulundu. TOF 0,8'e ulaşma süresi sigara içenlerde 178,458,8 ile içmeyenlerde 146,672,6 sn bulundu. TOF 0,9'a ulaşma süresi sigara içenlerde 200,855,8 sn iken sigara içmeyenlerde 170,477,8 sn bulundu. Sonuç: İstatistiksel olarak anlamlı olmasada TOF süreleri sigara içenlerde daha uzun bulundu. Sigara kullanımının sugammadeks kullanımı üzerine etkisinin araştırılması için daha geniş örneklem gruplarında yapılan çalışmalara ihtiyaç vardır.
Objective: Rocuronium is a non-depolarising, intermediate-acting, monoquaternary amino steroid and was brought into clinical use as a potentially ideal muscle relaxant. Post-operative residual curarisation (PORC) results from the prolonged effects of non-depolarising neuromuscular blocking agents. This is a common problem and seriously affects patient safety. No recent study has investigated the effects of sugammadex on smokers, which is often used to restore neuromuscular block and avoid PORC. This study compares the severity of the effects of sugammadex used for antagonising rocuronium bromide and antagonism durations in smokers and non-smokers. Methods: This randomised, prospective study included 40 patients scheduled for elective surgery and belonging to classes I and II based the American Society of Anesthesiologists classification, who were either smokers for at least 10 years or non-smokers. Patients underwent routine and neuromuscular monitoring. At induction, 2 mg kg1 propofol and 1 mcg kg1 intravenous fentanyl were applied. After the loss of eyelash reflex, 0.6 mg kg1 intravenous rocuronium was administered. Patients were intubated at train of four (TOF) 2. Anaesthesia was continued with 50% O2 50% air and 2% sevoflurane. Rocuronium, 0.15 mg kg1, was administered at TOF 2 during the operation. At the end of the operation, 2 mg kg1 sugammadex was administered. The times until TOF 0.7, 0.8 and 0.9 were recorded. Results: Intubation time was 132.846.4 s for smokers and 127.632.7 s for non-smokers. After sugammadex administration, the time to TOF 0.7 was 153.354.7 s in smokers and 12567.2 s in non-smokers. The times were 178.458.8 and 146.672.6 s for TOF 0.8 and 200.855.8 s and 170.477.8 s for TOF 0.9 in smokers and non-smokers, respectively. Conclusion: Although not statistically significant, the time to reach each TOF was longer for smokers. Larger populations and different perspectives are needed to find if sugammadex use is affected by smoking, which has negative effects on the body.
Objective: Rocuronium is a non-depolarising, intermediate-acting, monoquaternary amino steroid and was brought into clinical use as a potentially ideal muscle relaxant. Post-operative residual curarisation (PORC) results from the prolonged effects of non-depolarising neuromuscular blocking agents. This is a common problem and seriously affects patient safety. No recent study has investigated the effects of sugammadex on smokers, which is often used to restore neuromuscular block and avoid PORC. This study compares the severity of the effects of sugammadex used for antagonising rocuronium bromide and antagonism durations in smokers and non-smokers. Methods: This randomised, prospective study included 40 patients scheduled for elective surgery and belonging to classes I and II based the American Society of Anesthesiologists classification, who were either smokers for at least 10 years or non-smokers. Patients underwent routine and neuromuscular monitoring. At induction, 2 mg kg1 propofol and 1 mcg kg1 intravenous fentanyl were applied. After the loss of eyelash reflex, 0.6 mg kg1 intravenous rocuronium was administered. Patients were intubated at train of four (TOF) 2. Anaesthesia was continued with 50% O2 50% air and 2% sevoflurane. Rocuronium, 0.15 mg kg1, was administered at TOF 2 during the operation. At the end of the operation, 2 mg kg1 sugammadex was administered. The times until TOF 0.7, 0.8 and 0.9 were recorded. Results: Intubation time was 132.846.4 s for smokers and 127.632.7 s for non-smokers. After sugammadex administration, the time to TOF 0.7 was 153.354.7 s in smokers and 12567.2 s in non-smokers. The times were 178.458.8 and 146.672.6 s for TOF 0.8 and 200.855.8 s and 170.477.8 s for TOF 0.9 in smokers and non-smokers, respectively. Conclusion: Although not statistically significant, the time to reach each TOF was longer for smokers. Larger populations and different perspectives are needed to find if sugammadex use is affected by smoking, which has negative effects on the body.
Açıklama
Anahtar Kelimeler
Anestezi
Kaynak
Turkish Journal of Anaesthesiology and Reanimation
WoS Q Değeri
Scopus Q Değeri
Cilt
44
Sayı
4
