Kardiyak riskli hastalarda major alt extremite cerrahisi sonrası genel, lumbal epidural anestezi ve torakal epidural analjezinin BNP, ANP, katekolaminler ve troponin-ı salınımına etkisi

CELALETTİN DAĞLI

Kardiyak riskli hastalarda major alt extremite cerrahisi sonrası genel, lumbal epidural anestezi ve torakal epidural analjezinin BNP, ANP, katekolaminler ve troponin-ı salınımına etkisi

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Ataturk University, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Turkey

Approval Date: 2007

Thesis Language: Turkish

Student: CELALETTİN DAĞLI

Supervisor: Canan Atalay

Open Archive Collection: AVESIS Open Access Collection

Abstract:

In this study; the impact of three different anesthesia methods management on BNP, ANP, E,NE, cardiac troponin-I relase in the patients having cardiac risk and who will have major low extremity surgery was aimed. The patients was randomized and divided into three groups, each of them 20 people. General anesthesia for group GA, lumbar epidural anesthesia for group LEA and general anethesia+thoracic epidural analgesia for group TEA. Th4-5 from epidural catheter was kept on intra-postoperatively in such on may that the level of analgesia will be among Th1-8 (0.1% bupivakaine+50 ?gr fentanyl) while anesthesia induction in GA and TEA groups is made by thiopenthal+rocuronyum bromür, continuation of anesthesia was supplied by means N2O+sevoflurane and postoperative IV patient controlled analgesia was applied (morfine). In LEA groups epidural anesthesia from L2-4 level was applied (0.5% bupivakaine+50 ?gr fentanyl), postoperative analgesia was made from epidural cathater (3 mgr morphine+50 ?gr fentanyl). At the and of the operation after, 90 minutes of the postoperative skin incision of the patients, their ANP, BNP, E, NE and cardiac troponin-I levels were measured on the first, second and thirt postoperative days. There were no differences among the groups in terms of demographic input. During the perioperative period mean arterial pressure and heart rate in the group TEA (79.7mmHg, 68.2/min), were comprehesibly low as to Group GA (83.2mmHg, 80.1/min) and Group LEA (84.1mmHg, 80.5/min) (p<0,01). The starting values of ANP and BNP were smilar but with the surgery they began to increase understandably (p<0.01). On the other hant after the surgery ANP and BNP levels were understandably low in LEA (8.4 pg/mL; 130 pg/mL) group compared to those in the group GA (10 pg/mL; 162 pg/mL) and also low in group TEA (6.1 pg/mL; 69 pg/mL) compared to both (p<0,001). From the first day of the postoperative day the ANP and BNP values began to decrease, but the differences among the groups did not change and in all groups remained above the postoperative values until the thirth postoperative day. The plasma catecolamines were smilar at the begining, the values began to increase with surgical cautions. The values of NA did not show the difference between groups but the values of E was significantly lover in group TEA (632 pg/mL), in terms of group LEA (971 pg/mL) and group GA (1117 pg/mL) (p<0,001). The values of the plasma cardiac troponin-I remained same in all groups from the on-set (0.1pg/mL). In condusion in the patient having risk or who will have major low extremity surgery, observed that LEA had protective impact by reducing BNP release in terms of GA. At the save time by using opioid and local anesthetics were detected that TEA reduced BNP release significantly in terms of LEA and GA so if general anesthesia in administreted for coroner disease or to the patient with risk, we suggest that thoracal epidural analgesia should be given and used routinely. Key words: Coroner arter disease, thoracal epidural analgesia, lumbal epidural anesthesia, ANP, BNP, E, NE, Troponin-I