GKD Anest Yoð Bak Dern Derg. 2014; 20(4): 195-201 | DOI: 10.5222/GKDAD.2014.195

Koroner Bypass Cerrahisinde Sevofluran ve Desfluranýn Miyokardiyal Koruma Üzerine Etkilerinin Propofol ile Karþýlaþtýrýlmasý

Esin Erdem¹, Belkýs Tanrýverdi², Dilek Ceyhan^2
1Bozüyük Devlet Hastanesi Anesteziyoloji Ve Reanimasyon Kliniði, Bilecik,türkiye
²Osmangazi Üniversitesi Týp Fakültesi Anesteziyoloji Ve Reanimasyon Anabilim Dalý, Eskiþehir, Türkiye

AMAÇ: Amaç: Bu çalýþmanýn amacý kardiyopulmoner bypass (KPB) cerrahisi uygulanacak hastalarda sevofluran ve desfluranýn miyokard üzerindeki koruyucu etkilerini propofolün miyokard üzerindeki koruyucu etkileri ile miyokard hasarlanma belirteçleri kullanarak karþýlaþtýrmaktýr.
YÖNTEMLER: Etomidat 0.3 mgkg-1 ile anestezi indüksiyonundan sonra 0.1 mgkg-1 pankuronyum verildi. Anestezi idamesi Grup S: sevofluran (n: 20) %2-4, Grup D: desfluran (n: 20) %7-8 veya Grup K: propofol 50 µgkg-1 dk-1 ile saðlandý. Anestezi indüksiyonu öncesi, aort klempi kaldýrýldýktan sonra, postoperatif 2. ve 24 saatte alýnan kan örnekleri alýndý. Tüm kan örneklerinden Troponin I, kreatinin kinaz (CK) ve kreatinin kinaz MB (CKMB) deðerleri ölçüldü. Ayrýca aortaya klemp yerleþtirildikten sonra, aort klempi kaldýrýldýktan sonra ve protomin uygulamasý sonrasý alýnan kan örneklerinde malon (il) dialdehit (MDA) deðerleri ölçüldü.
BULGULAR: Gruplar arasýnda demografik veriler, greft sayýsý ve KPB pompa süresi açýsýndan istatistiksel yönden fark yoktu. Troponin I ve CK düzeyleri aort klempi kaldýrýldýktan sonra, postoperatif 2. ve 24 saatte tüm gruplarda arttý. Ancak bu artýþ gruplar karþýlaþtýrýldýðýnda istatistiksel yönden anlamlý deðildi. Yine MDA düzeyindeki artýþlarda istatistiksel yönden anlamlý deðildi. Tüm gruplardaki CKMB düzeyleri postoperatif 2. ve 24. saatte arttý ancak bu artýþ sevofuran grubunda desfluran ve propofol grubuna göre daha azdý.
SONUÇ: Sevofluran, desfluran ve propofol benzer kardiyak koruyucu etkiye sahiptir.

Anahtar Kelimeler: sevofluran, desfluran, miyokardiyal koruma, koroner bypass cerrahisi

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Effects of Sevoflurane and Desflurane on Myocardial Protection in Comparison with Propofol in Coronary Bypass Surgery

Esin Erdem¹, Belkýs Tanrýverdi², Dilek Ceyhan^2
1Department Of Anesthesiology And Reanimation,bozuyuk Goverment Hospital, Bilecik, Turkey
²Department Of Anesthesiology And Reanimation, Osmangazi University, Eskiþehir, Turkey

OBJECTIVE: The aim of this study is to compare with myocardial protective effects of sevoflurane and desflurane and myocardial protective effects of propofol via markers of myocardial injury in cardiopulmoner bypass graft surgery (CPB).
METHODS: After induction of general anesthesia with etomidate 0.3 mg/kg, a bolus dose of pancuronium 0.1 mg/kg was administered. For the maintenance of anesthesia, patients received either Group S: sevoflurane (n: 20) at 2-4%, Group D: desflurane (n: 20) at 7-8 % and Group K: propofol 50 µgkg-1 dk-1. Arterial blood samples were obtained as follows: before induction of anesthesia, after aortic unclamping, at postoperative 2nd hour and 24th hours. Troponin I, creatine kinase (CK) and creatine kinase-MB (CKMB) values were measured in all obtained samples. In addition arterial blood samples were obtained after aortic unclamping, after aortic unclamping and after protomine infusuion, malonil dialdehyde (MDA) was measured.
RESULTS: No statistically significant difference was found among the groups with respect to demographic characteristics, number of grafts, CPB pump duration. Troponin I and CK levels of all groups were increased after aortic clamp placement, at postoperative 2nd and 24th hours. However these increases were not statistically significant. Also, there was no significant increase of MDA level measurements on all groups. Kreatinin kinaz MB levels of all groups were increased postoperative 2nd and 24th hours but this increase in sevoflurane group is lesser than in propofol and desflurane groups.
CONCLUSION: Sevoflurane, desflurane and propofol have similar cardioprotective characteristics.

Keywords: sevoflurane, desflurane, myocardial protection, coronary bypass surgery

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