20.500.12556/DKUM-40455 Z BISPEKTRALNIM INDEKSOM VODEN UVOD V ANESTEZIJO PRI VELIKIH OPERACIJAH V TREBUŠNI VOTLINI: PRIMERJAVA UVODA Z ETOMIDATOM IN PROPOFOLOM Bispectral index guided induction of general anaesthesia in patients scheduled for major abdominal surgery: propofol versus etomidate Izhodišče – Namen naše dvojno slepe randomizirane raziskave je bila primerjava hemodinamskih učinkov z bispektralnim indeksom (BIS) vodene infuzije etomidata in propofola pri bolnikih, predvidenih za veliko operacijo v trebušni votlini. Metode – 46 bolnikov, predvidenih za veliko operacijo v trebušni votlini zaradi raka, smo naključno razporedili v dve skupini. Skupina E je za uvod v anestezijo dobila infuzijo etomidata, skupina P pa infuzijo propofola. Oba anestetika smo odmerjali do vrednosti BIS 60. Hitrost infuzije je bila 0,5 mg/kg/min za propofol in 0,05 mg/kg/min za etomidat. Meritve srednjega arterijskega tlaka (SAT), indeksa minutnega volumna srca (MVSI), indeksa sistemskega žilnega upora (SŽUI) in srčne frekvence (SF) smo začeli eno minuto pred odmerjanjem fentanila in jih nato ponavljali vsako minuto v naslednjih 20 minutah. Prav tako smo merili čas od začetka infuzije anestetika do: izgube palpebralnega refleksa, vrednosti BIS 60 in vstavljanja dihalne cevke. Zapisali smo porabljen odmerek anestetika. Vrednost p < 0,05 smo obravnavali kot statistično značilno. Rezultati – V analizo je bilo vključenih 46 bolnikov. Pred in med vstavljanjem dihalne cevke glede SAT, MVSI, SŽUI, SF, BIS in saturacije ni bilo statistično značilnih razlik med skupinama, le vrednost SAT je bila v skupini E med vstavljanjem dihalne cevke statistično značilno večja glede na skupino P (p = 0,019). Po vstavitvi dihalne cevke je bila vrednost SAT v skupini E statistično značilno večja od vrednosti v skupini P 1 (p = 0,002), 2 (p = 0,000), 3 (p = 0,002), 4 (p = 0,002), 5 (p = 0,018), 6 (p = 0,012) in 7 (p = 0,004) minut po vstavitvi. V skupini E je bila vrednost MVSI statistično značilno večja 2 (p = 0,039), 6 (p = 0,038) in 7 (p = 0,024) minut po vstavitvi dihalne cevke, medtem ko so bile razlike v vrednosti MVSI med skupinama 3 (p = 0,093), 4 (p = 0,055) in 5 (p = 0,068) minut po vstavitvi dihalne cevke na meji statistične značilnosti. V skupini E so bile večje kot v skupini P. Vrednosti SŽUI in SF se celoten čas po vstavitvi dihalne cevke med skupinama niso statistično značilno razlikovale. Med vstavljanjem dihalne cevke sta se vrednosti SAT in SF v skupini E statistično neznačilno razlikovali od izhodne vrednosti, medtem ko je bila vrednost SAT v skupini P statistično značilno nižja od izhodne vrednosti, vrednost SF pa se od izhodišča ni statistično značilno razlikovala. V obeh skupinah je bila vrednost MVSI v času od 3. minute pred vstavljanjem dihalne cevke do konca meritev statistično značilno manjša od izhodne vrednosti. Pri 23 bolnikih so se pojavili zapleti, ki so zahtevali rešilne odmerke zdravil: pri 10 bolnikih v skupini P in pri 13 v skupini E. Glede na pojav zapletov se skupini v splošnem nista razlikovali (p = 0,376). V skupini P je bilo več hipotenzije (p = 0,08), v skupini E pa statistično značilno več hipertenzije (p = 0,007) Zaključek – Z raziskavo smo ugotovili, da je uporaba propofola za uvod v anestezijo povezana z manj hipertenzije in tahikardije med vstavljanjem dihalne cevke v primerjavi z uporabo etomidata. Kljub temu, da so bili potrebni odmerki propofola zaradi odmerjanja glede na ustrezno globino anestezije manjši od sicer priporočenih enkratnih odmerkov v literaturi, je bila uporaba propofola pogosto povezana s pojavom hipotenzije po vstavitvi dihalne cevke. Prav tako smo ugotovili, da uporaba etomidata ni bila povezana z večjo stabilnostjo obtočil, saj so se pri bolnikih pojavljale tako hipertenzija in tahikardija med vstavljanjem dihalne cevke kot tudi hipotenzija in bradikardija po vstavitvi dihalne cevke. Menimo, da bi bilo merjenje globine anestezije (npr. z monitorjem BIS) lahko primerno orodje za prilagajanje odmerka hipnotika med uvodom v anestezijo pri posameznem bolniku. Background – The purpose of this study was to compare bispectral index (BIS) guided infusion of etomidate and propofol at anaesthesia induction with special reference to hemodynamic effects in patients scheduled for major abdominal surgery due to cancer. Methods – Fourty-six patients scheduled for major abdominal surgery due to cancer were randomly assigned to two gropus based on the induction of anaesthesia, which was performed with either an infusion of etomidate (E group) or propofol (P group). Both anaesthetics were titrated to a BIS value of 60. The speed of infusion was 0.5 mg/kg/min for propofol and 0.05 mg/kg/min for etomidate. Mean arterial pressure, cardiac index, heart rate and systemic vascular resistance index measurements were started 1 minute before intravenous fentanyl administration and were recorded every minute for 20 minutes. The time from the start of the anesthetic infusion until: the loss of palpebral reflex, the decrease of BIS value to 60 and the orotracheal intubation were measured. The total amount of the anesthetic dose was recorded. P < 0.05 was considered statistically significant. Results – Fourty-six patients were included in the analysis. Before and at intubation, there were no significant differences among the two groups with respect to mean arterial pressure, cardiac index, systemic vascular resistance index, bispectral index and saturation. At intubation, only mean arterial pressure was significantly higher in the E group (p=0.019). After intubation, mean arterial pressure was significantly higher 1 (p = 0.002), 2 (p = 0.000), 3 (p=0.002), 4 (p=0.002), 5 (p=0.018), 6 (p=0.012), and 7 (p=0.004) minutes after intubation in the E group with respect to the P group. In the E group, cardiac index was significantly higher 2 (p=0.039), 6 (p=0.038) and 7 (p=0.024) minutes after intubation, whereas 3 (p=0.093), 4 (p=0.055) and 5 (p=0.068) minutes after intubation the difference between the groups was on the limit of statistical significance. After intubation, there were no significant differences among the two groups with respect to systemic vascular resistance index and heart rate. In the E group, mean arterial pressure and heart rate increased during intubation and reached aproximately the baseline value. In the P group mean arterial pressure did not change at intubation and remained significantly decreased with respect to baseline, whereas there was no significant difference in heart rate compared to baseline. In both groups, cardiac index was significantly decreased from 3 minutes before intubation until the end of the measurements compared to baseline. Twenty-three patients developed complications; ten in the propofol group and thirteen in the etomidate group. There were no significant differences among the groups with respect to complications overall (p=0.376). The incidence of hypotension was higher in the P group than in the E group (8 vs. 3; p=0.08) and the incidence of hypertension was significantly higher in the E group than in the P group (10 vs. 2; p=0.007). Conclusions – Our study showed that the use of propofol resulted in less hypertension and tachycardia at and after intubation than etomidate. But even with the reduced doses given with the BIS-guided protocol, it often caused significant hypotension. On the other side, the use of etomidate was not associated with a more stable haemodynamics. Etomidate was associated with more hypertension and tachycardia during intubation and in some cases also caused hypotension and bradycardia after intubation. In our opinion, measuring anaesthesia depth (e.g. with BIS monitor) might be a good option to customize the anesthesia for each patient. etomidat propofol bispektralni indeks indeks minutnega volumna srca etomidate propofol bispectral index cardiac index true false false Slovenski jezik Angleški jezik Doktorska disertacija 2013-05-21 08:16:24 2013-06-03 10:48:00 2022-05-12 23:41:16 2021-04-23 03:34:09 2013 0 Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 512289592 URN:SI:UM:DK:WR5JKBKB DR_Moller_Petrun_Andreja_2013.pdf DR_Moller_Petrun_Andreja_2013.pdf 1 569E5228929EE1B1CFFE8C305DD49AE9 fcbb2ef3247f4e0c8f87d6d4509d707fef309a02f1781a5bbd15afb7511c9f46 f3c07fb0-7c09-11eb-bb7a-00155d0001ca 20.500.12556/dkum/01e348e7-fd9f-457d-a4c0-2f07fde24221 https://dk.um.si/Dokument.php?lang=slv&id=55354 Medicinska fakulteta 0 0 0