KORONER ARTER BYPASS CERRAHİSİNDE ANESTEZİ İNDÜKSİYONUNDA ETOMİDAT-MİDAZOLAM VE KETAMİN-MİDAZOLAM KOMBİNASYONLARININ HEMODİNAMİK ETKİLERİNİN KARŞILAŞTIRILMASI

Year 2023, Volume: 14 Issue: 1, 89 - 94, 23.03.2023

Özgür Kömürcü , Aynur Camkıran Fırat , Nilüfer Bayraktar , Atilla Sezgin , Gülnaz Arslan

https://doi.org/10.18663/tjcl.1219943

Cited By: 1

Abstract

Amaç: Ketamin-midazolam veya etomidat-midazolam kombinasyonları ile koroner arter baypas greftleme (KABG) cerrahisinin anestezi indüksiyonunun hemodinamik parametreler üzerindeki etkilerini karşılaştırmayı amaçladık.
Gereç ve Yöntemler: KABG cerrahisi uygulanan 40 yetişkin hasta, prospektif randomize çift kör çalışma için rastgele iki gruba ayrıldı. Ketamin grubu (n = 20) ve Etomidat grubu (n = 20). Anestezi indüksiyonu sonrası her iki grupta intraoperatif ve postoperatif hemodinamik değişkenler, adrenal bez fonksiyonları ve yoğun bakım süreci karşılaştırıldı.
Bulgular: Perioperatif hemodinamik parametreler gruplar arasında anlamlı farklılık göstermedi. Benzer başlangıç ölçümlerine rağmen kortizol seviyeleri, indüksiyondan 5 dakika sonra, yeniden ısınma sırasında ve postoperatif 1. gün ACTH stimülasyon testinden sonra grup ketaminde, grup etmidata göre anlamlı derecede yüksekti. Gruplar arasında postoperatif mekanik ventilasyon süresi, postoperatif deliryum sıklığı, yoğun bakım ve hastanede kalış süreleri açısından anlamlı fark yoktu.
Sonuç: Hemodinamik stabilite açısından ketamin-midazolam kombinasyonu, etomidat-midazolam kombinasyonuna göre kabul edilebilir bir alternatiftir. Ketamin-midazolam kombinasyonu ile karşılaştırıldığında, etomidat-midazolam kombinasyonu, intraoperatif ve erken postoperatif dönemlerde kortizol seviyelerini önemli ölçüde azaltır.

Keywords

Koroner arter bypas greftleme,, hemodinamik instabilite,, adrenal süpresyon,, etomidat,, ketamin

Thanks

Çalışmada destek ve katkısı için Prof. Dr. Arash Pirat hocamıza çok teşekkür ederiz.

Comparison of the hemodynamic effects of etomidate-midazolam and ketamine-midazolam combinations in anesthesia induction in coronary artery bypass surgery

Abstract

Aims: We aimed to compare the effects of anesthesia induction on hemodynamic parameters of ketamine-midazolam or etomidate-midazolam combinations and coronary artery bypass grafting surgery.
Material and Methods: 40 adult patients undergoing CABG were randomly allocated into two groups for this prospective randomized double-blinded study. Ketamine group (n = 20) and Etomidate group (n = 20). Intraoperative and postoperative hemodynamic variables, adrenal gland functions and intensive care period were compared after anesthesia induction with etomidate and ketamine.
Results: Perioperative hemodynamic parameters were not significantly different between the groups. Despite similar baseline measurements, cortisol levels were significantly higher 5 minutes after induction, during rewarming, and after ACTH stimulation test at postoperative day 1 in group ketamine than group etmidate. The groups were not significantly different in terms of duration of postoperative mechanical ventilation, frequency of postoperative delirium, and intensive care unit and hospital lengths of stay.
Conclusion: Ketamine-midazolam combination is an acceptable alternative to etomidate-midazolam combination in terms of hemodynamic stability. Compared with the ketamine-midazolam combination, the etomidate-midazolam combination significantly decreased cortisol levels during the intraoperative and early postoperative periods

Keywords

Coronary artery bypass grafting, hemodynamic instability, adrenal suppression, etomidate, ketamine

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