Fotopletizmografsko ispitivanje simpatičke blokade izazvane lumbalnom epiduralnom anestezijom bupivakainom i S-(+) ketaminom

Mihaljević, Slobodan (2006) Fotopletizmografsko ispitivanje simpatičke blokade izazvane lumbalnom epiduralnom anestezijom bupivakainom i S-(+) ketaminom. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Photoplethysmographic signal was analyzed using Biopac computer system. In order to quantify the signal power, we parallely identified the values of signal power parameters: pp, max, min, area, slope. Algorithms were used to detect marked points on PPG signal. Puls transit time was analyzed using parallely recorded ECG. Relations between t2/t1, p2/p1 and v/p1 were analyzed. Photoplethysmographic data was taken before anaesthesia, after infusion of crystaloids and after perydural lumbal sympathetical blockade. Instantaneously, the concentration of stress hormones (adrenalin, nor--adrenalin and cortisol) in plasma was quantified twice, before and after maximal lumbal sympatheticl blockade. The aim was to study out the possibilities that 0,5% of bupivacaine and low doses (25 mg) of S-(+)-ketamine could have on patients subjected to operation in epidural anaesthesia, which was recorded by PPG. Parameters were tested with Mann-Withney U-test, Wilcoxon’s pair test, Friedman ANOVA and analysis of variance with repeated assessment. Statistical analysis was made on PC using programme Statistica 6. Results: There were no significant statistical changes in power of signal partameters, time parameters, pulse transit time, analysis of pulse curve and derivated parameters for estimating arterial compiliance between the group where bupivacaine was used for epydural blockade and the group where S-(+)-Ketamine was used alongside bupivacain. Concentration of stress hormones in plasma changes were not recorded after epidural anaesthesia and before skin cut they were within the referent values in all groups of patients. Epidural addition of 25 mg S-(+)-Ketamine to 0,5% bupivacaine hasn't got an oppressive effect neither on sympathetical tonus below the level of epydural blockade, neither on hemodynamic, it doesn't lead to additional micro- or macrocirculation changes. Among useful features regarding improved qualities o anaesthesia and without having an effect on sympathetic nervous system below the level of blockade, these acquisitions contribute the more safety leading of epydural anaesthesia with addition of S-(+)-Ketamine.

Abstract in Croatian

Fotopletizmografski signal obrađen je kompjuterskom analizom Biopac sustavom. Za kvanitificiranje jačine signala paralelno su identificirane vrijednosti parametara jačine signala pp, max. ,min, area, slope. Za prepoznavanje vremenskih točaka korištene su oznake. Vrijeme prijenosa pulsa anlizirano je u pomoć paralelno snimanog EKG-a. Analizirani su odnosi t2/t1,P2/p1 ,v/p1.. Fotopletizmografski podaci su uzimani prije anestezije, poslije infuzije kristaloida i nakon epiduralne lumbalne simpatičke blokade. Istovremeno je kvantificirana koncentracija stresnih hormona u plazmi (adrenalin, noradrenalin i kortizol) u dva vremena prije i u vremenu maksimalne lumbalne simpatičke blokade. Cilj je bio istražiti kod bolesnika podvrgnutih operacijskom zahvatu u epiduralnoj anesteziji mogućnosti utjecaja 0,5% bupivacaina i niskih doza (25 mg) S-(+) ketamina datih u epiduralnoj anesteziji na PPG signale zabilježene PPG metodom. Parametri su testirani Mann-Whitney U-test, Wilcoxonov testom parova, Friedman ANOVA, analizom varijance s ponovljenim mjerenjem. Statistička obrada napravljena je na PC računalu u programu Statistica 6. Rezultati: Ne postoje značajne statističke promjene parametara jačine signala,vremenskih parametara trajanja, vremena prenosa pulsa, analize krivulje pulsa te izvedenih parametara za procjenu arterijske komplijanse između skupine je u kojoj je za epiduralnu blokadu korišten bupivakain i skupine u kojoj je uz bupivakain korišten S-(+) ketamin. Nisu evidentirane promjene koncentracije stresnih hormona u plazmi poslije epiduralne anestezije, a prije kožnog reza van referentnih područja niti u jednoj skupini bolesnika. Epiduralni dodatak 25 mg S-(+) ketamina o,5% bupivakainu ne djeluje deprimirajuće na tonus simpatikusa ispod nivoa epiduralne blokade, drugim riječima epiduralni dodatak S-(+) ketamina ne odražava se deprimirajuće na hemodinamiku , ne dovodi do dodatnih makro i mikrocirkulacijskih promjena. Uz korisne osobine poboljšanja kvaliteta anestezije i uz izostanak učinka na simpatikus ispod nivoa blokade ove spoznaje doprinose sigurnijem vođenju epiduralne anestezije s dodatkom S-(+) ketamina.

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