2024-03-28T10:55:13Z
http://medlib.mef.hr/cgi/oai2
oai:medlib.mef.hr:1682
2012-11-15T14:18:22Z
7374617475733D756E707562
7375626A656374733D574F:574F323030:5730323735
74797065733D746865736973
http://medlib.mef.hr/1682/
Usporedba sevofluranske anestezije i TIVA-e s obzirom na hemodinamske i biokemijske pokazatelje funkcije srca nakon velikih abdominalnih operacija
Kopić, Jasminka
WO 275-297 General Anesthesia
A lot of surgical patients with colorectal cancer are older patients, often with a significant coexisting cardiac disease. Despite improvements in surgery and anesthesiology, postoperative morbidity and mortality in this group of patients have changed little during the last decade. Clinical studies of myocardial preconditon with a volatile anesthetic, especially with sevofluran, have identified beneficial effects in a group of cardiac surgery patients. Based on these facts, this study has investigated the influence of volatile anesthesia with sevofluran on perioperative cardiac function and occurance of ischemic events in abdominal surgery patients.
80 surgical patients with colorectal cancer, undergoing elective abdominal surgery, were devided in two groups. 42 patients in the first group were anesthetized with sevoflurane-balanced anethesia, 38 patients in the second group with a total intravenous anesthesia. Investigation was approved by Ethic committee of General hospital “Dr. Josip Benčević” and Ethic committee of Medical school of University in Zagreb. All patients were given written informed consent. Categorical data was tested with the chi-squared and Fisher′s exact test and continuous data was tested with the Mann-Whitney U test. Groups were comparable regarding sex, age and cardiac risk index.
Troponin I and CKMb were analyzed, as well as cardiac index, cardiac function index and BNP, which represent cardiac ischemic injury and cardiac disfunction, respectively. Heat shock protein (HSP 70) was analyzed as a mediator of the preconditioning process and unspecific response of the cells to stress. There were recorded ICU days, hospital days and hospital mortality as endpoints.
There were no statistic differences between groups regarding Troponin I and CKMb level during perioperative period. During the perioperative period 7,1% of patients in the sevoflurane group and 2,6 patients in the TIVA group had myocardial ischemia. Most patients were ischemic 4 hours after the onset of the operation.
There were no statistic differences regarding hemodynamic variables CI and CFI between the groups. BNP level has raised in both groups of patients after 24 hours, but with no significant difference.
The level of HSP 70 has almost doubled after 24 hours in both groups of patients, but with no signifficant difference between the investigated groups. It suggests that surgical stress has caused synthesis of HSP 70, with no influence of the anesthesia technique. There were no significant differences between the groups regarding hospital stay, ICU stay and hospital mortality.
The results of our study didn′t confirm the preconditioning effect of sevoflurane, which was observed in cardiac surgery patients.
The small number of patients in connection with the possibility of unfavourable cardiac events is the limitation of this study. But nevertheless results are a valuable contribution to a better insight into clinical relevance of the preconditioning phenomenon in general surgical patients
2008-11-24
Thesis
NonPeerReviewed
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http://medlib.mef.hr/1682/1/kopi%C4%87.pdf
Kopić, Jasminka (2008) Usporedba sevofluranske anestezije i TIVA-e s obzirom na hemodinamske i biokemijske pokazatelje funkcije srca nakon velikih abdominalnih operacija. PhD thesis, Sveučilište u Zagrebu.