Kardiyak cerrahide ketaminin antiinflamatuar etkisinin araştırılması
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Ketamin antiinflamatuar etkisi bilinen bir anestezik ajandır. Çalışmamızda kardiyak cerrahi hasta
popülasyonunda intraoperatif ketamin infüzyonu ile bu özelliğin rutin immün-inflamatuar laboratuvar veri
analizleri ile doğrulanıp doğrulanamayacağı test edildi. İntraoperatif parametreler, postoperatif ağrı skorları,
analjezi gereksinimi ve hasta sonuçları üzerine etkileri araştırıldı.
Yöntem: Toplam 160 hasta kontrol grubu (n=80) ve ketamin grubu (n=80) olmak üzere iki gruba ayrıldı.
Ketamin grubunda indüksiyonda (1 mg/kg bolus) ve operasyon boyunca (idamede) (2,4 mg/kg/saat infüzyon)
ketamin verildi. Operasyon odasına alındıktan sonra sedoanaljezi yapıldı. Standart noninvaziv
(elektrokardiyogram, periferik oksijen satürasyonu) ve lokal anestezi altında invaziv arteriyel kan basınç
monitörizasyonları uygulandı. Düzeltilmiş vücut ağırlığına göre intravenöz anestezik ajanlar midazolam (0,1
mg/kg), fentanil (3 μg/kg), rokuronyum (0,6 mg/kg) indüksiyon ve remifentanil (0,1-0,3 μg/kg/dk) ve
sevoflurane (0,5-1 minimal alveolar konsantrasyonda) idamede kullanıldı. Hemodinamik takipler bazal
değerlerin %20 altında ya da üstünde olmasına göre yapıldı. Postoperatif analjezi için operasyonun sonunda
morfin (0,1 mg/kg) ve yoğun bakımda sedoanaljezi için ekstübasyona kadar remifentanil (0,05-0,1 μg/kg/dk) ve
deksmedetomidin (0,5-1 μg/kg/saat) infüzyonu uygulandı. Yoğun bakımda parasetamol (3x1 g) ve kurtarma (ek)
analjezisi olarak tramadol (1 mg/kg) verildi. İntraoperatif hemodinamikleri değerlendirmek için vazoaktif
inotropik skor (VIS) hesaplandı. Preoperatif ve postoperatif 1. gün rutin kan tetkikleri değerlendirilerek immüninflamatuar
parametreler [lökosit, nötrofil, lenfosit ve trombosit sayıları, C reaktif protein (CRP)] ve bunlardan
hesaplanan parametreler [(nötrofil/lenfosit oranı (NLR), NLR-indeksi, delta-NLR, trombosit/lenfosit oranı
(PLR), PRL-indeksi, delta-PLR, SIRI (sistemik inflamasyon yanıt indeksi) ve SII (sistemik immün-inflamasyon
indeksi)] kaydedildi. Postoperatif ekstübasyondan sonra ilk 24 saatte ağrı şiddeti [nümerik rating skala (NRS) ve
Prince Henry Hospital Ağrı Skoru (PHHS)], analjezi gereksinimi, ekstübasyon zamanı, yoğun bakım ve
hastanede kalış süreleri ve ilk 28 günlük mortalite oranları değerlendirildi.
Bulgular: Preoperatif immün-inflamatuar parametreler, gruplar arasında benzerdi. Postoperatif CRP, nötrofil,
NLR, NLR-indeksi, delta-NLR, PLR, delta-PLR, PLR-indeksi, SIRI ve SII ketamin grubunda anlamlı derecede
daha düşüktü (p<0,05). Postoperatif lenfosit, ketamin grubunda anlamlı olarak daha yüksekti (p<0,05). Bununla
birlikte lökosit, trombosit, delta-CRP ve CRP-indeksi gruplar arasında benzerdi (p>0,05). Ketamin grubunda
yoğun bakım ve hastane kalış süreleri anlamlı derecede daha kısa bulunmuş ve 28 günlük mortalite
görülmemiştir (p<0,05). Postoperatif ağrı şiddeti ketamin grubunda daha düşük olmasına rağmen (p<0,05) ek
analjezi ihtiyacı gruplar arasında benzerdi (p>0,05). Ketamin grubunda entübasyondan sonra ilk 5 dakikada
ölçülen sistolik ve ortalama arter basınçları kontrol grubuna göre daha yüksekti (p>0,05). Bununla birlikte
intraoperatif VIS gruplar arasında benzer bulundu (p>0,05).
Sonuç: Kardiyak cerrahide ketaminin antiinflamatuar etkinliği NLR ve PLR hesaplamaları ile de gösterildi. Bu
hasta hastalarda operasyon boyunca ketamin infüzyonu inflamatuar yanıtı azaltmakta etkin bulundu. Ayrıca
ketamin postoperatif akut ağrı, yoğun bakım ve hastanede kalış süreleri ve mortalite üzerine olumlu etkilere
sahip gibi gözükmektedir.
Objective: Ketamine is an anesthetic agent with known anti-inflammatory effect. In our study, we tested whether this feature could be confirmed by routine immune-inflammatory laboratory data analysis with intraoperative ketamine infusion in the cardiac surgery patient population. The effects on intraoperative parameters, postoperative pain scores, analgesia requirement and patient outcomes were investigated. Method: A total of 160 patients were divided into two groups as the control group (n=80) and the ketamine group (n=80). In the ketamine group, ketamine was given during induction (1 mg/kg bolus) and throughout the operation (maintenance) (2.4 mg/kg/hour infusion). After he was taken to the operating room, sedoanalgesia was performed. Standard noninvasive (electrocardiogram, peripheral oxygen saturation) and invasive arterial blood pressure monitoring were performed under local anesthesia. Intravenous anesthetic agents based on body weight corrected midazolam (0.1 mg/kg), fentanyl (3 μg/kg), rocuronium (0.6 mg/kg) induction and remifentanil (0.1- 0.3 μg/kg/min) and sevoflurane (at a minimal alveolar concentration of 0.5-1) were used for maintenance. Hemodynamic follow-ups were made according to 20% below or above baseline values. Morphine (0.1 mg/kg) was administered at the end of the operation for postoperative analgesia, and remifentanil (0.05-0.1 μg/kg/min) and dexmedetomidine (0.5-1 μg/kg/hour) infusion until extubation for sedoanalgesia in the intensive care unit. Paracetamol (3x1 g) and tramadol (1 mg/kg) as rescue (additional) analgesia were given in the intensive care unit. The vasoactive inotropic score (VIS) was calculated to evaluate intraoperative hemodynamics. Preoperative and postoperative 1st day routine blood tests were evaluated and immune-inflammatory parameters [leukocyte, neutrophil, lymphocyte and platelet counts, C-reactive protein (CRP)] and parameters calculated from these [(neutrophil/lymphocyte ratio (NLR), NLR-index, delta] -NLR, platelet/lymphocyte ratio (PLR), PRL-index, delta-PLR, SIRI (systemic inflammation response index), and SII (systemic immune-inflammation index)] were recorded. Pain severity [numerical rating scale (NRS) and Prince Henry Hospital Pain Score (PHHS)] in the first 24 hours after postoperative extubation, analgesia requirement, extubation time, intensive care and hospital stay, and first 28-day mortality rates were evaluated. Results: Preoperative immune-inflammatory parameters were similar between groups. Postoperative CRP, neutrophil, NLR, NLR-index, delta-NLR, PLR, delta-PLR, PLR-index, SIRI and SII were significantly lower in the ketamine group (p<0.05). Postoperative lymphocyte was significantly higher in the ketamine group (p<0.05). However, leukocyte, platelet, delta-CRP and CRP-index were similar between the groups (p>0.05). In the ketamine group, the length of stay in the intensive care unit and hospital was significantly shorter and 28-day mortality was not observed (p<0.05). Although the postoperative pain severity was lower in the ketamine group (p<0.05), the need for additional analgesia was similar between the groups (p>0.05). Systolic and mean arterial pressures measured in the first 5 minutes after intubation were higher in the ketamine group than in the control group (p>0.05). However, intraoperative VIS was similar between the groups (p>0.05). Conclusion: The anti-inflammatory activity of ketamine in cardiac surgery was also demonstrated by NLR and PLR calculations. In these patients, ketamine infusion throughout the operation was found to be effective in reducing the inflammatory response. In addition, ketamine seems to have positive effects on postoperative acute pain, intensive care and hospital stay, and mortality.
Objective: Ketamine is an anesthetic agent with known anti-inflammatory effect. In our study, we tested whether this feature could be confirmed by routine immune-inflammatory laboratory data analysis with intraoperative ketamine infusion in the cardiac surgery patient population. The effects on intraoperative parameters, postoperative pain scores, analgesia requirement and patient outcomes were investigated. Method: A total of 160 patients were divided into two groups as the control group (n=80) and the ketamine group (n=80). In the ketamine group, ketamine was given during induction (1 mg/kg bolus) and throughout the operation (maintenance) (2.4 mg/kg/hour infusion). After he was taken to the operating room, sedoanalgesia was performed. Standard noninvasive (electrocardiogram, peripheral oxygen saturation) and invasive arterial blood pressure monitoring were performed under local anesthesia. Intravenous anesthetic agents based on body weight corrected midazolam (0.1 mg/kg), fentanyl (3 μg/kg), rocuronium (0.6 mg/kg) induction and remifentanil (0.1- 0.3 μg/kg/min) and sevoflurane (at a minimal alveolar concentration of 0.5-1) were used for maintenance. Hemodynamic follow-ups were made according to 20% below or above baseline values. Morphine (0.1 mg/kg) was administered at the end of the operation for postoperative analgesia, and remifentanil (0.05-0.1 μg/kg/min) and dexmedetomidine (0.5-1 μg/kg/hour) infusion until extubation for sedoanalgesia in the intensive care unit. Paracetamol (3x1 g) and tramadol (1 mg/kg) as rescue (additional) analgesia were given in the intensive care unit. The vasoactive inotropic score (VIS) was calculated to evaluate intraoperative hemodynamics. Preoperative and postoperative 1st day routine blood tests were evaluated and immune-inflammatory parameters [leukocyte, neutrophil, lymphocyte and platelet counts, C-reactive protein (CRP)] and parameters calculated from these [(neutrophil/lymphocyte ratio (NLR), NLR-index, delta] -NLR, platelet/lymphocyte ratio (PLR), PRL-index, delta-PLR, SIRI (systemic inflammation response index), and SII (systemic immune-inflammation index)] were recorded. Pain severity [numerical rating scale (NRS) and Prince Henry Hospital Pain Score (PHHS)] in the first 24 hours after postoperative extubation, analgesia requirement, extubation time, intensive care and hospital stay, and first 28-day mortality rates were evaluated. Results: Preoperative immune-inflammatory parameters were similar between groups. Postoperative CRP, neutrophil, NLR, NLR-index, delta-NLR, PLR, delta-PLR, PLR-index, SIRI and SII were significantly lower in the ketamine group (p<0.05). Postoperative lymphocyte was significantly higher in the ketamine group (p<0.05). However, leukocyte, platelet, delta-CRP and CRP-index were similar between the groups (p>0.05). In the ketamine group, the length of stay in the intensive care unit and hospital was significantly shorter and 28-day mortality was not observed (p<0.05). Although the postoperative pain severity was lower in the ketamine group (p<0.05), the need for additional analgesia was similar between the groups (p>0.05). Systolic and mean arterial pressures measured in the first 5 minutes after intubation were higher in the ketamine group than in the control group (p>0.05). However, intraoperative VIS was similar between the groups (p>0.05). Conclusion: The anti-inflammatory activity of ketamine in cardiac surgery was also demonstrated by NLR and PLR calculations. In these patients, ketamine infusion throughout the operation was found to be effective in reducing the inflammatory response. In addition, ketamine seems to have positive effects on postoperative acute pain, intensive care and hospital stay, and mortality.
Açıklama
Anahtar Kelimeler
İmmün-inflamatuar biyobelirteçler, Kardiyak cerrahi, Ketamin, Nötrofil lenfosit oranı, Perioperatif inflamasyon, Trombosit lenfosit oranı, Immune-inflammatory biomarkers, Cardiac surgery, Ketamine, Neutrophil lymphocyte ratio, Perioperative inflammation, Platelet lymphocyte ratio
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Atay, T. (2023). Kardiyak cerrahide ketaminin antiinflamatuar etkisinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyon Anabilim Dalı, Konya.
