Evaluation of the Effect of Sevoflurane and Propofol Hypotensive Anesthesia on Blood Antioxidant Levels and HIF 1 Levels
Słowa kluczowe
Abstrakcyjny
Opis
Controlled hypotension is the voluntary reversible reduction of arterial blood pressure. Hypotensive anesthesia is a method of anesthesia in which blood pressure is reduced in a controlled manner, especially in certain surgeries. İt reduces intraoperative bleeding and need for blood transfusion and provides a clean surgical vision in narrow-field surgeries or with high bleeding potential. Hypotensive anesthesia can be performed according to mean blood pressure (MBP) or systolic blood pressure (SBP).
A non-invasive cerebral oximeter is used to see the changes in the brain due to high oxygen-dependent metabolism during induction and maintenance of anesthesia.
Hypoxia inducible factor (HIF) is a transcription factor involved in cell adaptation mechanism activated in response to hypoxia.
The biological activity of HIF 1 is determined by the expression and activity of the HIF 1a subunit.
Total antioxidant status (TAS) shows the total effect of all antioxidants in the human body and total oxidant status (TOS) shows the total effect of oxidants.
Near Infrared Spectroscopy (NIRS) allows continuous and non-invasive monitoring of cerebral oxygenation. HIF 1a, TAS and TOS are laboratory markers that predict tissue oxygenation and perfusion.
Hypotensive anesthesia can be performed according to both MBP and SBP. However, in our study that follow-up MBP is more advantageous/protective, although it is not supported by very strong data. The investigators recommend hypotensive anesthesia compared to MBP; but further studies are needed
Daktyle
| Ostatnia weryfikacja: | 04/30/2020 |
| Pierwsze przesłane: | 01/21/2020 |
| Szacowana liczba przesłanych rejestracji: | 01/27/2020 |
| Wysłany pierwszy: | 01/28/2020 |
| Ostatnia aktualizacja przesłana: | 05/06/2020 |
| Ostatnia opublikowana aktualizacja: | 05/10/2020 |
| Rzeczywista data rozpoczęcia badania: | 02/28/2019 |
| Szacowana data zakończenia podstawowej działalności: | 08/31/2019 |
| Szacowana data zakończenia badania: | 12/31/2020 |
Stan lub choroba
Interwencja / leczenie
Procedure: Mean Blood Pressure (MBP)
Drug: Add to 0.5 mcg / kg fentanyl.
Faza
Grupy ramion
| Ramię | Interwencja / leczenie |
|---|---|
| Active Comparator: Total intravenous anesthesia technique for group 1 patients Procedure/Surgery:Mean Blood Pressure (MBP) Mean blood pressure (MBP) 50-65 mmHg was applied with 6-10 mg / kg / h propofol and 0.0,4mcg / kg remifentanyl infusion / min. When BIS values are between 40-60 and muscle relaxation was sufficient (TOF 0), a 20% increase in the initial blood pressure and heart rate values of patients were added to 0.5 mcg / kg fentanyl. All patients received 5-8 ml / kg / h IV infusion of balanced electrolyte solution (Isolyte-S) during the operation.
Hemodynamic parameters (HR, SBP, OCD), BIS,TOF and SpO2 were recorded at 5 minute intervals.
Blood samples were taken from patients during preop preparation (t0), 30th minute (t1), 1st hour (t2) and 2nd hour (t3) of the operation. 5 ml of blood was taken from the untreated arm of all patients to the HIF1a, TAS and TOS values and sent to the biochemistry laboratory | |
| Active Comparator: Inhalation anesthesia technique for group 2 patients Procedure/Surgery:Mean Blood Pressure (MBP) Mean blood pressure (MBP) 50-65 mmHg was applied with 40% Oxygen 60% N2O2 and Sevoflurane at a concentration of 1.5-3.5% with 2 L / minTGA to provide a value of BIS between 40-60. When BIS values are between 40-60 and muscle relaxation was sufficient (TOF 0), a 20% increase in the initial blood pressure and heart rate values of patients were added to 0.5 mcg / kg fentanyl. All patients received 5-8 ml / kg / h IV infusion of balanced electrolyte solution (Isolyte-S) during the operation.
Hemodynamic parameters (HR, SBP, OCD), BIS,TOF and SpO2 were recorded at 5 minute intervals.
Blood samples were taken from patients during preop preparation (t0), 30th minute (t1), 1st hour (t2) and 2nd hour (t3) of the operation. 5 ml of blood was taken from the untreated arm of all patients to the HIF1a, TAS and TOS values and sent to the biochemistry laboratory |
Kryteria kwalifikacji
| Wiek kwalifikujący się do nauki | 18 Years Do 18 Years |
| Płeć kwalifikująca się do nauki | All |
| Przyjmuje zdrowych wolontariuszy | tak |
| Kryteria | Inclusion Criteria: - 18-55 years old - ASA Physical Status Classification System 1 - Undergoing to Elective rhinoplasty Exclusion Criteria: - Patients have any autoimmune disease - Smoking of patients - Development of any allergic reaction during the procedure - Failure to collect blood to be examined at the appropriate time - Body mass index is less than 19 or greater than 30 Termination criteria - Development of severe hypotension and bradycardia during measurements - Development of severe drug allergy during follow-up - In the event of any complications related to the surgical procedure |
Wynik
Podstawowe miary wyników
1. Evaluation of the relationship between hypotensive anesthesia technique and tissue hypoxia by HIF1a [Change from Baseline HIF 1a 30th minute (t1), 1st hour (t2) and 2st hour (t3)]
2. Evaluation of the relationship between hypotensive anesthesia technique and tissue hypoxia by the concentration of TAS [Change from Baseline TAS levels at 30th minute (t1), 1st hour (t2) and 2st hour (t3)]
3. Evaluation of the relationship between hypotensive anesthesia technique and tissue hypoxia by the concentration of TOS [Change from Baseline TOS levels at 30th minute (t1), 1st hour (t2) and 2st hour (t3)]
Miary wyników wtórnych
1. surgical satisfaction [postoperative 1 minute]
2. bleeding scores [postoperative 1 minute]
3. anesthetic consumption for group 1 propofol consumption (mg) and remifentanyl consumption(microgram) [postoperative 1 minute]
4. anesthetic consumption for group 2 N2O2 consumption (ml) and sevoflurane consumption (ml) [postoperative 1 minute]
