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Dr. Tülay Onay1
1
'U 0 ùDKLQ <NVHN
,
Dr. Sebahattin Uslu1,
Dr. Burhan Gencer2
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HWNLOHUL EL\RNLP\DVDO RODUDN LQFHOHQGL .OLQLN YH ODERUDWXDU RODUDN |WLURLG RODQ KDVWD LNL JUXED D\UÕODUDN
oDOÕúÕOGÕ øQGNVL\RQ , JUXSWD PJNJ VRG\XP WLRSHQWDQ YH PJNJ DWUDNXU\XP YHULOHUHN VD÷ODQGÕ øGDPH
anesteziye % 40 O , % 60 N O ve % 1,5 isofluranla devam edildi. II. grupta indüksiyon 0,2 mg/kg
GHKLGUREHQ]SHULGRO —JNJ IHQWDQLO YH PJNJ DWUDNXU\XPOD VD÷ODQGÕ øGDPHGH 2 ,% 60 N O ve
GDNLND DUDOÕNODUOD PJ IHQWDQLO YHULOGL +RUPRQODUÕQ WHVSLWL LoLQ NRQWURO LQGNVL\RQ VRQUDVÕ YH
VDDWWH YH SRVWRSHUDWLI VDDWWH NDQ |UQHNOHUL DOÕQGÕ , JUXSWD 7 VHYL\HVL VDDWWH S GúW ,,
JUXSWD LVH LQGNVL\RQGD S YH VDDWWH S \NVHOGL 7 YH 76+ GD KHU LNL JUXSWD GD GH÷LúLNOLN
S! ROPDGÕ +HU LNL JUXSWD GD VHUEHVW 7 S GúW 6HUEHVW 7 , JUXSWD YH VDDWWH
\NVHOGL S 6RQXo RODUDN WURLG KRUPRQ GH÷HUOHUL VÕQÕUGD YH\D \NVHN RODQ YDNDODUGD LVRIOXUDQ
DQHVWH]LVLQLQ WHUFLK HGLOPHVLQLQ GDKD L\L RODFD÷Õ NDQDDWLQH YDUGÕN >7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL
2
2
2
2
1997;4(4):371-374]
Anahtar Kelimeler:
øVRIOXUDQ IHQWDQLO WLURLG KRUPRQODUÕ
The effects of isoflurane and neurolept anaesthesia on thyroid hormones in thyroidectomic
patients
The effects of isoflurane and narcotics used in general anaesthesia on thyroid hormones were studied
biochemically. 40 patients who were euthyroid both hormonally and clinically divided to two groups. In 1st
group; induction was provided by using 5 mg/kg Na thiopenthal and 0.6 mg/kg atracrium. Anaesthesia has
been maintained with 40% O2, 60% N2O, and 1.5% isoflurane. Second group was induced with 0.2 mg/kg
dehydrobenzperidol, 40 µgr/kg fentanyl and 0.6 mg/kg atracrium, and maintained with 40% O2, 60% N2O,
and 0.05 mg fentanyl given at 20-30 minutes intervals. Hormone levels were obtained preoperatively,
immediately after induction, and postoperative 1st, 2nt, and 24th hours. T3 levels decreased at postoperative
1st hours in the first group (p<0.05) and elevated after the induction and 1st hour in the second group
(p<0.05). T4 and TSH levels did not change in both groups (p>0.05). Free T3 decreased in both groups
(p<0.05). Free T4 elevated at 1st, 2nt, and 24th hours in first group (p<0.05). We concluded that isoflurane
anaesthesia is a better choice for patients with high thyroid hormone levels are high or at the upper limits.
[Journal of Turgut Özal Medical Center 1997;4(4):371-374]
Key words: Isoflurane, fentanyl, thyroid hormones
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Journal of Turgut Özal Medical Center 4(4):1997
NXOODQÕODQ
aneljeziklerin
371
7LURLGHNWRPLN KDVWDODUGD LVRIOXUDQQ|UROHSW DQHVWH]LVLQLQ WLURLG KRUPRQODUÕ ]HULQH HWNLOHUL
T. Onay ve ark.
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dehidrobenzperidol+fentanil
verilerek
anestezi
úHNLOGH \NVHOLUNHQ YH VDDWOHUGHNL GH÷HUOHUL
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olarak incelendi.
(Tablo 2).
MATERYAL VE METOD
dDOÕúPDPÕ]D $6$ YH VÕQÕIODPDVÕQD JLUHQ X
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I.grup (iso)
II.grup (NRLA)
35 ± 1,5
38 ±5,2
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saat ve 24. saatlerdeki ölçümlerde her iki grupta da
(Tablo 3 ve 4).
%LULQFL JUXSWD VHUEHVW 7 GH÷HUOHUL WP
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GúPH LVH GDKD oRN DQODPOÕ RODUDN S EXOXQGX
(Tablo 5).
6HUXP VHUEHVW 7 GH÷HUOHUL , JUXSWD YH VDDWWH DQODPOÕ S ELU úHNLOGH \NVHOGL øNLQFL
JUXSWD LVH VDGHFH VDDWWHNL GH÷HU \NVHN RODUDN
bulundu (p<0,05) (Tablo 6).
Cins (K/E)
$÷ÕUOÕN NJ
12/8
14/6
65.00±7,52
60.25±5,30
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LY YHULOHUHN VD÷ODQGÕ PJNJ DWUDNXU\XP YHULOHUHN
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Entübasyonu takiben % 40 O2, %60 N2O
ve %1,5 isofluran ile idame anestezi
VD÷ODQGÕ YH DGDOH JHYúHPHVL GH IUDNVL\RQH
olarak verilen atrakuryum ile temin edildi.
II. gruptaki hastalara 0,2 mg/kg
dehidrobenzperidol
verilmesinden
5
dakika sonra 40 µg/kg fentanil ve 0,6
mg/kg atrakuryum verilerek entübasyon
2, %60 N2O
\DSÕOGÕ øGDPH DQHVWH]L 2
YH GDNLND DUDOÕNODUOD PJ IHQWDQLO
ve 10 mg atrakuryum ile devam ettirildi.
Kan örnekleri kontrol (indüksiyon öncesi),
7$57,ù0$
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6HUXP 7
I. grup
II.grup
Kontrol
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114,3±24,7 91,1 ±40,9*
101,4±20,3 123,2±21,8^
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II. grup
Kontrol
8,31±2,21
6,53±2,26
øQGNVL\RQ
8,64±2,66
7,99 ±3,01
1. saat
8,91±2,59
7,89±3,20
2. saat
8,83±1,85
7,66±2,81
24. saat
8,13±1,36
7,20±2,15
1. saat
1,10±0,86
4,43±4,93
2. saat
1,33±1,17
2,48±1,58
24. saat
1,17±1,37
2,13±1,43
2. saat
2,65±0,99*
2,29±0,71*
24. saat
2,44±0,76*
2,03±0,67**
2. saat
1,52±0,44*
1,28±0,45
24. saat
1,48±0,32*
1,39±0,42*
p>0,05
Tablo 4. Serum TSH düzeyleri
BULGULAR
Kontrol
I. grup 3,25±0,54
II.grup 3,35±0,90
*p<0,05, **p<0,001
372
2. saat
24. saat
97,7±33,3* 91,6±33,8*
93,1±28,3* 93,1±24,9*
Tablo 3 6HUXP 7 GH÷HUOHUL
Kontrol
I. grup 1,18±0,89
II. grup 1,97±1,26
p>0,05
Birinci grupta T3 seviyesinde bütün
1. saat
90,6±28,0"
124,9±19,7”_
*p>0,05, "p<0,05, ^p<0,001
LQGNVL\RQ VRQUDVÕ SHURSHUDWLI YH
SRVWRSHUDWLI VDDWOHUGH DOÕQGÕ 76+ 7
T4, FT3, FT4 düzeylerinin ölçümleri
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Tablo 5 6HUXP
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0,91±0,98
3,80±3,85
VHUEHVW 7
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2,98±0,56
1. saat
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3,06±0,39*
Tablo 6 6HUXP VHUEHVW 7 GH÷HUOHUL
I. grup
II. grup
Kontrol
1,14±0,31
1,04±0,4
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1,04±0,50
1,17±0,50
1. saat
1,52±0,5*
1,14±0,42
* p<0,05
7XUJXW g]DO 7ÕS 0HUNH]L 'HUJLVL Onay T, et al.
The effects of isoflurane-neurolept anaesthesia on thyroid hormones in thyroidectomic patients
KHP FHUUDKL\H KHP GH DQHVWH]L\H ED÷OÕ DUWPD YH
azalma olabilmektedir (1,2). Bir çok ilaçlar gibi
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GD |QHPOL ELU DUWPD ROPDGÕ÷ÕQÕ ELOGLUPLúOHUGLU dDOÕúPDPÕ]GD LVRIOXUDQ YH Q|UROHSW DQHVWH]L
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7 ]HULQGH DQODPOÕ ROPD\DQ GH÷LúLNOLNOHU \DSWÕ÷ÕQÕ
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GL÷HU ED]Õ DUDúWÕPDFÕODU 7
GH SHURSHUDWLI ELU
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GH SHURSHUDWLI D]DOPD\D
VHEHE ROGX÷XQX ELOGLUHQ DUDúWÕPDFÕODUÕQ J|UúOHUL
uyum göstermektedir.
ELOGLUPLúOHUGLU %L]LP oDOÕúPDPÕ]GD GD KHU LNL JUXSWD
VHUEHVW 7
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VHUEHVW 7
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benimsemekteyiz.
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her iki grupta serbest T4'de yükselme olmakla birlikte,
EX \NVHOPH LVRIOXUDQ JUXEXQGD GDKD EDUL] ELU úHNLOGH
J|UOG YH EX DUDúWÕUPDFÕODUÕQ J|UúOHUL\OH X\XP
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oDOÕúPDPÕ]ÕQ VRQXoODUÕQÕ GH÷HUOHQGLUGL÷LPL]GH WLURLG
KRUPRQ GH÷HUOHUL VÕQÕUGD RODQ YDNDODUGD YH\D úSKHOL
GXUXPODUGD YH DFLO ELU SDWRORMLVL RODQ WURLG KRUPRQODUÕ
yüksek hastalarda isofluran anestezisinin daha iyi
RODFD÷Õ NDQDDWLQH YDUGÕN
KAYNAKLAR
1.
Harland WA, Horton PW, Strang R, Fitzgerald B, Richards JR,
Holloway KB. Release of thyroxine from the liver during
anesthesia and surgery. Br J Anaesthesia 1974;46:818.
2.
Miras A, Gruel Y, Huchet C, Jeray A. Intered de l'isoflurane
dans la chirurqie des tentes lablopalitenses chez l'enfant. Les
Cohlers d' O.R.L 1989;7:523.
3.
Kampmann JP, Hansen M. Clinical pharmacokinetics of
antityroid drugs. Clin. Pharmocokin 1981;6:401.
4.
Gottardis M, Mutz N, Fill H. Das verhatten der freren thyroxin
and
triiodtyronin-serum
konzentrationen
nach
kurzandavernden
balancierten
inhalati
onsnarkosen.
Anaesthesist 1987;36:132.
5.
Sparaqino E, Pivano P, Fanten G, Mantredda G, Tagliabo A,
Ghiron P, Michelene G, Lanza E. Blood level changes of T3,
T4 and TSH during surgical stress and isoflurane anaesthesia .
Minerva Med 1990;81:5.
6.
Oyama T, Taniquchi K, Ishihara H, Matsuki A, Maeda A,
Murakawa T, Kuda T. Effects of enflurane anesthasia and
surgery on endocrine function in man. Br J Anaesth
1979;51:141.
Hall ve ark. (12), Stanley ve ark. (13) ve Gieseteve
DUN \DSWÕNODUÕ oDOÕúPDODUGD IHQWDQLOLQ GRSDPLQ
norepinefrin, büyüme hormonu ve kortizon gibi stres
KRUPRQODUÕQÕ GúN YH\D RUWD GR]ODUGD DUWWÕUGÕ÷ÕQÕ
ELOGLUPLúOHUGLU %X DUDúWÕPDFÕODU IHQWDQLO YHULOHQ
JUXSWD 7 \NVHOPHVLQL VWUHV IDNW|UQH ED÷ODPÕúODUGÕU
%L]LP EXOJXODUÕPÕ]GD GD 7 VHYL\HVL IHQWDQLO
grubunda indüksiyon ve 1. saatte yükseldi, Bu
VRQXoODUOD 7
Q VWUHV IDNW|UQH ED÷OÕ RODUDN IHQWDQ\O
JUXEXQGD \NVHOGL÷LQL VDYXQDQ DUDúWÕUPDFÕODUÕQ
J|UúOHULQH NDWÕOPDNWD\Õ]
+DUODQG YH DUN /DQ]D YH DUN YH GL÷HU ED]Õ
DUDúWÕUPDFÕODU \DSWÕNODUÕ oDOÕúPDODUGD 7
GH KHU
LNL DMDQOD GD DQODPOÕ \NVHOPHOHU ROGX÷XQX UDSRU
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DQODPOÕ ROPD\DQ KDILI \NVHOPHOHU ROGX %L]LP
EXOJXODUÕPÕ] 7
GH oRN EDUL] GHJLúLNOHU ROGX÷XQX
VDYXQDQ DUDúWÕUPDFÕODUÕQ J|UúOHULQH X\PDPDNWDGÕU
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Journal of Turgut Özal Medical Center 4(4):1997
7.
.DUDPDQOÕR÷OX % ùHQJ|QO 2 3DPXNoX = øVRIOXUDQ HQIOXUDQ
YH
KDORWKDQ
ÕQ
NDUúÕODúWÕUÕOPDVÕ
76+
7UN
7
$QHVW
YH
7
5HDQ
]HULQH
&HP
HWNLOHULQLQ
0HFPXDVÕ
20: 181-4.
8.
Lanza V, Mercadante S, Latteri S,Latteri MT, Bellance L. La
reponse neuro-endocrinienne a l'anaestehisa par isoflurane .
Ann Fr Anesth Reanim 1986;5:120.
9.
Lanza V, Di Plazza D, Marici ML, Di Plazza A, Galluzo A. La
reponse neuro-endokriniennechez l'hamme a I'anaesthisia par
alfatesine an Ethrane. Ann Anesthisiol Fr 1979; 20:281.
373
7LURLGHNWRPLN KDVWDODUGD LVRIOXUDQQ|UROHSW DQHVWH]LVLQLQ WLURLG KRUPRQODUÕ ]HULQH HWNLOHUL
10. Sum DCW, Tan PPC, Chanliao M. The effects at halothane
and isoflurane on serum throxine (T4) and triiodothyronine
(T3). Anaest Sinica 1988;26:391.
11. Oyama T. Endocrine responses to anaesthetic agents. Br J
Anaesth 1973; 45:276.
12. Hall GM, et al. Substrate mobilization during surgery.
Anaesthesia 1978;33:924.
13. Stanley TH. Catecholamine and cortisol responses to fentanyloxygen anesthesia for coronary operations. Anesthesiology
1980;53:250.
374
T. Onay ve ark.
14. Giesete AH. Urinary epinephrine and norepinephrine during
Innovar-nitrous oxide anesthesia in man. Anesthesiology
1967;28:71.
<D]ÕúPD DGUHVL : Dr. Tülay ONAY
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