İsofluran ve propofol anestezisinin serum TSH, T3, T4 düzeylerine etkilerinin karşılaştırılması

The comparison of the effects of isoflurane and propofol anaesthesia on serum TSH, T3 and T4 levels

Özet

Cerrahi ve anestezinin endokrin fonksiyona etkileri iyi bilinmektedir. Ancak propofol anestezisinin tiroid fonksiyonuna etkilerini içeren detayli bir çalismaya rastlayamadik. Amacimiz propopofol anestezisinin tiroid hormonlari üzerine etkilerini arastirarak, isofluran anestezisi ile karsilastirmaktir. ASA I-II sinifi, ötiroid,baska endokrin bozuklugu olmayan 30 olguda çalisma gerçeklestirildi. Rutin premedikasyon uygulanan olgularda indüksiyon 1. grupta (n=15) I.V. 0.05 mg fentanil, 5-7 mg/kg tiyopental, ll. grupta (n=15) I.V. 0.05mg fentanil, 2 mg/kg propofol ile yapildi. 1 mg/kg süksinilkolin ile entübe edilen olgularda 1. grupta % 1-1.5 isofluran, II. grupta 6-10 mg/kg/saat propofol ve %50 O2 + % 50 N2O ile anestezi idamesi uygulandi. Kas gevsemesi atrakuryum ile saglandi. Serum TSH, T3,T4 ( Total, Serbest) düzeylerini saptamak için kan örnekleri indüksiyon öncesi ( kontrol ) , sonrasi, intraoperatif 1.saat postoperatif 2. ve 24. saatlerde alindi. Kemilüminesans yöntemi ile elde edilen veriler student's t ile istatistiksel olarak degerlendirildi. p<0.05 Anlamli kabul edildi . (p< 0.01) (p< 0.05). Gruplar arasi karsilastirmada 1. Gruptaki bu düsme anlamli. Her iki grupta TSH serum düzeyleri degismedi . Grup 1'deki postoperatif 24. saatteki T T3, FT3 serum düzeylerindeki düsme anlamli idi (p< 0.05). TT4 serum düzeylerinde 1. grupta intraoperatif 1. saatte anlamli yükselme oldu( p< 0.05). Gruplararasi fark analizinde bir anlamlilik yoktu. F T4 serum düzeylerinde 1. grupta intraoperatif 1.saat ve postoperatif 2. saatte anlamli yükselme ( p < 0.01) (p< 0.05) tespit edildi. Gruplar arasi karsilastirmada FT4'teki bu yükselmeler anlamli bulundu (p<0.01) (p<0.05). Sonuç olarak,propofolun hipertiroidi hastalar güvenle kullanilabilecek,isoflurana iyi bir alternatif ajan oldugu kanisina varildi.

Abstract

The effects of surgery and anaesthesia on endocrine functions are well known. However detailed studies about the effects of propofol on thyroid functions are absent. The aim of this study is to study the effect of propofol anaesthesia on thyroid hormones and to compare it with isoflurane anaesthesia. This study was performed on ASA I-II class,euthyroid 30 patients without endocrine pathologies. After premedication, induction was performed in the first group (n=15) with i.v. 0,05 mg fentanyl, 5-7 mg thiopental; in the second group (n=15) with i.v. 0,05 fentanyl, 2 mg/kg propofol. Patients were intubated with i.v . 1 mg/kg succinylcholine, maintenance was done with %1-1,5 isoflurane %50 O2-%50 N2O + atracurium in the first group and 6-10 mg/kg/h propofol + %50 O2+%50 N2O atracurium in the second group. Blood samples were obtained before induction(control), after induction, first hour intraoperatively on postoperative 2nd and 24 th hours chemiluminesance method was used for the plasma TSH,TT3, FT3,TT4, FT4 analyses. The TSH serum levels did not change in both groups. A significant decrease in TT3, FT3 serum levels in the 24th hour postoperatively was observed in the first group (p<0,01), (p<0,05).This decrease, in the first group was significant between the groups (p<0,05). Significant increases in serum TT4 levels occured first hour intraoperatively in the first group (p<0,05). No difference was found between the groups. Asignificant increases in serum FT4 levels was recorded in the 1st hour intraoperatively and 2nd hour postoperatively in the first group(p<0.01) (p<0.05)The increases was significant between the groups (p<0.01)(p<0.05). We conclude that propofol is safe alternative agent to isoflurane in hyperthyroid patients.

Anahtar kelimeler: Triiyodotronin,Propofol,Anestezikler,Tirotropin,İzofluran,Hipertiroidi