Sevofluran, isofluran ve propofolün tiroid fonksiyonlarına etkileri

Aim. The purpose of this study was to compare the effects of frequently used anesthetic agents, that are sevoflurane, isoflurane and propofol on thyroid metabolism during and after anesthesia. Methods. The study was done with euthyroid patients; 22 women and 23 men (total n: 45) aged 28-70. Patients were divided in to three groups, one as sevoflurane (n=15), one as isoflurane (n=15) and one as propofol (n=15). Preoperatively, 15 minutes after induction, 30 minutes after surgical insicion and postoperatively in the 30th minute blood samples were taken from all of the patients. The variations of f T , f T and TSH levels were studied. Results. f T levels started to decrease at induction with all anesthetic agents and the decrease was most evident in postoperative period. On the other hand f T levels increased in all groups after surgical insicion and postoperatively. However, the increase in f T levels with propofol anesthesia was significantly lower than the f T levels with inhalation agents. In all groups TSH levels were found higher only at the postoperative period. Conclusion. With this findings; propofol can be a more suitable agents than isoflurane and sevoflurane in anesthetic procedures for emergent patients with hyperthyroidism.

Özet

Amaç. Sık kullanılan anestezik ajanlardan sevofluran, isofluran ve propofolün anestezi sırasında ve sonrasında tiroid metabolizmasına olan etkilerinin karşılaştırılması amaçlandı. Yöntem. Çalışma 28-70 yaşları arasında 22 bayan, 23 erkek toplam 45 ötiroid hasta üzerinde yapıldı. Hastalar sevofluran, isofluran, propofol anestezileri uygulanmak üzere üç gruba ayrıldı. Tüm hastalardan preoperatif, indüksiyondan 15 dakika sonra, cerrahi kesiden 30 dakika sonra ve postoperatif 30. dakikada olmak üzere dört kez kan alındı. sT₃, sT₄, TSH seviyelerindeki değişime bakıldı. Bulgular. Her üç anestezik ajanla da anestezi indüksiyonundan itibaren postoperatif daha belirgin olmak üzere sT₃ seviyeleri azaldı. Yine tüm gruplarda cerrahi sonrası ve postoperatif olarak sT₄ seviyelerinde yükselme gözlendi. Fakat propofol grubundaki yükselme diğer iki gruba göre anlamlı olarak daha azdı. Tüm gruplarda TSH değerleri sadece postoperatif olarak arttı. Sonuç. Bu verilerin ışığında acil olarak özellikle hipertiroidisi olan hastalara anestezi vermek gerektiğinde propofolün diğer ajanlara göre öncelikle tercih edilebilecek bir ajan olduğu kanaatindeyiz.

Anahtar sözcükler: Sevofluran, İsofluran, Propofol, Tiroksin, Triiyodotironin, TSH, cerrahi stress

 

Abstract

Aim. The purpose of this study was to compare the effects of frequently used anesthetic agents, that are sevoflurane, isoflurane and propofol on thyroid metabolism during and after anesthesia. Methods. The study was done with euthyroid patients; 22 women and 23 men (total n: 45) aged 28-70. Patients were divided in to three groups, one as sevoflurane (n=15), one as isoflurane (n=15) and one as propofol (n=15). Preoperatively, 15 minutes after induction, 30 minutes after surgical insicion and postoperatively in the 30th minute blood samples were taken from all of the patients. The variations of _fT₃, _fT₄ and TSH levels were studied. Results. _fT₃ levels started to decrease at induction with all anesthetic agents and the decrease was most evident in postoperative period. On the other hand _fT₄ levels increased in all groups after surgical insicion and postoperatively. However, the increase in _fT₄ levels with propofol anesthesia was significantly lower than the _fT₄ levels with inhalation agents. In all groups TSH levels were found higher only at the postoperative period. Conclusion. With this findings; propofol can be a more suitable agents than isoflurane and sevoflurane in anesthetic procedures for emergent patients with hyperthyroidism.

Keywords: Sevoflurane, Isoflurane, Propofol, Thyroksine, Triiodothyronine, TSH, Surgical stress