Öz
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.
Anahtar Kelimeler
Sevoflurane Isoflurane Propofol Thyroksine Triiodothyronine TSH Surgical stress
Kaynakça
- Oyama T, Shibata S, Matsuki A, Kudo Thyroxine distribution during halothane anesthesia in man. Anesth Analg 1969; 48: 715-9.
- Marana E, Colicci S, Meo F, Marana R, Proietti R. Neuruendocrine stress response in gynecological laparoscopy: TIVA with propofol versus sevoflurane anesthesia. J Clin Anesth 2010; 22: 250-5.
- Wood M, Berman ML, Harbison RD, Hoyle P, Phythyon JM, Wood AJ. Halothane-induced hepatic necrosis in triiodothyronine-pretreated rats. Anesthesiology 1980; 52: 470-6.
- Kayhan Z. Klinik anestezi. 3. baskı. Ankara: Logos yayıncılık; 2004; pp: 406-23. Türkmen ÜA, Kara D, Köksal Ç. Tiroid Bezi Hastalıklarında Anestezik Yaklaşım. Okmeydanı Tıp Dergisi 2012; 28: 48-55.
- Roizen MF. Diseases of the endocrine system. In: Benumof JL ed, Anesthesia and uncommen diseases. 4th ed. Philadelphia: WB Saunders Co; 1999; pp: 2237
- Arınç H, Gündüz H, Uyan C. Tirid hormonu ve Kardiyovasküler Sistem. Turkiye Klinikleri J Cardiovasc Sci 2006; 18: 138-42.
- Erdoğan MF. Günümüzde Tiroid Hastalarına Yaklaşım. Dahili Tıp Bilimleri Dergisi 2006; 13: 132-51.
- Siegers CP, Mackenroth T, Wachter S, Younes M. Effects of thyroid dysfunction on the metabolism of halothane, enflurane and methoxyflurane in rats. Pharmacology 1981; 22: 41-6.
- Roizen MF, Fleisher LA. Anesthetic Implications of Concurrent Diseases. In: Miller RD. Miller's Anesthesia. 7 th ed. Philadelphia: Churchill Livingstone Elsevier; 2010; pp: 1086-9.
- Chernow B, Alexander HR, Smallridge RC, Thompson WR, Cook D, Beardsley D, Fink MP, Lake CR, Fletcher JR. Hormonal responses to graded surgical stress. Arch Intern Med 1987; 147: 1273-78.
- Gottardis M, Mutz N, Fill H. The behavior of free thyroxine and triiodothyronine concentrations after short-term balanced inhalation anesthesia. Anaesthesist 1987; 36: 132-6.
- Hintze G, Braverman LE, Ingbar SH. The effect of surgical stress on the in vitro metabolism of thyroxine by rat liver, kidney, and brain. Endocrinolgy 1991; 128: 146-5
- Halevy S, Liu-Barnett M, Ross PL, Roginsky MS. Serum thyroid hormones changes in patients undergoing caesarean section under general or regional anaesthesia. Br J Anaesth 1978; 50: 1053-57.
- Imberti R, Maira G, Confortini MC, Preseglio I, Domenegati E. Effect of fentanyl-oxygen anesthesia during cardiac surgery on serum thyroid hormones. Acta Anaesthesiol Scand 1988; 39: 217-22.
- Oyama T, Taniguchi K, Ishihara H, Matsuki A, Maeda A, Murakawa T, Kudo T. Effects of enflurane anaesthesia and surgery on endocrine function in man. Br J Anaesth 1979; 51: 141-8.
- Börner U, Klimek M, Schoengen H, Lynch J, Peschau C, Schicha H. The influence of various anesthetics on the release and metabolism of thyroid hormones: Results of two clinical studies. Anesth Analg 1995; 81: 612-8.
- Seitz W, Lübbe N, Hamkens A, Verner L, Bornscheuer A. Endocrine reaction pattern: midazolam-fentanyl anesthesia versus inhalation anesthesia. Anasth Intensivther Notfallmed 1988; 23: 61-8.
- Chikenji T, Mizutani M, Kitsukawa Y. Anaesthesia, not surgical stress, induces increases in serum concentrations of reverse triiodothyronine and thyroxine during surgery. Exp Clin Endocrinol 1990; 95: 217-23.
- Reinhardt W, Mocker V, Jockenhövel F, Olbricht T, Reinwein D, Mann K, Sadony V. Influence of coronary artery bypass surgery on thyroid hormone parameters. Horm Res 1997; 47: 1-8.
- Seitz W, Bechstein W, Onken G, Fritz K, Kirchner E. Endocrine reaction pattern in abdominal surgical patients as affected by isoflurane anesthesia. Anaesthesist 1985; 34: 451-5.
- Oyama T, Shibata S, Matsuki A, Kudo T. Thyroid--adrenocortical responses to anaesthesia in man. Anaesthesia 1969; 24: 19-27.
- Lanza V, Mercadante S, Latteri S, Latteri MT, Bellanca L. Neuroendocrine response to anesthesia with isoflurane. Ann Fr Anesth Reanim 1986; 5: 120-3.
- Kharasch ED. Biotransformation of sevoflurane. Anesth Analg 1995; 81: S27-38. Wade JG, Stevens WC. Isoflurane: an anesthetic for the eighties? Anesth Analg 1981; 60: 666-82.
- Oyama T, Matsuki A, Kudo T. Effect of ether, thiopentone anaesthesia and surgery on plasma thyroid-stimulating hormone (TSH) levels in man. Br J Anaesth 1972; 44: 841-4.
- Oyama T, Matsuki A, Kudo T. Effect of halothane, methoxyflurane anaesthesia and surgery on plasma thyroid-stimulating hormone (TSH) levels in man. Anaesthesia 1972; 27: 3-8.
- Murphy MR. Opioids. In: Clinical anesthesia. Barash PG, Cullen BF, Stoelting RK eds. 3rd ed., Philadelphia :Lippincott Company;1995; pp: 413-38.
- Macdonald RG, Chapman C, Franklin H. Thyroid-pituitary response to cardiopulmonary bypass. Br J Anaesth 1976; 48: 225-30.
Öz
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
Anahtar Kelimeler
Sevofluran İsofluran Propofol Tiroksin Triiyodotironin TSH cerrahi stress
Kaynakça
- Oyama T, Shibata S, Matsuki A, Kudo Thyroxine distribution during halothane anesthesia in man. Anesth Analg 1969; 48: 715-9.
- Marana E, Colicci S, Meo F, Marana R, Proietti R. Neuruendocrine stress response in gynecological laparoscopy: TIVA with propofol versus sevoflurane anesthesia. J Clin Anesth 2010; 22: 250-5.
- Wood M, Berman ML, Harbison RD, Hoyle P, Phythyon JM, Wood AJ. Halothane-induced hepatic necrosis in triiodothyronine-pretreated rats. Anesthesiology 1980; 52: 470-6.
- Kayhan Z. Klinik anestezi. 3. baskı. Ankara: Logos yayıncılık; 2004; pp: 406-23. Türkmen ÜA, Kara D, Köksal Ç. Tiroid Bezi Hastalıklarında Anestezik Yaklaşım. Okmeydanı Tıp Dergisi 2012; 28: 48-55.
- Roizen MF. Diseases of the endocrine system. In: Benumof JL ed, Anesthesia and uncommen diseases. 4th ed. Philadelphia: WB Saunders Co; 1999; pp: 2237
- Arınç H, Gündüz H, Uyan C. Tirid hormonu ve Kardiyovasküler Sistem. Turkiye Klinikleri J Cardiovasc Sci 2006; 18: 138-42.
- Erdoğan MF. Günümüzde Tiroid Hastalarına Yaklaşım. Dahili Tıp Bilimleri Dergisi 2006; 13: 132-51.
- Siegers CP, Mackenroth T, Wachter S, Younes M. Effects of thyroid dysfunction on the metabolism of halothane, enflurane and methoxyflurane in rats. Pharmacology 1981; 22: 41-6.
- Roizen MF, Fleisher LA. Anesthetic Implications of Concurrent Diseases. In: Miller RD. Miller's Anesthesia. 7 th ed. Philadelphia: Churchill Livingstone Elsevier; 2010; pp: 1086-9.
- Chernow B, Alexander HR, Smallridge RC, Thompson WR, Cook D, Beardsley D, Fink MP, Lake CR, Fletcher JR. Hormonal responses to graded surgical stress. Arch Intern Med 1987; 147: 1273-78.
- Gottardis M, Mutz N, Fill H. The behavior of free thyroxine and triiodothyronine concentrations after short-term balanced inhalation anesthesia. Anaesthesist 1987; 36: 132-6.
- Hintze G, Braverman LE, Ingbar SH. The effect of surgical stress on the in vitro metabolism of thyroxine by rat liver, kidney, and brain. Endocrinolgy 1991; 128: 146-5
- Halevy S, Liu-Barnett M, Ross PL, Roginsky MS. Serum thyroid hormones changes in patients undergoing caesarean section under general or regional anaesthesia. Br J Anaesth 1978; 50: 1053-57.
- Imberti R, Maira G, Confortini MC, Preseglio I, Domenegati E. Effect of fentanyl-oxygen anesthesia during cardiac surgery on serum thyroid hormones. Acta Anaesthesiol Scand 1988; 39: 217-22.
- Oyama T, Taniguchi K, Ishihara H, Matsuki A, Maeda A, Murakawa T, Kudo T. Effects of enflurane anaesthesia and surgery on endocrine function in man. Br J Anaesth 1979; 51: 141-8.
- Börner U, Klimek M, Schoengen H, Lynch J, Peschau C, Schicha H. The influence of various anesthetics on the release and metabolism of thyroid hormones: Results of two clinical studies. Anesth Analg 1995; 81: 612-8.
- Seitz W, Lübbe N, Hamkens A, Verner L, Bornscheuer A. Endocrine reaction pattern: midazolam-fentanyl anesthesia versus inhalation anesthesia. Anasth Intensivther Notfallmed 1988; 23: 61-8.
- Chikenji T, Mizutani M, Kitsukawa Y. Anaesthesia, not surgical stress, induces increases in serum concentrations of reverse triiodothyronine and thyroxine during surgery. Exp Clin Endocrinol 1990; 95: 217-23.
- Reinhardt W, Mocker V, Jockenhövel F, Olbricht T, Reinwein D, Mann K, Sadony V. Influence of coronary artery bypass surgery on thyroid hormone parameters. Horm Res 1997; 47: 1-8.
- Seitz W, Bechstein W, Onken G, Fritz K, Kirchner E. Endocrine reaction pattern in abdominal surgical patients as affected by isoflurane anesthesia. Anaesthesist 1985; 34: 451-5.
- Oyama T, Shibata S, Matsuki A, Kudo T. Thyroid--adrenocortical responses to anaesthesia in man. Anaesthesia 1969; 24: 19-27.
- Lanza V, Mercadante S, Latteri S, Latteri MT, Bellanca L. Neuroendocrine response to anesthesia with isoflurane. Ann Fr Anesth Reanim 1986; 5: 120-3.
- Kharasch ED. Biotransformation of sevoflurane. Anesth Analg 1995; 81: S27-38. Wade JG, Stevens WC. Isoflurane: an anesthetic for the eighties? Anesth Analg 1981; 60: 666-82.
- Oyama T, Matsuki A, Kudo T. Effect of ether, thiopentone anaesthesia and surgery on plasma thyroid-stimulating hormone (TSH) levels in man. Br J Anaesth 1972; 44: 841-4.
- Oyama T, Matsuki A, Kudo T. Effect of halothane, methoxyflurane anaesthesia and surgery on plasma thyroid-stimulating hormone (TSH) levels in man. Anaesthesia 1972; 27: 3-8.
- Murphy MR. Opioids. In: Clinical anesthesia. Barash PG, Cullen BF, Stoelting RK eds. 3rd ed., Philadelphia :Lippincott Company;1995; pp: 413-38.
- Macdonald RG, Chapman C, Franklin H. Thyroid-pituitary response to cardiopulmonary bypass. Br J Anaesth 1976; 48: 225-30.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 24 Nisan 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 3 |