Being compared with lidocaine,alfentanyl,and lidocaine-alfentanyl effects on preventing from hemodinamic replies forming in the intubation

Introduction: Trakeal entubasyon leads to increarse in heart in heart pace and blood pressure also level of plasma katekolamin. It is stoted that while ?his doesn?t cause problem in healthy people, it may cause problem in some ill people. We olmed to compore function of lidokain alfentanil and lidokain alfentanil under control of hemodinamic answer occuring related to trakeal entubasyon.Material and Method: Our work was conducted on 60 patients who between 18 and 60 from ASAI-II group entering mallampati class 1-2 and quality of entubasyon 1(chin is loose, vocal cords are and stil, no diaphgram movement) and 2 (chin is loose;vocal cords are open and still) planred some elective surgical operations requiring endotrakeal entubasyon after the permission of Health Ministery ethic committee and verbal, written approval of patient.Patients were seperoted 3 groups including 20 patients in each are as randomized in their turn. The work was conducted as double blind. Premedikasyon wasn?t applied to patients. After patients werw token to operation room, noninvaziv blood pressure (NIKB), elektrokardiogram(EKG) and puls oksimetri (SpO2) monitorizasyon were applied. Heart poce, sistolic, diastolic, average arter pressure were recorded as bazal values.Medicine was given in 40 seconds 2 minutes before entubasyon, with izotonic completed to 10 cc after muscle relaxant. Patients who were Lidokain (Group L) were given (n=20) 1,5 mg/kg lidokain. Patients who are in Alfentanil (Group A)(n=20) were given 20 mcg/kg and patients who were in Lidokain-Alfentanil (Group L-A) (n=20) were given 1,5 mg/kg lidokain-20 mcg/kg alfentanil. Patients whose entubasyon time exceeding 30 seconds weren?t included in work and during work patient?s supine position wasn?t changed.5 minutes before midozolam induksiyon 0,03 mg/kg dose was given and as stard to general anesthesic inducsion in propofol 2 mg/kg dose until eyelash reflex disappears.It was given in 30 seconds.Vekuronyum was given in 0,1 mg/kg dose and after waiting 3 minutes, entubasyon was done. (no:8-8,5 entubasyon tube used for men, no:7-7,75 entubasyon tube used for women).Untıl entubasyon, patient ventilated with %100 O2. Anesthesia maintenance of was % 2 sevoflorone and it was continued with %50 air oxygen mixture. Standart anesthesia monitorizotion with blood pressure, EKG,02 saturation, end-tidal CO2 monitorizotion were followed.Patient?s sistolic arter pressure (SAB), diastolic arter pressure (DAB), average arter pressure (OAB),heart pace (KAH) and parsiyel oxygen pressure (SpO2) values were recorded after patient lied on bed is bazal values again after induction, after and before entubasyon and they were wtitten in patient?s form at 1,2,3,4,5,7,10 minutes.Side effects and complications which belong to endotrakeal entubasyon were taken into consideration.Values below KAH 50/min were accepted is bradikardi 0,5 mg i.v. atropin was planned to be applied. If SAB below 60 seconds with below %30 bazal value, it was accepted as hipotansiyon, 5mg i.v. efedrin was planned to be applied.Statistic Analysis: Average and standart deviation values ( ) were used for defining statistic of always changeables. Proportion and frequency values were used for discontinued changeables.Bonferroni test from Post-Hoc tests was used to find out group?s averaga values are direction variance analysis and from which group difference resulted from.Khi-kare tests were used in couple groups average student?s test and tablo?s analysis.Hypothesis are couple directions when it is P?0,05 difference was accepted important.Statistical packet program SPSS 15.0 for Windows was used in statistical analysis.(SPSS Inc., Chicago, IL,USA)Findings: While Sistolic Arter Pressure was decreasing compared with bazal values in each three grouos, after 2,3,5 minutes SAB decrease in Group AL entubasyon which made difference among groups in this decrease was lower than decrease in Group A. SAB decrease in Group AL was lower than Group L.While SAB measure after 1 minute and 10 minutes at group L entubasyon didn?t change noticeably in bazal values, other measures changed noticeably. Decrease in SAB measure at Group AL was found meaningful statistically.Diastolic Arter Pressure (DAB)While in each three groups DAB values decreased in bazal values in these decreases what mode meaningful difference; while in DAB decrease in Group AL before entubasyon and 7 and 10 minutes after was lower than Group L decrease, 2 and 3 minute after entubasyon DAB decrease in AL was lower than Group L. Again DAB decrease in group A 10 minutes after entubasyon was lower than group L statistically.While DAB measures which are in Group L 1,2,3,7,10 minutes after entubasyon didn?t change noticeably, decrease in all measures were found meaningful statistically.While DAB measures which are in group A 1,2,3,4,5 minutes after entubasyon didn?t change noticeably, decrease after induksiyon and before entubasyon was found meaningful statistically.Decrease in all measures at Group AL was found meaningful.Average Arter Pressure (OAB)While OAB values was decreasing in ench three Groups; what mode difference among these groups in decrease, whilw OAB decrease in group AL, 2and 3 minutes after entubasyon was lower than decrease in Group A, OAB decrease in group AL 7 and 10 minutes after entubasyon was lower than decrease in Group L.While OAB measures 1,7 and 10 minutes after entubasyon in group L didn?t change noticeably in bazal values, decrease in other measures was found meaningful.While OAB measures 1,2,3,4 and 5 minutes after entubasyon in group A didn?t change noticeably in bazal values, decrease in after induksiyon, before entubasyon measure 7,10 minutes after entubasyon from measures was found meaningful.Decrease in Group AL at all measures was found meaningful.Heart Pace (KAH)Each three groups (KAH) weren?t found meaningful statistically when compared in all measure evalutions.KAH measures, after induksiyon at Group L before entubasyon 1,2,3,4,5,7,10 minutes after entubasyon didn?t change noticeably in bazal values.KAH measures after induksiyon at Group A, before entubasyon 1,2,3,4,5,7 and 10 minutes after entubasyon didn?t change noticeably in bazal values.KAH measures after induksiyon at Group AL, 1,2,3 minutes after entubasyon didn?t change noticeably in bazal values. Noticeable decrease in bazal values before entubasyon 4,5,7 and 10 minutes after entubasyon in KAH measure was found meaning statistically.Parsiyel Oxygen Pressure (POB)While SpO2 values were increasing compared bazal values, in this decrease what mode difference among groups; while SpO2 increase in Group AL was higher than Group L 1 minute after entubasyon.SpO2 measures before entubasyon after induksiyon 1,2,3,4,5,7,10 minutes after entubasyon were found meaningful according to noticeable increasing bazal values.Result: We found out that lidokain and afentanil have similar effects under control of entubasyon that is related to hemodinamic answer. Giving lidokain and afentanil together leads to decrease below normal clinic values in SAB and DAB values and decrease in normal clinic borders OAB and KAH values. Aso result, we found out that giving 20 mcg/kg alfentanil and 1,5 mg/kg lidokain separate or 20 mcg/kg alfentanil and 1,5 mg/kg lidokain together is effective when used in chosen patient groups under control of hemodinamic answer.