Ulus Travma Acil Cerrahi Derg. 2012; 18(1): 5-10 | DOI: 10.5505/tjtes.2012.67044

Epidural anestezinin kolon cerrahisinde anastomoz kaçaðý üzerine etkisi: Deneysel araþtýrma

Tayfun Adanýr¹, Murat Aksun¹, Gülþah Yýlmaz Karaören¹, Türker Karabuða², Okay Nazlý³, Atilla Þencan¹, Mehmet Köseoðlu^4
1Atatürk Eðitim Ve Araþtýrma Hastanesi, Anesteziyoloji Ve Reanimasyon Kliniði, Ýzmir
²Atatürk Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýzmir
³Muðla Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Muðla
⁴Atatürk Eðitim Ve Araþtýrma Hastanesi, Biyokimya Bölümü, Ýzmir

AMAÇ
Bir hayvan modelinde, sürekli epidural anestezi ile kolon anastomozunun gücü arasýndaki iliþki araþtýrýldý.
GEREÇ VE YÖNTEM
Beyaz erkek 14 adet Yeni Zelanda tavþaný çalýþmaya alýndý ve randomize iki grup oluþturuldu. Grup 1’de (n=7) epiduralden sürekli olarak %0,9’luk NaCl infüzyonu (0,4 mlkg-1 bolus ve 0,2 mlkg-1 sa-1 infüzyon) ve Grup 2’de (n=7) epiduralden sürekli olarak %1’lik lidokain infüzyonu (0,4 mlkg-1 bolus ve 0.2 ml kg-1 sa-1 infuzyon) uygulandý. Ýnfüzyonlara, operasyonlarýn baþýnda baþlandý ve cerrahi sonrasý 6. saate kadar sürdürüldü. Bütün deney hayvanlarýna genel anestezi altýnda sað kolon rezeksiyonu ve kolo-kolonik anastomoz uygulandý. Cerrahi sonrasý 4. gün, re-laparotomi yapýlýp in situ olarak anastomoz patlama basýnçlarý ölçüldü. Dikiþ hattýný içine alan 1 cm’lik segment çýkartýlýp, hidroksiprolin ve kollajen düzeyleri ölçüldü.
BULGULAR
Anastomoz patlama basýnçlarý, epidural lidokain grubunda (medyan 248 mmHg - [117-300]) serum fizyolojik grubuna (medyan 109 mmHg - [47-176]) göre anlamlý derecede yüksek bulundu (p=0,006). Doku örneðindeki hidroksiprolin ve kollajen düzeyleri açýsýndan gruplar arasýnda fark yoktu (p>0,05).
SONUÇ
Kolon anastomozunun dayanýklýlýðýnýn epidural lidokain infüzyonu ile artabileceðini düþünüyoruz.

Anahtar Kelimeler: Anastomoz dayanýklýlýðý, kolon cerrahisi; epidural anestezi; lidokain.

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Effect of epidural anesthesia on anastomotic leakage in colonic surgery: experimental study

Tayfun Adanýr¹, Murat Aksun¹, Gülþah Yýlmaz Karaören¹, Türker Karabuða², Okay Nazlý³, Atilla Þencan¹, Mehmet Köseoðlu^4
1Ataturk Training And Research Hospital, Department Of Anesthesiology And Icu, Izmir, Turkey.
²Ataturk Training And Research Hospital, Department Of Surgery, Izmir, Turkey.
³Mugla University, Medical Faculty, Department Of Surgery, Mugla, Turkey.
⁴Ataturk Training And Research Hospital, Department Of Biochemistry, Izmir, Turkey.

BACKGROUND
The association between the infusion of continuous epidural anesthesia and the anastomotic strength of colonic anastomosis was examined in an animal model.
METHODS
Fourteen white male New Zealand rabbits were included in the study and randomly assigned to two groups. Group 1 (n=7) had continuous epidural 0.9% NaCl infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion) and Group 2 (n=7) had continuous epidural 1% lidocaine infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion). Infusions started at the beginning of the operation and were continued for six hours postoperatively. All experimental animals underwent right colon resection and colo-colonic anastomosis under general anesthesia. On the fourth postoperative day, relaparotomy was applied and the bursting pressures of the anastomosis (BPA) were measured in situ. Segments 1-cm long consisting of the complete suture lines were excised, and the levels of hydroxyproline and collagen were measured.
RESULTS
BPAs were statistically higher in the epidural lidocaine group (median: 248 mmHg; min 117 - max 300) than in the saline group (median: 109 mmHg; min 47 - max 176) (p=0.006). There was no difference between the groups in terms of hydroxyproline and collagen levels in the sample tissues (p>0.05).
CONCLUSION
We concluded that the strength of colonic anastomosis may be increased by epidural lidocaine infusion.

Keywords: Anastomotic strength, colonic anastomosis; epidural anesthesia; lidocaine.

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ATIF KOPYALA