İnhalasyon Anestezikleri
Özet
İnhalasyon anestezikleri, genel anestezinin indüksiyonu ve idamesinde temel taşlardan biridir. Günümüz pratiğinde en sık nitröz oksit, sevofluran, desfluran ve izofluran kullanılmaktadır. Bu ajanlar, merkezi sinir sistemindeki GABA ve potasyum kanalları üzerinden etki ederek amnezi ve hareketsizlik sağlarlar. Potansiyelleri, deneklerin %50'sinin ağrılı uyarana yanıt vermediği konsantrasyonu ifade eden "Minimum Alveoler Konsantrasyon" (MAC) değeri ile ölçülür. Kullanımları sırasında postoperatif bulantı ve kusma en yaygın yan etki iken, Malign Hipertermi (MH) nadir fakat hayati bir komplikasyondur. Ayrıca her ajanın kendine özgü toksisite riskleri (sevofluranda nefrotoksisite, desfluranda karbon monoksit birikimi gibi) mevcuttur. Gelecekteki uygulamalar açısından Xenon gazı; nöroprotektif özellikleri, hemodinamik stabilitesi ve çevre dostu yapısıyla öne çıksa da yüksek maliyeti önemli bir kısıtlılıktır. Güvenli uygulama için ASA standartlarına uygun monitörizasyon ve multidisipliner bir sağlık ekibi iş birliği esastır.
Inhalation anesthetics are cornerstones in the induction and maintenance of general anesthesia. In today's practice, nitrous oxide, sevoflurane, desflurane, and isoflurane are most commonly used. These agents act via GABA and potassium channels in the central nervous system to provide amnesia and immobility. Their potency is measured by the "Minimum Alveolar Concentration" (MAC) value, which represents the concentration at which 50% of subjects do not respond to a painful stimulus. While postoperative nausea and vomiting are the most common side effects during use, Malignant Hyperthermia (MH) is a rare but life-threatening complication. Additionally, each agent has specific toxicity risks, such as nephrotoxicity with sevoflurane and carbon monoxide accumulation with desflurane. Regarding future applications, Xenon gas stands out with its neuroprotective properties, hemodynamic stability, and eco-friendly nature, although high cost remains a significant limitation. For safe administration, monitoring in accordance with ASA standards and a multidisciplinary healthcare team collaboration are essential.
Referanslar
Deng J, Lei C, Chen Y, at all. Neuroprotective gases--fantasy or reality for clinical use? Prog Neurobiol. 2014;115:210-45.
Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127(5):1246-1258.
Aranake A, Mashour GA, Avidan MS. Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia. 2013;68(5):512-22.
Brosnan RJ. Inhaled anesthetics in horses. Vet Clin North Am Equine Pract. 2013;29(1):69-87.
Scheiermann P, Herzog F, Siebenhofer A, at all. Intravenous versus inhalational anesthesia for pediatric inpatient surgery - A systematic review and meta-analysis. J Clin Anesth. 2018;49:19 25.
Hopkins PM, Gupta PK, Bilmen JG. Malignant hyperthermia. Handb Clin Neurol. 2018;157:645-661.
Rosenberg H, Pollock N, Schiemann A, at all. Malignant hyperthermia: a review. Orphanet J Rare Dis. 2015-04;10:93.
Voulgarelis S, Scott JP. Monitoring for Nonoperating Room Anesthesia. Anesthesiol Clin. 2017;35(4):591-599.
Finger RG, Mallmann C, Nedel WL. BIS monitoring in sedated, mechanically ventilated patients: right tool in the wrong patients? A meta-analysis. Intensive Care Med. 2016;42(6):1086-7. [PubMed]
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Jan 1, 2018. Halothane Anesthetics.
Dayan AD. Analgesic use of inhaled methoxyflurane: Evaluation of its potential nephrotoxicity. Hum Exp Toxicol. 2016;35(1):91-100.
Ong Sio LCL, Dela Cruz RGC, Bautista AF. Sevoflurane and renal function: a meta-analysis of randomized trials. Med Gas Res. 2017;7(3):186-193.
Kapoor MC, Vakamudi M. Desflurane - revisited. J Anaesthesiol Clin Pharmacol. 2012;28(1):92-100.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): Jan 1, 2018. Halogenated Anesthetics.
Olutoye OA, Sheikh F, Zamora IJ, at all. Repeated isoflurane exposure and neuroapoptosis in the midgestation fetal sheep brain. Am J Obstet Gynecol. 2016;214(4):542.e1-542.e8.
Esencan E, Yuksel S, Tosun YB, at all. XENON in medical area: emphasis on neuroprotection in hypoxia and anesthesia. Med Gas Res. 2013;3(1):4.
Jin Z, Piazza O, Ma D, at all. Xenon anesthesia and beyond: pros and cons. Minerva Anestesiol. 2019;85(1):83-89.
Neukirchen M, Hipp J, Schaefer MS, at all. Cardiovascular stability and unchanged muscle sympathetic activity during xenon anaesthesia: role of norepinephrine uptake inhibition. Br J Anaesth. 2012;109(6):887 96.
Rylova A, Maze M. Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures. J Neurosurg Anesthesiol. 2019;31(1):18-29.
Jia P, Teng J, Zou J, at all. Xenon Protects Against Septic Acute Kidney Injury via miR-21 Target Signaling Pathway. Crit Care Med. 2015;43(7):e250-9.
Baur CP, Klingler W, Jurkat-Rott K, at all. Xenon does not induce contracture in human malignant hyperthermia muscle. Br J Anaesth. 2000;85(5):712-6.
Goto T, Saito H, Nakata Y, at all. Emergence times from xenon anaesthesia are independent of the duration of anaesthesia. Br J Anaesth. 1997;79(5):595-9.
Law LS, Lo EA, Gan TJ. Xenon Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg. 2016;122(3):678-697.
Hou B, Li F, Ou S, at all. Comparison of recovery parameters for xenon versus other inhalation anesthetics: systematic review and meta-analysis. J Clin Anesth. 2016;29:65-74.
Kelen D, Robertson NJ. Experimental treatments for hypoxic ischaemic encephalopathy. Early Hum Dev. 2010;86(6):369-77.
Lachmann B, Armbruster S, Schairer W, at all. Safety and efficacy of xenon in routine use as an inhalational anaesthetic. Lancet. 1990;335(8703):1413-5.
Mapleson WW. Effect of age on MAC in humans: a meta-analysis. Br J Anaesth. 1996;76(2):179-85.
Al Tmimi L, Verbrugghe P, Van de Velde M, at all. Intraoperative xenon for prevention of delirium after on-pump cardiac surgery: a randomised, observer-blind, controlled clinical trial. Br J Anaesth. 2020;28.
Schaefer MS, Treschan TA, Gauch J, at all. Influence of xenon on pulmonary mechanics and lung aeration in patients with healthy lungs. Br J Anaesth. 2018 Jun;120(6):1394-1400. [PubMed]
Coburn M, Kunitz O, Baumert JH, at all. Randomized controlled trial of the haemodynamic and recovery effects of xenon or propofol anaesthesia. Br J Anaesth. 2005;94(2):198-202.
