Effects of TIVA and Inhalation Anesthesia on Oxidative Stress Factors During Hypotensive Anesthesia
Condition: Oxidative Stress; Anesthesia
MeSH terms: Respiratory Aspiration
Study type: Interventional

Summary: 
      Total intravenous anesthesia (TIVA) and inhalation anesthesia are two anesthesia methods that
      can be preferred for the maintenance of anesthesia. Sevoflurane and propofol are drugs used
      frequently in these methods. This study aims to investigate and compare the effects of
      inhalation anesthesia using sevoflurane and TIVA using propofol on oxidative stress in
      patients undergoing controlled hypotensive anesthesia.
    

Detailed description: 
      Controlled hypotension is defined as keeping systolic blood pressure in the range of 80-90
      mmHg or mean arterial pressure in the range of 50-65 mmHg. Pharmacological and
      non-pharmacological methods can be used to achieve controlled hypotension. Intravenous
      anesthetics, inhalation anesthetics, opioids, calcium channel blockers, beta blockers,
      nitrate derivatives are frequently used drugs for this purpose.

      General anesthesia maintenance is applied in two ways: total intravenous anesthesia (TIVA)
      and inhalation anesthesia. The pharmacokinetic and pharmacodynamic properties of drugs used
      in both methods are quite different.

      Products of the body's oxidant antioxidant balance can be measured by biochemical methods and
      information about this balance can be obtained. Thiols are the regions of proteins most
      susceptible to oxidation, and the conversion of thiols to disulfides and oxyacids is the
      earliest marker of radical-mediated protein oxidation.

      Total antioxidant status (TAS) shows the total effect of all antioxidants in the human body
      and total oxidant status (TOS) shows the total effect of oxidants.

      In this study, it was aimed to investigate and compare the effects of inhalation anesthesia
      using sevoflurane and total intravenous anesthesia using propofol on oxidative stress in
      rhinoplasty cases under controlled hypotension. This assessment was planned using TAS (total
      antioxidant status), TOS (total oxidant status), Catalase, Myeloperoxidase (MPO), Total
      Thiol, Native Thiol and Disulfide parameters.
    

Intervention name(s): Total Intravenous Anesthesia(TIVA); Inhalation Anesthesia
Intervention type(s): Drug; Drug
Intervention description(s): Ventilation of the patients was provided with a mixture of 40% oxygen and 60% air. Along with induction, propofol at a dose of 6-10 mg/kg/hour and remifentanil infusion at a dose of 0.3-0.4 mcg/kg/min were started for the maintenance of anesthesia. Drug concentrations were adjusted to maintain BIS values between 40-60 in the maintenance of anesthesia.
The MAP target was determined to be in the range of 50-65 mmHg. Blood was collected and stored to measure TAS, TOS, Catalase, Myeloperoxidase, Total Thiol, Native Thiol and Disulfide parameters before and after induction at 5,30,60 and 120 minutes. Hemodynamic data (HR, SBP, DBP, MAP, SpO2) and BIS values of the patients were recorded at 5-minute intervals. The extubation time was recorded. The surgical field opinion and satisfaction assessment were made by Boezaart Scoring and the survey presented to the surgeon, respectively. The patients were followed up for 30 minutes; numerical pain scores and nausea-vomiting scores were recorded; Ventilation of the patients was provided with a mixture of 40% oxygen and 60% N2O. As soon as mechanical ventilation started, sevoflurane was opened at a concentration of 2-3% with a MAK value of 1.1-1.3. Drug concentrations were adjusted to maintain BIS values between 40-60 in the maintenance of anesthesia.
The MAP target was determined to be in the range of 50-65 mmHg. Blood was collected and stored to measure TAS, TOS, Catalase, Myeloperoxidase, Total Thiol, Native Thiol and Disulfide parameters before and after induction at 5,30,60 and 120 minutes. Hemodynamic data (HR, SBP, DBP, MAP, SpO2) and BIS values of the patients were recorded at 5-minute intervals. The extubation time was recorded. At the end of the surgery, the surgical field opinion and satisfaction assessment were made by Boezaart Scoring and the survey presented to the surgeon, respectively. The patients were followed up for 30 minutes; numerical pain scores and nausea-vomiting scores were recorded.
Other intervention name(s): Group 1; Group 2
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study is a randomized controlled prospective study to be performed in 60 patients ASA 1 between the ages of 18-55 who will undergo elective rhinoplasty. History of smoking, alcohol, and drug use, who had a BMI>30 are excluding from the study. BIS and TOF monitoring are performing in all patients undergoing standard anesthesia induction. Patients divided into two groups with closed envelope method; TIVA(Group1) and inhalation anesthesia(Group2). In both, MAP target is determining to be in the range of 50-65 mmHg. Blood sample is collecting and storing to measure TAS, TOS, Catalase, Myeloperoxidase, Total Thiol, Native Thiol and Disulfide parameters, before induction and 5, 30, 60 and 120 minutes after induction. The extubation time is recording. The surgical field opinion and satisfaction assessment and the survey presented to the surgeon, respectively. The patients by following up in the recovery unit for 30 minutes; numerical pain scores and nausea-vomiting scores is recording.
Masking: Single (Participant)
Primary purpose: Screening
Keywords: Total intravenous anesthesia (TIVA); inhalation anesthesia; Thiol-disulphide; Oxidative stress