Određivanje aktivnosti simpatikusa fotopletizmografijom kod epiduralne analgezije u porođaju

doctoral thesis

• Title (english): Photoplethysmographic evaluation of sympathetic activity during epidural analgesia for vaginal delivery
• Author: Krešimir Reiner; VIAF: 51149842001102840268
• Mentor: Slobodan Mihaljević (mentor)
• Committee member: Dinko Tonković (predsjednik povjerenstva)
• Committee member: Gordan Zlopaša (član povjerenstva)
• Committee member: Višnja Majerić-Kogler (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2020-12-28, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics
• Universal decimal classification (UDC): 618 - Gynaecology. Obstetrics

Abstract

Fotopletizmografijom je moguće kvantificirati razliku u stupnju simpatektomije između lokalnih anestetika nakon aplikacije u epiduralni prostor. Postavljenjem fotopletizmografskog uređaja na ruku, moguće je mjeriti aktivnost simpatikusa iznad razine epiduralnog bloka.
Hipoteza istraživanja je kako ropivakain izaziva manji stupanj simpatektomije u odnosu na levobupivakain nakon aplikacije u epiduralni prostor.
U studiju je uključeno 60 trudnica kod kojih je indicirana epiduralna analgezija za porođaj. Ispitanice su randomizirane s obzirom na tip lokalnog anestetika: 10 ml 0.125% levobupivakaina ili 10 ml 0.125% ropivakaina. Fotopletizmografski signal na ruci i na nozi, krvni tlak te VAS ljestvica (VAS – visual analogue scale), zabilježeni su prije, te 5, 10 i 20 minuta nakon aplikacije epiduralne analgezije.
Fotopletizmografski parametri mjereni na nozi pokazuju trend kontinuiranog porasta što odražava simpatektomiju te povećanje vaskularne popustljivosti u anatomskom području zahvaćenim epiduralnim blokom. Premda između levobupivakaina i ropivakaina postoji razlika za PTT (PTT – pulse transit time), nisu zabilježene razlike između skupina u smislu analgetskog učinka i hemodinamskih komplikacija te je za zaključiti kako su oba lijeka jednako sigurna i učinkovita za epiduralnu analgeziju.
Temeljem promjena fotopletizmografskih parametara na ruci, za zaključiti je kako se aktivnost simpatikusa smanjuje i iznad razine epiduralnog bloka no potrebne se daljnje studije za konačne zaključke.

Abstract (english)

By using photoplethysmography, it is possible to quantify the difference in sympathectomy between local anesthetics after epidural administration. By placing the photoplethysmographic probe on finger, it is possible to measure sympathetic activity above the level of block.
Hypothesis of the study is that ropivacaine causes less sympathectomy than levobupivacaine after epidural administration.
60 parturients were included in the study. Parturients were randomised by the type of local anesthetic administered for epidural analgesia during labour: 10 ml of 0.125% levobupivacaine or 10 ml of 0.125% ropivacaine. Photoplethysmographic signal on toe and finger, blood pressure and VAS (VAS – visual analogue scale) were recorded before and 5, 10 and 20 minutes after administering epidural analgesia.
Photoplethysmographic parameters measured on foot increased continuously, which reflects sympathectomy and increased vascular compliance in the level of epidural block. Although a difference was found for PTT (PTT – pulse transit time), no differences between groups were found regarding analgesic efficacy and hemodynamic complications which leaded to conclusion that both drugs are equally effective and safe for epidural administration.
Based on photoplethysmographic changes measured on the finger, it is to conclude that sympathetic activity decreases above the level of the block but further studies are necessary for final conclusions.

• Keywords: Levobupivakain; Ropivakain; Anestetici; lokalno; Analgezija; epiduralna; Fotopletizmografija; Farmaceutski pripravci; Krvni tlak; Vizualna analogna skala; Anestezija; lokalno; Trudovi; Opstetrički; Analgetici; Analiza pulsnog vala; Simpatektomija; Nožni prsti
• Keywords (english): Levobupivacaine; Ropivacaine; Anesthetics; Local; Analgesia; Epidural; Photoplethysmography; Pharmaceutical Preparations; Blood Pressure; Visual Analog Scale; Anesthesia; Local; Labor; Obstetric; Analgesics; Pulse Wave Analysis; Sympathectomy; Toes
• Language: croatian
• URN:NBN: urn:nbn:hr:105:085205
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Catalog URL: https://katalog.nsk.hr/F/19IT7Y755V1NXQJPHCLYSQGPF6BLAPPF179HQ7FAXXMYBYGMV5-46692?func=find-e&request=Odre%C4%91ivanje+aktivnosti+simpatikusa+fotopletizmografijom+kod+epiduralne+analgezije+u+poro%C4%91aju&find_scan_code=FIND_NAS&adjacent=N&local_base=MF_WEB&x=0&y=0&filter_code_1=WLN&filter_request_1=&filter_code_2=WYR&filter_request_2=&filter_code_3=WYR&filter_request_3=&filter_code_4=WFM&filter_request_4=
• Type of resource: Text
• Extent: 89 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-22 09:31:54