Utjecaj primjene deksametazona u spinalnoj anesteziji kod prijeloma bedrene kosti

doctoral thesis

• Title (english): Influence of dexamethasone administration in spinal anesthesia for femur fracture
• Author: Livija Šakić
• Mentor: Dinko Tonković (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-07-04, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Proksimalni prijelomi bedrene kosti (PPBK) najčešći su uzrok prijma u bolnicu za kiruršku
rekonstrukciju kuka s visokim poslijeoperacijskim morbiditetom.
Hipoteza je da jedna intratekalna doza deksametazona u spinalnoj anesteziji s
levobupivakainom snižava poslijeoperacijsku bol i kognitivne promjene svijesti.
U istraživanje je uključeno 60 pacijenata s PPBK, ASA statusa 2 i 3 randomiziranih u dvije
skupine: DLSA skupina je primila 8 mg deksametazona tijekom uvođenja spinalne anestezije
sa 12.5 mg 0.5%-tnog levobupivakaina. LSA skupina primila je samo levobupivakain.
Poslijeoperacijska kognitivna promjena svijesti procijenjivana je CAM-ICU bodovnom
ljestvicom, intenzitet boli zbrojem VAS te su mjerene vrijednosti kortizola i glukoze u krvi
prije i poslije operacije.
Kirurška korekcija poslije 48 sati od prijma učinjena je kod 63% pacijenata. U skupini LSA
koristio se efedrin (P=0,044). U skupini DLSA zabilježeno je kraće trajanje hospitalizacije
(P=0.045), kraće vrijeme od operacije do otpusta (P=0,044), manji udio POKD i delirija
(P=0,043), kraći nastup bloka(P=0,005), dulje trajanje analgezije (P<0,001) i niže vrijednosti
kortizola. Regresijskim modelom (P=0,048), u skupini DLSA je snižena vjerojatnost nastanka
poremećaja svijesti za 7,67 puta.
Zaključci: Intratekalna primjena deksametazona u spinalnoj anesteziji umanjuje stresni
odgovor sniženjem kortizola, boli, POKD s kvalitetnijom rehabilitacijom, skraćenom
hospitalizacijom bez utjecaja na krvarenje.

Abstract (english)

Proximal femur fractures are the most common cause of emergency admission to hospital with
high postoperative morbidity. The hypothesis is that one single shot of dexamethasone with levobupivacaine in spinal
anesthesia reduces postoperative pain and cognitive disturbances. The study included 60 patients with proximal femur fracture, ASA status 2 and 3 who were
randomized into two groups. DLSA group received 8 mg of dexamethasone and 12.5 mg of
0.5% levobupivacaine intrathecally. LSA group received only levobupivacaine. The
postoperative cognitive disturbance was evaluated with CAM-ICU score scale, the pain
intensity was measured with VAS scale and cortisol and glucose samples were taken before and
after surgery. Surgical correction was made in 63% of patients in 48 hours after admission.
Ephedrine was used in LSA group, P=0,044. We found shorter hospitalization in DLSA group
(P=0,045), shorter duration from surgery to discharge (P=0,044), there was lower occurrence
of delirium and POCD (P=0,043), longer analgesia (P<0,001) and lower cortisol levels. Regression model in DLSA group showed less occurrence of postoperative cognitive
disturbance for 7,67 times. Conclusion: Intrathecal administration of dexamethasone in spinal anesthesia reduces stress
response by lowering cortisol levels, pain, occurrence of POCD with better rehabilitation
quality and shorter hospitalization without affecting bleeding.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:407336
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 111 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:03:53