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    The evaluation of Qtc interval, Qtc dispersion, dysrhythmia and heart rate variability undergoing sevoflurane and desflurane anesthesia in laporoscopic surgery
    (2007) Kaymak, Çetin; Doğru, Tolga; Başar, Hülya
    Introduction: The aim of the present study was to asses the effects of sevoflurane and desflurane as inhalational anaesthetics on heart rate variability, dysrhythmias, QT interval and QT dispersion in patients who will undergo laporoscopic cholecystectomy under general anaesthesia. Material and Methods: 34 patients who will undergo elective laparoscopic cholecystectomy are enrolled in the study. The patients were monitored with Holter device 15 minutes before the anaesthesia induction till 30 minutes in recovery room. Anaesthesia was induced using 4-7 mg kg-1 thiopental sodium, l ?g kg -1 fentanyl and 1 mg kg-1 vecuronium for muscle relaxation. Cases were randomized into 2 groups; Group 1 Sevoflurane, Croup 2 Desflurane. End tidal CO2, O2, N2O were monitorized and ventilation were maintained to Keep EtCO2 between 30-40 mmHg. Minimum, maximum, mean heart rates and heart rate variability parameters included low frequency (LF), high frequency (HF) values which are heart rate variability Parameters, LF/HF ratio, Global Sympathetic Index (GSI), R-R intervals were measured in preoperative, intraoperative periods and 2 nd, 10th and 30th minutes after extubation. Atrial and ventricular dysrhythmias (AES, VES) were determined. QT interval was corrected using Bazett's formula (QTc=QT?RR). QT dispersion was calculated by finding shortest and longest QT interval. Results: Assessing data from Holter Monitor maximum heart rates values were significantly higher in Desflurane group (p=0.049). LF/HF ratio, GSI values were higher in Desflurane group in perioperative period except in induction-extubation events. Maximum R-R intervals in Sovoflurane group in perioperative period were significantly higher. In desflurane group QT intervals were significantly longer and QT dispersion was significantly more frequent. Positive correlation between sympathetic tonus increase and YES was recognized in both groups. Conclusion: In this study sympathetic activation was frequently seen in desflurane group, Severe dysrhythmias did not occur in both groups. Although both desflurane and sevoflurane increased the rate of QT, the increased of QTc and QTd in desflurane anesthesia were significantly higher than sevoflurane anesthesia.
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    The relationship between the QT interval and autonomous and anthropometric features
    (2007) Doğru, Tolga; Günaydın, Sedar; Şimşek, Vedat; Tulmaç, Murat; Güneri, Mahmut
    Objectives: We investigated the effect of anthropometric and autonomous factors on the QT interval in both sexes. Study design: The study included 237 individuals (114 males, 123 females) who were asymptomatic and had no abnormal laboratory or physical findings. The mean age was 47 years (range 20 to 79 years) for men, and 39 years (range 20 to 71 years) for women. All the participants were subjected to a careful history taking, physical examination, routine biochemical examinations, electrocardiographic recording, 24-hour Holter monitoring, and when necessary, color Doppler echocardiography and treadmill exercise test. Serum estrogen levels, serum free and total testosterone levels were also measured in males. Results: The minimum QT interval was significantly lower in males (p=0.043). The mean QT (p=0.022) and QTc (p<0.001) intervals in females, and QT dispersion in males (p=0.025) were significantly higher. In male participants, the maximum QT interval (p=0.049) and QT dispersion (p=0.043) were significantly different between age groups of 20-44 years and 45-69 years. Parasympathetic activity played a determinant role in the mean and maximum QT intervals. Anthropometric features were not correlated with the QT interval in females, whereas in males, waist-hip ratio was positively correlated with the mean QT and minimum QTc intervals (r=0.188, p=0.049 and r=0.236, p=0.013, respectively). Serum sex hormone levels were significantly effective on the QT interval in males. Conclusion: Concerning anthropometric and autonomic factors, the QT interval is significantly influenced by gender-related features.
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    Relationship of left ventricular mass to insulin sensitivity and body mass index in healthy individuals
    (Taylor & Francis Ltd, 2006) Ebinç, Haksun; Ayerden Ebinç, Fatma; Nur Özkurt, Zübeyde; Doğru, Tolga; Yilmaz, Murat
    Objective-The objective of this study was to investigate the contribution of insulin resistance, hyperinsulinaemia and obesity, independently of other major factors, to changes in left ventricular mass a cardiovascular risk indicator, in a healthy population without co-morbid states such as diabetes or hypertension. Methods and results-This cross-sectional relational study was perfomed in 153 healthy subjects, comprising 76 men and 77 women with ages ranging from 23 to 67 years. All of them were normotensive and had a normal oral glucose tolerance test, none had cardiovascular disease and none were taking any medication. Weight, height and waist circumference were measured and BMI was calculated.A blood sample was drawn in the fasting state: plasma glucose, insulin, serum total and high density lipoprotein (HDL), low density lipoprotein cholesterol and triglycerides were measured. Insulin resistance was determined by the 'Homeostasis Assessment Model' (HOMA-IR). Subjects were studied by echocardiography. The left ventricular mass was calculated by using the anatomically validated formula of Devereux et al. Results - Left ventricular mass significantly and positively correlated with BMI, age, systolic and diastolic blood pressure and fasting blood glucose. The correlation of left ventricular mass with fasting blood glucose was not maintained after controlling for BMI. BMI, fasting blood glucose, HOMAIR, systolic and diastolic blood pressure showed significant differences with higher values for people with left ventricular hypertrophy. The logistic regression analysis showed a strong association between left ventricular hypertrophy and BMI (p < 0.05). Conclusion - Insulin resistance and fasting insulin is not associated with left ventricular hypertrophy in healthy people, independent of obesity. Obesity appears to be an independent risk factor for left ventricular hypertrophy.
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    The relationship between orthostatic differences in arterial blood pressure and autonomic tone: gender variability
    (Aves, 2007) Doğru, Tolga; Günaydın, Serdar; Şimşek, Vedat; Tulmaç, Murat; Tireli, Emine
    Objectives: The differences in orthostatic blood pressure result from dynamic changes in the sympathovagal balance. We studied sex-related variations in autonomic tone regulation. Study design: The study included 237 individuals (114 males, 123 females) who were asymptomatic and had no abnormal laboratory or physical findings. The mean age was 47 years (range 20 to 79 years) for men, and 39 years (range 20 to 71 years) for women. All the participants were subjected to a careful history taking, physical examination, routine biochemical examinations, electrocardiographic recording, 24-hour Holter monitoring, and orthostatic tests. Results: In heart rate variability analysis, parasympathetic tone parameters, in particular the high frequency (HF) component was significantly high in females, whereas sympathetic tone parameters, in particular the low frequency (LF)/HF ratio was significantly high in males (p< 0.001). The normalized LF component in males showed positive correlations with systolic (r= 0.308, p= 0.001) and diastolic (r= 0.301, p= 0.002) blood pressures during the rapid stand test; this correlation was not seen in females. Blood pressures obtained in the second minute of the rapid supine test following the stand test were in positive correlation with the LF/HF ratio in both sexes. In males, variations in systolic and diastolic blood pressures during rest, stand, and supine positions were primarily influenced by the LF component and HF component, respectively. In females, variations in systolic blood pressure during the three positions were not correlated with autonomic tone components, but variations in diastolic blood pressure were primarily affected by the LF/HF ratio. Conclusion: Autonomic system works through varying priorities in both sexes and this causes sex-related differences in orthostatic tolerance.