Enflurane 및 Propofol을 이용한 전신 마취시 혈청 T3, T4측정치의 변화

Abstract

[한글]

마취제의 갑상선 호르몬에 대한 영향은 다양하다. 인간에서 ether, halothane등은 혈청 T^^4 를 증가시킨다고 알려져있으며, methoxyflurane, isoflurane, nitrous oxide는 혈청 T^^3, T^^4에 별 영향이 없는 것으로 보고되어 있다. 최근에 널리 쓰이는 흡입 마취제

인 enflurane는 혈청 T^^3 는 감소시키고 혈청 T^^ 4는 증가시키는 것으로 보고되었으며 최근 각광받는 정맥 마취제인 propofol의 갑상선 호르몬에 대한 영향은 확실히 알려지지 않아서 이들 enflurane및 propofol이 혈청 T^^3, T^^4 미치는 영향을 알아보고자 하였다.

현재나 과거에 갑상선 질환을 앓은 적이 없는 선택 수술을 받을 환자 34명을 대상으로 하여 임의로 enflurane군 12명과 Propofol군 22명으로 나누어 Enflurane군에서는 thiopental 5mg/kg로 마취 유도후 O^^2 2L/min, N^^2O 2L/min, enflurane(1.0-2.5%)로 마취유지를 하였으며, propofol군에서는 propofol 2mg/kg로 마취 유도후 0^^2 2L/min, N^^2O 4L/min와 propofol 50-150mcg/kg/min 점적 주사로 마취 유지 하였다. 수술실 도착 후 5분, 마취 유도 후 1분, 기관내 삽관 직후, 피부 절개 직후, 수술 도중, 발관 후 10분에 혈압과 심박동수를 측정하고 혈액을 채취하여 혈청 T^3, T^^4를 화학 발광 면역법으로 정량 분석한 결과 아래와 같은 결과를 얻었다.

1. Enflurane군에서 혈청 T^^3 는 기준치에 비해 발관 후 감소하는 경향을 보였다. 혈청 T^^4 의 변화는 thiopental로 마취 유도후 기준치에 비해 의미있는 감소를 보였고, 발관 후 기준치에 비해 증가하는 경향을 보였다.

2. Propofol군에서 혈청 T^^3 는 기준치에 비해 발관 후 감소하는 경향을 보였고, 혈청 T^^4는 피부 절개 후, 발관 후 기준치에 비해 의미있는 증가를 보였다.

이상의 결과로 enflurane, propofol 모두 혈청 T^^3 는 감소시키고 혈청 T^^4 는 증가시키는 것을 알 수 있으며 특히 propofol 마취 후 혈청 T^^4가 의미있게 증가하는 것을 알 수 있다.

The changes of serum trliodothyronine(T^^3), thyroxine(T^^4) levels during general

anethesia with enflurane and propofol

Young Seok Jee

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Ryung Choi)

The effect of various anesthetic agents on serum T^^4 levels have been reviewed.

In man, ether, halothane, enflurane all increase serum T^^4 levels whereat nitrous

oxide, isoflurane have little effect. Intravenous anesthetic agents almost decrease

serum T^^3 levels but propofol has no known effect on serum T^^3, T^^4.

Investigations were done in 34 patients scheduled elective surgery with general

anesthesia, who were divided into two groups(Enflurane group: 12, propofol

group:22). No clinical signs of thyroid disturbances could be observed

preoperatively in the patients. Anesthesia was induced with thiopental 5mg/kg in

enflurane group, propofol 2mg/kg in propofol group, and maintained with O^^2

2L/min, N^^2 O 2L/min, enflurane(1.0-2.5%) in enflurane group, O^^2 2L/min, N^^2 O

4L/min and continuous controlled infusion of propofol (50-150mcg/kg/min ) in

propofol group. Blood samples were collected at 5 minute after arriving in

operating room, 1 minute after induction, 5 minute after intubation, 1 minute after

skin incision, during operation, 10 minute after ektubation. Blood samples were

centrifused and serum was taken from each sample. Determinations of T^^3 and T^^4

were performed using enhanced chemiluminescence immunoassay(ELIA). Comparisons of

our results were made using repeated measures analysis of variance, paired students

t-test and statistically significant when p value was less than 0.05. The results

are summerized as follows:

1. In enflurane group, serum T^^3 levels showed a decreasing tendency after

extubation compared to baseline. Decreasing serum T^^4 after administration of

thiopental could be considered statistically significant and serum T^^4 levels

showed a decreasing tendency after extubation compared to baseline.

2. In propofol group, serum T^^3 levels showed a decreasing tendency after

extubation compared to baseline. Rises in serum T^^4 after incision and extubation

could be considered statistically significant.

Based on these results, no direct negative influence of propofol need be expected

on T^^4 /T^^3 metabolism in euthyroid patients. However, the changes in these

hormones, although with in the physiological range here, indicate that propofol may

adversely influence their levels in the presence of ani feat thyroid disease.

[영문]

The effect of various anesthetic agents on serum T^^4 levels have been reviewed. In man, ether, halothane, enflurane all increase serum T^^4 levels whereat nitrous oxide, isoflurane have little effect. Intravenous anesthetic agents almost decrease serum T^^3 levels but propofol has no known effect on serum T^^3, T^^4.

Investigations were done in 34 patients scheduled elective surgery with general anesthesia, who were divided into two groups(Enflurane group: 12, propofol group:22). No clinical signs of thyroid disturbances could be observed preoperatively in the patients. Anesthesia was induced with thiopental 5mg/kg in enflurane group, propofol 2mg/kg in propofol group, and maintained with O^^2 2L/min, N^^2 O 2L/min, enflurane(1.0-2.5%) in enflurane group, O^^2 2L/min, N^^2 O 4L/min and continuous controlled infusion of propofol (50-150mcg/kg/min ) in propofol group. Blood samples were collected at 5 minute after arriving in

operating room, 1 minute after induction, 5 minute after intubation, 1 minute after skin incision, during operation, 10 minute after ektubation. Blood samples were centrifused and serum was taken from each sample. Determinations of T^^3 and T^^4

were performed using enhanced chemiluminescence immunoassay(ELIA). Comparisons of our results were made using repeated measures analysis of variance, paired students t-test and statistically significant when p value was less than 0.05. The results are summerized as follows:

1. In enflurane group, serum T^^3 levels showed a decreasing tendency after extubation compared to baseline. Decreasing serum T^^4 after administration of thiopental could be considered statistically significant and serum T^^4 levels showed a decreasing tendency after extubation compared to baseline.

2. In propofol group, serum T^^3 levels showed a decreasing tendency after extubation compared to baseline. Rises in serum T^^4 after incision and extubation could be considered statistically significant.

Based on these results, no direct negative influence of propofol need be expected on T^^4 /T^^3 metabolism in euthyroid patients. However, the changes in these hormones, although with in the physiological range here, indicate that propofol may

adversely influence their levels in the presence of ani feat thyroid disease.