Nazal cerrahi girişimlerde kontrollü hipotansiyon uygulamasında deksmedetomidin ve remifentanilin etkinliğinin karşılaştırılması
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Date
2011
Authors
Kaya, Atila
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızın amacı, fonksiyonel endoskopik sinus cerrahisi (FESS) ve septorinoplasti sırasında kontrollü hipotansiyon sağlanmasında ve cerrahi saha koşullarının düzeltilmesinde santral α2-adrenerjik agonist deksmedetomidin ile μ agonist olan remifentanilin karşılaştırılması idi.Elektif FESS ve septorinoplasti planlanan 50 ASA I-II hasta, anestezi indüksiyonu öncesi 10 dk'nın üzerinde 0.5 μg/kg takiben idamede 0.5-1 μg/kg/sa deksmedetomidin infüzyonu (Grup D, n=25) ya da indüksiyonu öncesi 1 dk'nın üzerinde 0.5 μg/kg takiben idamede 0.2-0.5 μg/kg/dk remifentanil infüzyonu (Grup R, n=25) almak için ayrıldılar. İnfüzyon hızları ortalama arteriyel basıncı (OAB) 60-80 mmHg düzeyinde idame edecek şekilde titre edildi. Anestezi %50 O2/N2O içinde sevofluran ile BIS değerleri 40-60 sınırları içinde sürdürüldü. Kalp hızı (KH) ve OAB değerleri, ilaç tüketimleri ve maliyetleri, cerrahi saha koşulları, derlenme özellikleri, komplikasyonlar, ağrı, cerrah ve hasta memnuniyet skorları kaydedildi. Arteryel kan gazları değerlendirildi.Çalışma ilacının verilmesi, indüksiyon ve ekstübasyon sonrası KH'deki azalmalar Grup D'de daha yüksekti (p<0.01, p<0.01, p<0.05). OAB değerleri infüzyonun sonlandırılmasının 10. dk'sında ve ekstübasyon öncesi daha düşüktü (p<0.05, p<0.05). Baz açığındaki değişiklikler, cerrahi sonrası Grup D'de daha yüksekti. Wilson sedasyon skoru derlenme ünitesinde 15. dk.'da Grup D'de daha yüksekti (p<0.05). Diğer değerlendirilen parametreler iki grup için benzerdi. Maliyet etkinliği Grup D'de yüksekti (p<0.001).Sevofluran ile kombine edilen hem deksmedetomidin hem de remifentanil FESS ve septorinoplasti için yeterli kontrollü hipotansiyon ve uygun cerrahi koşullar sağladı. Bununla birlikte, nazal cerrahide hipotansif yaklaşımın klinik olarak uygun olduğu hastalarda deksmedetomidin veyaremifentanilin seçilmesinde maliyet etkinliği düşünüldüğünde, remifentanilin daha akılcı bir yaklaşım olacağı kanısına varıldı.
The aim of our study was to compare dexmedetomidine, a central A2-adrenergic agonist with remifentanil, a μ-specific agonists, regarding their effects in achieving controlled hypotension and improving surgical field exposure during functional endoscopic sinus surgery (FESS) and septorhinoplasty. Fifty ASA I-II patients scheduled for elective (FESS) and septorhinoplasty were randomly assigned to receive either dexmedetomidine 0.5 μg/kg over 10 min before anesthesia induction followed by 0.5-1 μg/kg/h infusion during maintenance (Group D, n=25) or remifentanil 0.5 μg/kg over 1 min before anesthesia induction followed by 0.2-0.5 μg/kg/min infusion during maintenance (Group R, n=25). The infusion rates were titrated to maintain mean arterial pressure (MAP) of 60 to 80 mmHg. Anesthesia was maintained sevoflurane in %50 O2/N2O to achieve of BIS values in a range of 40-60. Values of heart rate (HR) and MAP, drug consumptions and costs, surgical field exposure conditions, recovery properties, complications, pain and satisfaction scores for surgeon and patient were recorded. Arterial blood gases were evaluated.Decreases in HR were higher in the Group D at after administration of study drug and induction, and extubation (p<0.01, p<0.01, p<0.05). MAP values were lower in the Group D at 10 min after stopping the infusion and before extubation (p<0.05, p<0.05). Changes in base deficit were higher in the Group D after surgery (p<0.05). Wilson sedation score was higher in the Group D at 15 min in recovery room (p<0.05). The other evaluated parameters were similar for two groups. Cost effectiveness was higher in the Group D (p<0.001).Both dexmedetomidine and remifentanil when combined sevoflurane provided adequate controlled hypotension and proper surgical conditions for FESS and septorhinoplasty. However, if cost-effectiveness was considered in the decision to adopt dexmedetomidine or remifentanil for nasal surgery, remifentanil is likely to be the favoured treatment for patients for whom either hypotensive approach is clinically appropriate.
The aim of our study was to compare dexmedetomidine, a central A2-adrenergic agonist with remifentanil, a μ-specific agonists, regarding their effects in achieving controlled hypotension and improving surgical field exposure during functional endoscopic sinus surgery (FESS) and septorhinoplasty. Fifty ASA I-II patients scheduled for elective (FESS) and septorhinoplasty were randomly assigned to receive either dexmedetomidine 0.5 μg/kg over 10 min before anesthesia induction followed by 0.5-1 μg/kg/h infusion during maintenance (Group D, n=25) or remifentanil 0.5 μg/kg over 1 min before anesthesia induction followed by 0.2-0.5 μg/kg/min infusion during maintenance (Group R, n=25). The infusion rates were titrated to maintain mean arterial pressure (MAP) of 60 to 80 mmHg. Anesthesia was maintained sevoflurane in %50 O2/N2O to achieve of BIS values in a range of 40-60. Values of heart rate (HR) and MAP, drug consumptions and costs, surgical field exposure conditions, recovery properties, complications, pain and satisfaction scores for surgeon and patient were recorded. Arterial blood gases were evaluated.Decreases in HR were higher in the Group D at after administration of study drug and induction, and extubation (p<0.01, p<0.01, p<0.05). MAP values were lower in the Group D at 10 min after stopping the infusion and before extubation (p<0.05, p<0.05). Changes in base deficit were higher in the Group D after surgery (p<0.05). Wilson sedation score was higher in the Group D at 15 min in recovery room (p<0.05). The other evaluated parameters were similar for two groups. Cost effectiveness was higher in the Group D (p<0.001).Both dexmedetomidine and remifentanil when combined sevoflurane provided adequate controlled hypotension and proper surgical conditions for FESS and septorhinoplasty. However, if cost-effectiveness was considered in the decision to adopt dexmedetomidine or remifentanil for nasal surgery, remifentanil is likely to be the favoured treatment for patients for whom either hypotensive approach is clinically appropriate.
Description
Keywords
Kontrollü hipotansiyon, Deksmedetomidin, Remifentanil, Cerrahi koşullar, Endoskopik sinus cerrahisi, Controlled hypotension, Dexmedetomidine, Remifentanil, Surgical conditions, Endoscopic sinus surgery
Citation
Kaya, A. (2011). Nazal cerrahi girişimlerde kontrollü hipotansiyon uygulamasında deksmedetomidin ve remifentanilin etkinliğinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.