Propofol ve deksmedetomidin sedasyonunun göz i̇çi basıncı üzerine olan etkilerinin karşılaştırılması
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Date
2008-05-14
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Uludağ Üniversitesi
Abstract
Rejyonal anestezi ile oftalmik cerrahi dışı operasyon geçirecek olgularda propofol ve deksmedetomidin sedasyonunun göz içi basıncına etkilerini karşılaştırmayı amaçladık. Aksiller pleksus bloğu ile birlikte sedasyon uygulaması planlanan, 60 elektif el cerrahisi olgusu randomize olarak iki gruba ayrıldı. Grup P (n=30)’de propofol, 1mg kg-1 iv 10 dakikada yükleme dozu sonrası, Ramsay Sedasyon Skor’u (RSS) 3-4 olacak şekilde 50-100 μg kg-1dk-1 iv infüzyonuna devam edildi. Grup D (n=30)’deki olgulara deksmedetomidin, 1 μg kg-1sa-1 iv 10 dakika yükleme dozu sonrası RSS’u 3-4 olacak şekilde 0.2-0.7 μg kg-1sa-1 infüzyonuna devam edildi. Göz içi basınçları, çalışma ilacı yükleme dozu öncesi (kontrol değer) ve sonrası, operasyonun 15. ve 30. dakikalarında, operasyon sonunda "Tonopen XL aplanasyon tonometresi ile ölçüldü. Propofol göz içi basıncını yükleme dozu sonrası ortalama %18.6, 15.dakikada %17.8, 30.dakikada %21.7, operasyon sonunda %13.3 düşürdü. Deksmedetomidin ise göz içi basıncını yükleme dozu sonrası %34.1, 15.dakikada %36.4, 30.dakikada %42.1 operasyon sonunda ise %40.1 düşürdü. Gruplar birbirleriyle karşılaştırıldığında kontrol değere göre göz içi basıncını düşürme oranlarının istatistiksel olarak anlamlı olduğu görüldü (p<0.05). Olgularda bulantı, kusma, alerji, hipotansiyon, bradikardi ve apne gözlenmedi. Propofol ve deksmedetomidin oftalmik cerrahide güvenle kullanılabilecek sedatif ajanlardır. Sedasyon düzeylerinin hemodinamik etkilerinin benzer olmasının yanı sıra, göz içi basıncını daha fazla düşürmesi nedeniyle deksmedetomidin öncelikle tercih edilebilir.
We aimed to compare the effects of propofol and dexmedetomidine sedation on intraocular pressure in patients undergoing non-ophthalmic surgery with regional anaesthesia. Sixty patients; whom were scheduled for axillary plexus block and sedation for elective hand surgery, were randomly separated into two groups. Group P (n=30) received propofol 1 mg kg-1 iv as a loading dose and continued to receive 50-100 mg kg-1 dk-1 iv infusion at 10 min, as Ramsay sedation score were ensured to be 3-4. Group D (n=30) received dexmedetomidine 1 mg kg-1 hr-1 iv as a loading dose at 10 min, followed by a continuous 0.2-0.7 mg kg-1 hr-1 infusion while Ramsay Sedation Score were also ensured to be 3-4. Intraocular pressure of the patients were measured with “Tonopen XL applanation tonometer” before the sedative agent (control measurement), after the loading dose, at 15th, 30 th minute of operation and at the end of the operation. Propofol decreased intraocular pressure by 18.6% after the loading dose, 17.8% at the 15th minute, 21.7% at the 30th minute and 13.3% at the end of the operation. Dexmedetomidine decreased intraocular pressure by 34.1% after the loading dose, 36.4% at the 15th minute, 42.1% at the 30th minute and 40.1% at the end of the operation. When we compared two groups; the decrease in intraocular pressure was significantly different (p<0.05). Vomiting, nausea, allergic reaction, hypotension, bradycardy and apnea were not observed in any patient. Propofol and dexmedetomidine can safely be used in ophthalmic surgery as a sedative agent. Dexmedetomidine can be preferred as the first alternative as it has similar haemodynamic effects and more significantly reduces intraocular pressure.
We aimed to compare the effects of propofol and dexmedetomidine sedation on intraocular pressure in patients undergoing non-ophthalmic surgery with regional anaesthesia. Sixty patients; whom were scheduled for axillary plexus block and sedation for elective hand surgery, were randomly separated into two groups. Group P (n=30) received propofol 1 mg kg-1 iv as a loading dose and continued to receive 50-100 mg kg-1 dk-1 iv infusion at 10 min, as Ramsay sedation score were ensured to be 3-4. Group D (n=30) received dexmedetomidine 1 mg kg-1 hr-1 iv as a loading dose at 10 min, followed by a continuous 0.2-0.7 mg kg-1 hr-1 infusion while Ramsay Sedation Score were also ensured to be 3-4. Intraocular pressure of the patients were measured with “Tonopen XL applanation tonometer” before the sedative agent (control measurement), after the loading dose, at 15th, 30 th minute of operation and at the end of the operation. Propofol decreased intraocular pressure by 18.6% after the loading dose, 17.8% at the 15th minute, 21.7% at the 30th minute and 13.3% at the end of the operation. Dexmedetomidine decreased intraocular pressure by 34.1% after the loading dose, 36.4% at the 15th minute, 42.1% at the 30th minute and 40.1% at the end of the operation. When we compared two groups; the decrease in intraocular pressure was significantly different (p<0.05). Vomiting, nausea, allergic reaction, hypotension, bradycardy and apnea were not observed in any patient. Propofol and dexmedetomidine can safely be used in ophthalmic surgery as a sedative agent. Dexmedetomidine can be preferred as the first alternative as it has similar haemodynamic effects and more significantly reduces intraocular pressure.
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Keywords
Göz içi basıncı, Sedasyon, Propofol, Deksmedetomidin, Intraocular pressure, Sedation
Citation
Kalyoncu, A. vd. (2008). “Propofol ve deksmedetomidin sedasyonunun göz i̇çi basıncı üzerine olan etkilerinin karşılaştırılması”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 34(2), 65-70.