Disk hernisi operasyonlarında sevorane + N2 0 İle propofol + alfentanil anestezilerinin karşılaştırılması
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Date
1998
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Uludağ Üniversitesi
Abstract
Mikrocerrahi ile elektif lumbal disk hernisi operasyonlarında uygulanan inhalasyon anestezisi (sevoflurane + N2 O) veya total intravenöz anestezi (propofol + alfentanil} arasındaki hemodinamik reaksiyonlar. ameliyat sonrası derlenme ve anaijezik gereksinimi yönünden farkiart saptayabilmek için, ASA I-II risk puanlamasında ve 18-65 yaşlarında 50 hasta, randomize olarak 25 'erlik iki gruba ayrılmıştır. 20 pg/kg alfentanil, 1.5 mg/kg propofol,0,1 mg/kg vecuronium ile standart anestezi indüksiyonunda sonra birinci grupta anesteziye 6 mg/kg /st. propofol 1 pg/kg/dak. Afemanil infüzyonu ikinci grupta % 50 N20 ( oksijen) karışımında sevofluran ile devant edilmiştir. 1.grupta alfentanil ve propofol infüzyonu ll. grupta sevofluran konsantrasyonları, cerrahi girişim için yeterli anestezi derinliğini sağlayacak şekilde ayarlanmıştır. Ameliyatın sonunda infüzyonlar veya sevofluran akmu kesilerek anesteziden uymuş yeterli 5 spontan solunumun geri dönüş (Vr>-4 ml/kg), trakeal eksplinasyon, hastanın gözlerini açması ve ismini söyleyebilmesi ile aptamil. Postoperatif dönemde analjezik isteminin sıklığı ve gerekli hasta kontrollü analjezi uygulanarak iki saat süre içinde izlenmiştir. Ağrı şiddeti visuel analog skala ile saptanmış, bulantı ve kusma. postoperatif üşütme titreme kaydedilmiştir. Sevofluran anestezisi uygulananlarda. trakeal intiiba lezyon ve cilt insizyonu, sistemik arter basmcmm ve kalp atım morlaşma neden , gruplar arasında bunun başka hemodinamik fark izlenmemiştir. Spanlan remilasyonım geri dönüşü (3.2 vs 6,3 min). ekstübasyon (3,8 vs 9,5 min). hastanın gözlerini açması ve isminin söyleyebilmesi alfentanil + propofol grubunda daha kısa sürede gerçekleşmiştir. Alfentanil + propofol grubundaki hastalarda postoperatif üşüme titreme daha sıklık izlenmiş. ağrı skorları, analjezik gereksinimi ve bulantı-kusma sıklığı yönünden gruplar arasında fark saptanmamıştır.
To ascertain whether there is a difference between total intravenous anaesthesia with propofol (P) and alfentanil (A) and inhalation anaesthesia with sevof/urane (S) and nitrous oxide (N) with regard to haemodynamic reactions, recovery profile and postoperative analgesic demand in patients scheduled for elective microsurgical er ebral disc resection. 50 patients (ASA 1-11) 18-65 years) were randomly assigned to receive total intravenous anaesthesia with propofol and alfentanil or inhalational anaesthesia with sevoflurane and nitrous oxide. After standardised induction of anaesthesia in both groups 20 pg/kg alfentanil.1.5 mg/kg propofol. 0,1 mg/kg vecuronium the patients of the first group received a constant infusion of 6 mg/kg/h. propofol and 1 pg/kg/min. alfentanil. In the second group. anaesthesia ıvas maintained with sevoflurane in 50 % N10. The administration of sevoj/urane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anesthesia. At the end of surgery the anesthetics were discontinued and early emergence from anaesthesia was assessed by measuring time to spontaneous ventilation (V1 >4 ml kg). tracheal tubing. opening of the eyes and stating the correct name. The Frequency of analgesics and total demand for analgesic.1 were determined using patient controlled analgesia and recorded for 2 postoperatively. In addition, the pa in !eve! of the patients ll' as measured on a visual analogue scafe and the incidence of postoperative shivering, nausea and iting was not ed Patients anaesthetised with sevoflurane responded to tracheal intubation and skin incision with increasing blood pressure and shoıı ed higher heC/1'/ rates than patients anaesthetised with propofol and alfentanil but there were no other haemodynamic differences between the groups in response to surgical stimuli. There were significantly shorter times to sponeos ventilation (3.2 vs 6,3 min) extubation (3.8 vs 9,5 min). eye opening (3,0 vs. 11,5 min) and giving name (4,8 ws. 14.3 min), in patients anaesthetised with alfentanil and propofol than those receiving desflurane and nitro 1s oxide 1-however patients anaesthetised with ıvith alfentanil and propofol had a greater incidence of postoperative shivering. There ırere no significant differences between the tıvo roı~ps in the patients' pa in scores. analgesic demand and incidence of nausea and vomiting.
To ascertain whether there is a difference between total intravenous anaesthesia with propofol (P) and alfentanil (A) and inhalation anaesthesia with sevof/urane (S) and nitrous oxide (N) with regard to haemodynamic reactions, recovery profile and postoperative analgesic demand in patients scheduled for elective microsurgical er ebral disc resection. 50 patients (ASA 1-11) 18-65 years) were randomly assigned to receive total intravenous anaesthesia with propofol and alfentanil or inhalational anaesthesia with sevoflurane and nitrous oxide. After standardised induction of anaesthesia in both groups 20 pg/kg alfentanil.1.5 mg/kg propofol. 0,1 mg/kg vecuronium the patients of the first group received a constant infusion of 6 mg/kg/h. propofol and 1 pg/kg/min. alfentanil. In the second group. anaesthesia ıvas maintained with sevoflurane in 50 % N10. The administration of sevoj/urane and the infusion of the anaesthetics were adjusted to maintain a surgical depth of anesthesia. At the end of surgery the anesthetics were discontinued and early emergence from anaesthesia was assessed by measuring time to spontaneous ventilation (V1 >4 ml kg). tracheal tubing. opening of the eyes and stating the correct name. The Frequency of analgesics and total demand for analgesic.1 were determined using patient controlled analgesia and recorded for 2 postoperatively. In addition, the pa in !eve! of the patients ll' as measured on a visual analogue scafe and the incidence of postoperative shivering, nausea and iting was not ed Patients anaesthetised with sevoflurane responded to tracheal intubation and skin incision with increasing blood pressure and shoıı ed higher heC/1'/ rates than patients anaesthetised with propofol and alfentanil but there were no other haemodynamic differences between the groups in response to surgical stimuli. There were significantly shorter times to sponeos ventilation (3.2 vs 6,3 min) extubation (3.8 vs 9,5 min). eye opening (3,0 vs. 11,5 min) and giving name (4,8 ws. 14.3 min), in patients anaesthetised with alfentanil and propofol than those receiving desflurane and nitro 1s oxide 1-however patients anaesthetised with ıvith alfentanil and propofol had a greater incidence of postoperative shivering. There ırere no significant differences between the tıvo roı~ps in the patients' pa in scores. analgesic demand and incidence of nausea and vomiting.
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Keywords
Propofol, Sevofluran, Kardiyovasküler etkiler, Oerlenme süreleri, Sevoflurane, Cardiovascular effects, Emergence times, Recovery
Citation
Erinçler, T. vd. (1998). ''Disk hernisi operasyonlarında sevorane + N2 0 İle propofol + alfentanil anestezilerinin karşılaştırılması''Uludağ Üniversitesi Tıp Fakültesi Dergisi, 25(1-2-3), 13-18.