Ketamin ve deksmedetomidinin propofol ile ko-indüksiyonunun laringeal maske yerleştirme başarısına etkilerinin karşılaştırılması
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Date
2012
Authors
Ahun, Filiz
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda; hava yolu sağlanmasında laringeal maske (LMA) yerleştirilmesinde ketamin veya deksmedetomidinin, propofol ile ko-indüksiyonunun hemodinamik yanıta, LMA yerleştirme başarısına, indüksiyonda uygulanan propofolün doz gereksinimine olan etkilerini karşılaştırmayı amaçladık.18?60 yaş arası, ASA I-II, 90 olgu çalışmaya dahil edildi. Rutin monitorizasyon sonrası, Grup Ketamin-Propofol'de; 0,5 mg/kg ketamin, Grup Deksmedetomidin-Propofol'de; 0,5 µg/kg deksmedetomidin ve Grup Kontrol'de; serum fizyolojik İV 5 dk içinde uygulandı. Tüm olgulara kirpik refleksi kayboluncaya kadar propofol İV uygulanmasından 60 sn sonra LMA yerleştirildi. İndüksiyondaki propofol dozu kaydedildi. LMA yerleştirme başarısı; ağız açıklığı, öksürme, yutkunma, hareket, laringospazm, yerleştirme kolaylığını içeren skorlama ile değerlendirildi. Olguların arteriyel basınçları, kalp hızı, periferik oksijen satürasyonu, soluk sonu CO2 değerleri; indüksiyon öncesi (kontrol), indüksiyon sonrası, LMA yerleştirilmesinden 1, 2, 4, 6, 8 ve 10 dk sonra kaydedildi.Ağız açıklığı, hava yolu reflekslerinin baskılanması ve hareket olmaması Grup Deksmedetomidin-Propofol'de Grup Ketamin-Propofol ve Grup Kontrol'e göre daha iyi bulundu (p<0.001, p<0.05). Laringeal maske yerleştirme skoru, Grup Deksmedetomidin-Propofol'de, Grup Ketamin-Propofol ve Grup Kontrol'e göre daha iyi gözlendi (p<0.001, p<0.001). İndüksiyonda gereken propofol dozu Grup Deksmedetomidin-Propofol ve Grup Ketamin-Propofol'de kontrol grubuna göre daha az bulundu (p<0.001, p<0.001). Gruplar arası karşılaştırmada Grup Ketamin-Propofol'de LMA üzerindeki sekresyon miktarı (p<0.001) ve kan bulaşı (p=0.037) daha fazla görüldü. Tüm gruplarda indüksiyon sonrası arteriyel basınç değerlerinde, kontrol değerlere göre azalma gözlendi. Bu azalma tüm zamanlarda özellikle de indüksiyon sonrasında Grup Ketamin-Propofol'de Grup Deksmedetomidin-Propofol ve Grup Kontrol'e göre daha azdı. Grup Deksmedetomidin-Propofol'de tüm zamanlarda kalp hızı düşüşü Grup Ketamin-Propofol ve Grup Kontrol'e göre daha belirgindi.Sonuç olarak; ketamin ve deksmedetomidinin propofol ile ko-indüksiyonu, propofol doz gereksinimini azaltmıştır. Ketamin hemodinamik parametreleri daha az etkilediğinden, deksmedetomidin daha iyi LMA yerleştirme koşulları sağladığından, propofol ile ko-indüksiyonda uygun hastalarda birbirlerine alternatif olabilecekleri kanısındayız.
In our study, we aimed to investigate the effect of co-induction of ketamine or dexmedetomidine with propofol on the hemodynamic response, the success of LMA placement and the dose of propofol requirement for the induction in the placement of laryngeal mask (LMA) to ensure an airway.A total of 90 patients with ASA I-II, aged between 18 and 60 years-old were enrolled to the study. Following the routine monitorization, ketamine 0.5 mg/kg was given in the Group Ketamine-Propofol, dexmedetomidine 0.5 µg/kg was given in the Group Dexmedetomidine-Propofol or salin 20 ml IV was given in the Group Kontrol within five minutes. In all patients, LMA was placed 60 minutes after the administration of propofol IV until that the lash reflex has disappeared. Induction doses of propofol were recorded. The success of LMA placement was evaluated using a scoring system that included mouth opening, coughing, swallowing, movement, laryngospasm and the easiness of placement. For the patients, arterial pressures, heart rate, peripheral oxygen saturation and end tidal CO2 pressures were recorded before the induction (control), after the induction and 1, 2, 4, 6, 8 and 10 minutes after the placement of LMA.Mouth opening, the suppression of airway reflexes and the absence of movement were found to be better in the Group Dexmedetomidine-Propofol compared to the Group Ketamine-Propofol and the Group Control (p<0.001, p<0.05). Score for the placement of laryngeal mask was observed better in the Group Dexmedetomidine-Propofol compared to the Group Ketamine-Propofol and the Group Control (p<0.001, p<0.001). Dose of propofol in the induction was lowered in the Group Dexmedetomidine-Propofol and in the Group Ketamine-Propofol compared to Group Control (p<0.001, p<0.001). In the Group Ketamine-Propofol, the amount of secretion on LMA (p<0.001) and blood transmission (p=0.037) were more commonly observed. In all the groups, arterial pressure values following the induction showed a decrease compared to control values. These decreases were less at all times particularly after induction in the Group Ketamine-Propofol compared to the Group Dexmedetomidine-Propofol and the Group Control. Decreases of heart rate were more prominent at all times in the Group of Dexmedetomidine-Propofol compared to the Group Ketamine-Propofol and the Control Group.Consequently, co-induction of ketamine and dexmedetomidine decreased the dose requirement of propofol. As the hemodynamic parameters with the ketamine were less affected and dexmedetomidine provided better conditions for placement of LMA, we believed that these agents might be alternatives of each other in appropriate patients during the co-induction with propofol.
In our study, we aimed to investigate the effect of co-induction of ketamine or dexmedetomidine with propofol on the hemodynamic response, the success of LMA placement and the dose of propofol requirement for the induction in the placement of laryngeal mask (LMA) to ensure an airway.A total of 90 patients with ASA I-II, aged between 18 and 60 years-old were enrolled to the study. Following the routine monitorization, ketamine 0.5 mg/kg was given in the Group Ketamine-Propofol, dexmedetomidine 0.5 µg/kg was given in the Group Dexmedetomidine-Propofol or salin 20 ml IV was given in the Group Kontrol within five minutes. In all patients, LMA was placed 60 minutes after the administration of propofol IV until that the lash reflex has disappeared. Induction doses of propofol were recorded. The success of LMA placement was evaluated using a scoring system that included mouth opening, coughing, swallowing, movement, laryngospasm and the easiness of placement. For the patients, arterial pressures, heart rate, peripheral oxygen saturation and end tidal CO2 pressures were recorded before the induction (control), after the induction and 1, 2, 4, 6, 8 and 10 minutes after the placement of LMA.Mouth opening, the suppression of airway reflexes and the absence of movement were found to be better in the Group Dexmedetomidine-Propofol compared to the Group Ketamine-Propofol and the Group Control (p<0.001, p<0.05). Score for the placement of laryngeal mask was observed better in the Group Dexmedetomidine-Propofol compared to the Group Ketamine-Propofol and the Group Control (p<0.001, p<0.001). Dose of propofol in the induction was lowered in the Group Dexmedetomidine-Propofol and in the Group Ketamine-Propofol compared to Group Control (p<0.001, p<0.001). In the Group Ketamine-Propofol, the amount of secretion on LMA (p<0.001) and blood transmission (p=0.037) were more commonly observed. In all the groups, arterial pressure values following the induction showed a decrease compared to control values. These decreases were less at all times particularly after induction in the Group Ketamine-Propofol compared to the Group Dexmedetomidine-Propofol and the Group Control. Decreases of heart rate were more prominent at all times in the Group of Dexmedetomidine-Propofol compared to the Group Ketamine-Propofol and the Control Group.Consequently, co-induction of ketamine and dexmedetomidine decreased the dose requirement of propofol. As the hemodynamic parameters with the ketamine were less affected and dexmedetomidine provided better conditions for placement of LMA, we believed that these agents might be alternatives of each other in appropriate patients during the co-induction with propofol.
Description
Keywords
Ketamin, Deksmedetomidin, Propofol, Hemodinamik, Laringeal maskeler, Ketamine, Dexmedetomidine, Hemodynamics, Laryngeal masks
Citation
Ahun, F. (2012). Ketamin ve deksmedetomidinin propofol ile ko-indüksiyonunun laringeal maske yerleştirme başarısına etkilerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.