Süheyla ÜNVER, Güldeniz ARGUN, Sinem GEVENKİRİŞ

Brakiterapi Alan Jinekolojik Kanserli Hastalarda Anestezi Uygulamasına Opioid Eklenmesinin Derlenme Üzerine Etkileri

Bu çalışmada, jinekolojik kanserli hastalarda brakiterapi için günübirlik anestezi uygula- malarında tek başına propofol kullanımı ile propofole ilaveten fentanil kullanımının, anesteziden derlenme süresi, postoperatif analjezik tüketimi ve taburculuk sürelerine etkilerini retrospektif olarak araştırmayı planladık. Yöntem: Yerel Etik Kuruldan çalışma onayı alındıktan sonra, 5 aylık sürede brakiterapi yapılan 67 hasta çalışmaya dahil edildi. Bütün hastalara premedikasyon amaçlı midazolam, indüksiyon için propofol ve gerektiğinde fentanil uygulanmıştı. Kayıtlardan ulaşılan hastalar, opioid kullanılan (Grup I, n=37) ve kullanılmayan (Grup II, n=30) olmak üzere 2 gruba ayrıldı. İşlem süreleri, kulla- nılan ilaç dozları, hemodinamik veriler, derlenme süreleri, taburculuk süreleri kayıtlardan ulaşıla- rak değerlendirildi. Bulgular: Operasyon süresi 2 grupta benzerdi. Propofol tüketimi Grup I’de ortalama 1.865 mg kg -1 , Grup II’de 2.03 mg kg -1 idi (p>0.05). Ortalama fentanil tüketimi opioid grubunda 1.12 mcg kg -1 idi ve yaş ortalaması bu grupta anlamlı olarak düşüktü. Postoperatif analjezik tüketimi, der- lenme zamanı ve taburculuk zamanı bakımından 2 grup arasında fark yoktu. Sonuç: Günübirlik girişimlerde hastanın anesteziden kısa sürede derlenmesi için yarılanma ömrü kısa anestetikler tercih edilmektedir. Çalışmamızda, brakiterapi için anestezi uygulamasında fen- tanil gereksinimi olan hastaların yaş ortalamasının daha düşük olduğunu ve ilave verilen fentani- lin derlenme süresinde anlamlı uzamaya neden olmadığını bulduk.

The Effects of Adding Opioids to Anesthesia on the Recovery of Patients with Gynecological Cancer Receiving Brachytherapy

Objective: The aim of this retrospective study was to investigate the effects of using propofolalone and in combination with fentanyl on postoperative analgesic consumption, duration ofrecovery and discharge for brachytherapy in patients with gynecological cancer.Method: After obtaining the study approval from the local ethics committee, 67 patients whounderwent brachytherapy within 5 months were included in the study. All patients received mida-zolam for premedication and propofol (in case of need together with fentanyl) for induction.Patients were categorised into two groups as those using (Group I, n=37) and not using opioids(Group II, n=30). The duration of the procedure, drug doses, hemodynamic data, time to recoveryand discharge were obtained from records and evaluated.Results: The duration of operation was similar in both groups. Propofol consumption was 1.865mg kg -1 in Group I and 2.03 mg kg -1 in Group II (p>0.05). The average fentanyl consumption in theopioid group was 1.12 mg kg -1 and the average age was significantly lower in this group. No dif-ference was detected between the groups in terms of the analgesic consumption and the time torecovery and discharge.Conclusion: Anesthetics with shorter half-life are preferred in daily interventions. This studyshowed that the average age of the patients who required fentanyl during anesthesia forbrachytherapy was lower; and the fentanyl that is administered additionally did not lead to sig-nificant prolongation of recovery time.

PDF

___

Bhanabhai H, Samant REC, Grenier L, Lowry S. Pain assessment during conscious sedation for cervical can- cer high-dose-rate brachytherapy. Curr Onco. 2013;20:307-10. https://doi.org/10.3747/co.20.1404
Roessler B, Six LM, Gustorff B. Anaesthesia for brachy- therapy. Curr Opin Anaesthesiol. 2008;21:514-8. https://doi.org/10.1097/ACO.0b013e32830413cb
Rollison B, Strang P. Pain, nausea and anxiety during intra-uterine brachytherapy of cervical carcinomas. Support Care Cancer. 1995;3:205-7. https://doi.org/10.1007/BF00368893
Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013;19:463-81. https://doi.org/10.3748/wjg.v19.i4.463
Robertson DJ, Jacobs DP, Mackenzie TA, Oringer JA, Rothstein RI. Clinical trial: a randomized, study comparing meperidine (pethidine) and fentanyl in adult gast- rointestinal endoscopy. Aliment Pharmacol There. 2009;29:817-23. https://doi.org/10.1111/j.1365-2036.2009.03943.x
Wang D, Chen C, Chen J, et al. The use of propofol as a sedative agent in gastrointestinal endoscopy: a meta- analysis. PLoS One. 2013;8:53311. https://doi.org/10.1371/journal.pone.0053311
Gras S, Servin F, Bedairia E, et al. The effect of preope- rative heart rate and anxiety on the propofol dose required for loss of consciousness. Anesth Analg. 2010;110:89-93. https://doi.org/10.1213/ANE.0b013e3181c5bd11
Tsai CJ, Chu KS, Chen TI, Lu DV, Wang HM, Lu IC. A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation. Anaesthesia. 2010;65:254-9. https://doi.org/10.1111/j.1365-2044.2009.06226.x
Lam F, Liao CC, Lee YJ, Wang W, Kuo CJ, Lin CS. Different dosing regimens for propofol induction in obese pati- ents. Acta Anaesthesiol Taiwan. 2013;51:53-7. https://doi.org/10.1016/j.aat.2013.06.009
Hsu CD, Huang JM, Chuang YP, et al. Propofol target- controlled infusion for sedated gastrointestinal endos- copy: A comparisonof propofol alone versus Propofole fentanyle midazolam. Kaohsiung J Med Sci. 2015;31:1-5. https://doi.org/10.1016/j.kjms.2015.09.004
Mendez LC, Choi S, D’Alimonte L, Barnes E, Barbera L, Leung E. Opioid consumption and pain in gynecologi- cal cancer patients treated with interstitial brachythe- rapy. Brachytheraphy. 2017;16:870-6. https://doi.org/10.1016/j.brachy.2017.04.246
Latremoliere A, Woolf C. Central sensitization: a gene- rator of pain hypersensitivity by central neural plasti- city. J Pain. 2009;10:895-926. https://doi.org/10.1016/j.jpain.2009.06.012
Frankart AJ, Meier T, Minges TL, Kharofa J. Comparison of spinal and general anesthesia approaches for MRI- guided brachytherapy for cervical cancer. Brachytherapy. 2018;17:761-7. https://doi.org/10.1016/j.brachy.2018.05.002