ÇOCUKLARDA SEVOFLURAN VE SEVOFLURAN-REMİFENTANİL UYGULAMALARINDA BİSPEKTRAL İNDEKS DEĞERLERİNİN KARŞILAŞTIRILMASI

Amaç: Çalışmamız, genel anestezi için sevofluran uygulanan çocuklarda remifentanilin anestezi derinliği, sevofluran tüketimi,hemodinamik parametreler üzerine etkilerini karşılaştırmak amacıyla planlandı.Yöntem: 3-10 yaş arasında, ASA I-II grubu 60 hasta çalışmaya dahil edildi. Monitörizasyondan sonra hastalar 2 grubaayrıldı. Anestezi indüksiyonu tüm hastalarda % 8 sevofluran, N2O ve O2ile sağlandı. İndüksiyonu takiben grup I'de anestezi idamesisevofluran (Minimum alveoler konsantrasyon (MAK): % 0,5-2) inhalasyonu ile yapıldı. Grup II'de 0,5 mikrogram/kilogramremifentanil 1 dakikada yüklendi, idamede sevofluran inhalasyonu ve 0,25 µg kg-1h-1remifentanil infüzyonu uygulandı. Sevoflurankonsantrasyonu sistolik ve diyastolik arter basınçları, kalp atım hızı bazal değerlerinin +/-%20 sınırları içinde tutulacak şekildeMAK: % 0,5-2 arasında titre edildi. Grup II'de kullanılan remifentanil infüzyon hızı sabit tutuldu. İntraoperatif bispektral indeks(BİS) değerleri, kalp hızı, sistolik, diyastolik kan basıncı, oksijen saturasyonu, end tidal sevofluran konsantrasyonu, gözyaşı,terleme, öksürme, ıkınma gibi somatik refleksler 15 dakikada bir kaydedildi. Bulgular: Tüm ölçümlerde grup II'deki hastaların kalp atım hızı grup I'den düşüktü (p0,05). Grup I'de end tidal sevofluran değerleri grup II'den yüksek iken (p

COMPARISON OF BISPECTRAL INDEX VALUES IN SEVOFLURANE AND SEVOFLURANE-REMIFENTANIL ADMINISTRATION IN CHILDREN

Objective: This study was designed to compare the effects of remifentanil on anesthesia depth, sevoflurane consumption,hemodynamic parameters on children administered sevoflurane for general anesthesia.Method: 60 children aged 3-10 years were included and allocated to 2 groups. The anesthesia was induced with sevofluranein nitrousoxide/oxygen in all children. Anesthesia was maintained with sevoflurane (Minimum alveolar concentration (MAC):% 0,5-2) in group I. In group II, 0,5 microgram/kilogram remifentanil was given for one minute, anesthesia was maintained withsevoflurane , 0,25 µg kg-1h-1remifentanil infusion. Sevoflurane concentration was titrated to be +/-20% of normalvalue of systolic, diastolic blood pressure and heart rate. Remifentanil infusion rate was kept constant in group II. Intraoperativebispectral index (BIS) values, heart rate, systolic, diastolic blood pressure, oxygen saturation, end tidal sevoflurane concentration,somatic reflexes (tears, sweating, cough, strain) were recorded every 15 minutes.Results: In all measurement, heart rates were lower in group II than group I (p

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1. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev 2007; 17: CD003843.
2. Guignard B, Coste C, Menigaux C, Chauvin M. Reduced isoflurane consumption with bispectral index monitoring. Acta Anesthesiol Scand 2001; 45: 308-314.
3. Tafl N, Tür A, Kocamano¤lu S. Bispektral indeks ile anestezi derinli¤i izlemenin volatil ajan tüketimi, derlenme kriterleri ve hastanede kal›fl süresine etkisi. Türk Anest Rean Der Dergisi 2008; 36: 340-345.
4. Özensoy A, Ayazo¤lu T, Çal›m M, Geyik F, Toptan F. Bispektral indeks ile total intravenöz anestezi derinli¤i izlemi; propofol ajan tüketimi, derlenme kriterleri ve fark›nda olmaya etkisi. Cumhuriyet T›p Derg 2013; 35: 382-388.
5. Denman WT, Swanson E, Rosow D, Ezbicki K, Connors P, Rosow C. Pediatric evaluation of the bispectral index (bis) monitor and correlation of bis with end tidal sevoflurane concentratin in infants and children. Anesth Analg 2000; 90: 872-877.
6. Song D, Grish PJ, White PF. Titration of volatil anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology 1997; 87: 842-848.
7. Sebel PS, Lang E, Rampil IJ, et al. A multicenter study of bispectral electroencephalogram analysis of monitoring anesthetic effect. Anesth Analg 1997; 84: 891-899.
8. Liu JS, Zhang JM, Yue Y. Variation of B‹S monitoring in paediatric patients undergoing propofol-remifentanil anaesthesia. Eur J Anaesthesiol 2008; 25: 821-825.
9. Whyte SD, Booker PD. Bispectral index during isoflurane anesthesia in pediatric patients. Anesth Analg 2004; 98: 1644-1649.
10. Kawaraguchi Y, Fukumitsu K, Kinouchi K, Hirao O, Miyamoto Y, Taniguchi A. Bispectralindex (BIS) in infants anesthetized with sevoflurane in nitrousoxide and oxygen. Masui 2003; 52: 389-393.
11. Davidson AJ, McCann ME, Devavaram P, et al. The differences in the bispectral index between infants and children during emergence from anesthesia after circumcision surgery. Anesth Analg 2001; 93: 326-330.
12. Rodriguez RA, Hall LE, Duggan S, Splinter WM. The bispectral index does not correlate with clinical signs of inhalational anesthesia during sevoflurane induction and arousal in children. Can J Anaesth 2004; 51: 472-480.
13. Kern D, Fourcade O, Mazoid JX, et al. The relationship between bispectral index and end-tidal concentration of sevoflurane during anesthesia and recovery in spontaneously ventilating children. Pediatric Anaesthesia 2007; 17: 249-254.
14. McCann ME, Bacsik J, Davidson A, Auble S, Sullivan L, Laussen P. The correlation of B‹S with end-tidal sevoflurane concentration and haemodynamic parameters in preschoolers. Paediatr Anaesth 2002; 12: 519-525.
15. Malviya S, Voepel-Lewis T, Tait AR, Watcha MF, Sadhasivain S, Friesen RH. Effect of age and sedative agent on the accuracy of bispectral index in detecting depth of sedation in children. Pediatrics 2007; 120: 461-470.
16. Mi WD, Sakai T, Kudo T, Kudo M, Matsuki A. Performance of bispectral index and auditory evoked potential monitors in detecting loss of consciousness during anaesthetic induction with propofol with and without fentanyl. Eur J Anaesthesiol 2004; 21: 807-811.
17. Vanluchene AL, Struys MM, Heyse BE, Mortier EP. Spectral entropy measurement of patient responsiveness during propofol and remifentanil: a comparison with the bispectral index. Br J Anaesth 2004; 93: 645-654.
18. Weber F, Füssel U, Gruber M, Hobbhahn J. The use of Remifentanil for intubation in paediatric patients during sevoflurane anaesthesia guided by B‹S monitoring. Anaesthesia 2003; 58: 749-755.
19. Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassonyi E. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Br J Anaesth 2001; 86: 523-527.
20. Ifl›k B, Tüzüner T, Tezkirecio¤lu M, Öztafl N. Nitrousoxide sedation and bispectral index. Eur J Dent 2007; 1: 240-245.