ÇAĞLA BALİ, Mehmet ÖZALEVLİ, Hakkı ÜNLÜGENÇ, Ceylan IŞIK, Tayfun GÜLER

COMPARISON OF TWO DIFFERENT DOSES OF INTRAVENOUS MORPHINE ON DESFLURANE CONSUMPTION IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY

Amaç: Bu çalıflma abdominal histerektomi ameliyatlarında, anestezi indüksiyonunda iki farklı dozda intravenöz olarak kullanılan morfinin desfluran tüketimi, ekstübasyon ve derlenme süreleri, hemodinamik değiflkenler ve postoperati f analjezik ihtiyacı üzerine etkilerini değerlendirmek amacıyla planlandı. Yöntem: Elekti f abdominal histerektomi yapılması planlanan 90 hasta randomize olarak 3 gruba ayrıldı. Anestezi indüksiyonunu takiben Grup Sye (n=30) 10 mL salin, Grup M1e (n=30) 0.1 mg kg-1 morfin, Grup M2ye (n=30) 0.2 mg kg-1 morfin 10 mL volüm içerisinde intravenöz olarak verildi. Anestezi idamesi için % 33 O2 ve % 67 N2 O içerisinde %6 konsantrasyonda desfluran kullanıldı. Anestezi derinliği Bispektral indeks (BIS) monitörizasyonu ile izlendi. BIS değerleri 40-60 arasında tutulacak flekilde desfluran konsantrasyonları %1lik oranda değifltirildi. Desfluran konsantrasyonu ve tüketimi, ekstübasyon ve derlenme süreleri, hemodinamik değiflkenler, postoperati f ağrı skorları ve ek anal jezik ihtiyacı kaydedildi. Bulgular: Salin grubu ile karflılafltırıldığında BIS değerlerinin, morfin uygulanan iki grupta da istatistiksel olarak daha düflük olduğu belirlendi (p

TOTAL ABDOMNAL HSTEREKTOM HASTALARINDA FARKLI K DOZDA KULLANILAN NTRAVENÖZ MORFNN DESFLURAN TÜKETM ÜZERNE ETKSNN KARfiILAfiTIRILMASI

Objective: This study evaluates the effects of two di fferent doses of morphine used at anesthesia induction on desflurane consumption, extubation and recovery times, hemodynamic variables and postoperative analgesic requirements during abdominal hysterectomy. Method: Ninety patients, scheduled for elective abdominal hysterectomy were randomly allocated into three groups. After induction of anesthesia, patients in Group S (n=30) received 10 mL saline, Group M1 (n=30) received 0.1 mg kg-1 morphine and Group M2 (n=30) received 0.2 mg kg-1 morphine in 10 mL volume intravenously. Anesthesia was maintained with desflurane 6% in a mixture of 33% oxygen and 67% nitrous oxide. The depth of anesthesia was monitorized with Bispectral Index (BIS). BIS levels were kept within 40-60 by changing the concentration of desflurane by 1%. Desflurane concentrations and consumption, time to extubation and recovery, hemodynamic variables, postoperative pain scores and supplement analgesic consumption were recorded. Results: Compared with saline group, BIS values were signi ficantly lower in the both morphine groups (p<0.001). Desflurane consumption was signi ficantly lower in both morphine groups (72.75 mL in Group S, 48.22 mL in Group M1 and 15.53 mL in Group M2), (p<0.01). The extubation times were similar but recovery times were longer in the morphine groups (p<0.001). Mean arterial pressure, heart rate variables were higher in Group S than the other groups (p<0.01). Postoperative analgesic requirements were higher in Group S than in morphine groups (p<0.01), while more supplemental analgesic were required in the low dose morphine group than in high dose morphine group (p<0.01). Conclusion: In this study, it was concluded that two di fferent doses of intravenous morphine used at anesthesia induction signi ficantly decreased the consumption of desflurane with increased time to recovery without changing time to extubation, and provided effective analgesia with stable hemodynamics in patients undergoing total abdominal hysterectomy.

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1. Tonner PH. Balanced anaesthesia today. Best Pract Res Clin Anaesthesiol 2005; 19: 475-484. 2. Fukuda K. Opioids. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Millers Anesthesia, Volume 1 Seventh Edition. USA, Elsevier, 2009; 890-995 3. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. The Cochrane database of systematic reviews 2014; 6: CD003843. 4. Laster MJ, Fang Z, Eger EI. Specific gravities of desflurane, enflurane, halothane, isoflurane, and sevoflurane. Anesth Analg 1994; 78: 1152-1153. 5. Jones RM, Cashman JN, Mant TG. Clinical impressions and cardiorespiratory effects of a new fluorinated inhalation anaesthetic, desflurane (I-653), in volunteers. Br J Anaesth 1990; 64: 11-15. 6. Torri G. Inhalation anesthetics: a review. Minerva Anestesiol 2010; 76: 215-228. 7. Daniel M, Weiskopf RB, Noorani M, Eger EI. Fentanyl augments the blockade of the sympathetic response to incision (MAC-BAR) produced by desflurane and isoflurane: desflurane and isoflurane MAC-BAR without and with fentanyl. Anesthesiology 1998; 88: 43-49. 8. Ghouri AF, White PF. Effect of fentanyl and nitrous oxide on the desflurane anesthetic requirement. Anesth Analg 1991; 72: 377-381. 9. Billard V, Servin F, Guignard B, et al. Desflurane-remifentanil- nitrous oxide anaesthesia for abdominal surgery: optimal concent- rations and recovery features. Acta Anaesthesiol Scand 2004; 48: 355-364. 10. Wilhelm W, Berg K, Langhammer A, et al. [Remifentanil in gynecologic laparoscopy. A comparison of consciousness and circulatory effects of a combination with desflurane and propofol]. Anasthesiol Intensivmed Notfallmed Schmerzther 1998; 33: 552-556. 11. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology 1997; 87: 842-848. 12. Guignard B, Coste C, Menigaux C, Chauvin M. Reduced isoflurane consumption with bispectral index monitoring. Acta Anaesthesiol Scand 2001; 45: 308-314. 13. Gottschalk A, Smith DS. New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician 2001; 63: 1979-1984. 14. Campiglia L, Cappellini I, Consales G, et al. Premedication with sublingual morphine sulphate in abdominal surgery. Clin Drug Investig 2009; 29 Suppl 1: 25-30. 15. Richmond CE, Bromley LM, Woolf CJ. Preoperative morphine pre-empts postoperative pain. Lancet 1993; 342: 73-75. 16. Kiliçkan L, Toker K. The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response. Panminerva Med 2001; 43: 171-175. 17. Schmid ER. [Cardiac risk patients in anesthesia]. Ther Umsch 1991; 48: 365-373. 18. Gemma M, Tommasino C, Cozzi S, et al. Remifentanil provides hemodynamic stability and faster awakening time in transspheno- idal surgery. Anesth Analg 2002; 94: 163-168. 19. Twersky RS, Jamerson B, Warner DS, Fleisher LA, Hogue S. Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth 2001; 13: 407-416. 20. Murphy MJ, Hooper VD, Sullivan E, Clifford T, Apfel CC. Identification of risk factors for postoperative nausea and vomiting in the perianesthesia adult patient. J Perianesth Nurs 2006; 21: 377-384. 21. Karlsen KL, Persson E, Wennberg E, Stenqvist O. Anaesthesia, recovery and postoperative nausea and vomiting after breast surgery. A comparison between desflurane, sevoflurane and isoflurane anaesthesia. Acta Anaesthesiol Scand 2000; 44: 489-493.