Zeynep COŞKUN, Bilge ÇELEBİOĞLU, Ülkü AYPAR

Endotrakeal entübasyon ve laringeal maske uygulamalarında tiyopental, midazolam, midazolam-deksametazon ile indüksiyonun postoperatif bulantı ve kusma üzerine etkileri

Çalışmada, midazolamın indüksiyonda tek başına veya deksametazon ile kombine olarak verilmesinin ve endotrakeal entübasyon (ETE) veya laringeal maske (LMA) uygulamalarının postoperatif bulantı ve kusma (POBK) üzerine etkisi değerlendirildi. Majör jinekolojik cerrahi planlanan ASA I-II grubundan 150 hasta 6 gruba ayrıldı. İlk 3 gruba (A) ETE, ikinci gruba (B) LMA uygulandı. ETE ve LMA gruplarında indüksiyon; I. Gruplarda (A1, B1); 6 mg.kg1 tiyopental, II. Gruplarda (A2, B2); 0.2 mg.kg-1 midazolam, III. Gruplarda (A3, B3; 0.2 mg.kg-1 midazolam ve 8 mg deksametazon ile sağlandı. Anestezi uygulamasına %1-1.5 izofluran, %50 N2O/O2 ve vekuronyum ile devam edildi. Postoperatif bulantı ve kusma açısından; ETE ve LMA uygulanan hasta grupları arasında istatistiksel olarak bir farklılık saptanmadı. İlaçlar gözönüne alındığında; kusma, midazolam ve deksametazon uygulanan hasta gruplarında diğer gruplara oranla istatistiksel olarak düşük bulundu (p

Anahtar Kelimeler:

Larinks maskeleri, Tiyopental, Cerrahi işlemler, operatif, Deksametazon, Vekuronyum bromid, Entübasyon, intratrakeal, Anestezi, Midazolam, Ameliyat sonrası bulantı ve kusma

Comparison of the effects of induction with thiopental, midazolam, midazolam-dexamethasone on postoperative nausea vomiting for endotracheal intubation and laringeal mask airway insertion

The effects of administration of midazolam alone or in combination with dexamethasone during induction and endotracheal intubation (ETI) or laryngeal mask airway (LMA) insertion on postoperative nausea and vomiting (PONV) were assessed. One hundred fifty ASA I-II patients scheduled for major gynecological surgery were divided into 6 groups. ETI was applied to the first 3 groups (A) and LMA was inserted to the second 3 groups (B). Following agents were used for induction in ETI and LMA groups: In the first groups; (A1, B1) 6 mg.kg-1 thiopental, in the second groups; (A2, B2) 0.2 mg.kg-1 midazolam, in the third groups; (A3, B3) 0.2 mg.kg-1 midazolam and 8 mg dexamethasone. Anesthesia was maintained by isoflurane, N2O/O2 and vecuronium. There was no statistically significant difference between ETI and LMA groups with respect to PONV. Attacks of vomiting were significantly lower in midazolam and dexamethasone groups (p<0.05). It is concluded that 0.2 mg/kg of midazolam given for induction did not affect PONV but the addition of dexamethasone provided a prophylactic antiemetic effect. There were no significant differences between the effects of ETI and LMA insertion on PONV.

Keywords:

Laryngeal Masks, Thiopental, Surgical Procedures, Operative, Dexamethasone, Vecuronium Bromide, Intubation, Intratracheal, Anesthesia, Midazolam, Postoperative Nausea and Vomiting,

___

1. Korttila K. The sludy ol postoperative nausea and vomiting, Br J Anaesth 1992; 69 (suppl 1): 205-35.
2. Paxton LD, Mckay AC, Mırakhur KK. Prevention of nausea and vomiting after day case gynaecological laparascopy. Anaesthesia 1995; 50: 403-6.
3. Splinter WM. MacNeill MB. Menard EA, et al. Midazolam reduceas vomiting after tonsillectomy in children. Can J Anaesth 1995:42:201-3.
4. Mitchelson F. Pharmacological agents affecting emesis.Drugs 1999; 43: (3)295-315.
5. Watcha MF, White PF. Postoperative nausea and vomiting. Anesthesiology 1992; 77: 162-84.
6. Di Florio T. The use of midazolam for persistent postoperative nausea and vomiting. Anaesth Intens Care 1992; 20:383-6.
7. Stephens SH, Silvey VL, Wheeler RM. Randomized, double-blind comparison of the antiemetic effect of metoclopramide and lorazepam with or without dexamethasone in patients receiving high-dose cisplatin, Cancer 1990; 66: 443-6.
8. McKenzie R,Tantisira B, Karambelkar DJ,et al. Comparison of ondansetron with ondansetron plus dexamethasone in the prevention of postoperative nausea and vomiting. Anesth Analg 1994; 79; 961-4.
9. Fujii Y, Tanaka H, Toyoka H. Granisetron-dexamethasone combination reduces postoperative nausea and vomiting. Can J Anaesth 1995; 42:387-90.
10. The Italian Grup For Antiemetic Research. Dexamethasone. granisetron. or hoth for the prevention ot nausea and vomiting during chemotherapy for cancer. N Engl J Med 1995; 332; 1-5.
11. Takada K, Murai T, Kanayama T. Koshikawa N. Effects of midazolam and flunitrazepam on the release of dopamine from rat strlatum measured by in vivo microdialysis. Br J Anaesth 1993; 70: 181-5.
12. Jensen S, Schou-olesen A. Hüttel MS. Use of midazolam as induction agent:comparison with thiopentone. Br J Anaesth l982; 54: 605-7.
13. Saarnivaara L. Klemola UM, Lindgren L, et al Comparison of propofol methohexitone and midazolam as anaesthetic induction agents in patients undergoing otolaryngological surgery Anaesthesia 1988: 43: 115.
14. Warrick PD, Belo SE. Second dose of antiemetic does not decrease postoperative nausea and vomiting. Can J Anaesth 1994; 41:34.
15. Wittmann PH. Wittmann FW. Laryngeal mask and gastric dilatation. Anaesthesia 1991; 46: 1083.
16. Lack A. Regurgilation using a laringeal mask. Anaesthesia 1993:48:734.
17. Cyna AM. MacLeod DM. The laryngeal mask: cautionary tales. Anaesthesia 1990; 45: 167.
18. Nanji GM, Maltby JR. Vomiting ami aspiration pneumonitis with the laryngeal mask airway. Can J Anaesth 1992; 39: 69-70.
19. Asasi T, Morris S. The laringeal mask airway: its features, effects and role. Can J Anaesth 1994; 41: 930-60.