Yusuf DOĞAN, Alp ALPTEKİN, Derya ÖZKAN, Emine ARIK, Haluk GÜMÜŞ

Entübasyon sırasında oluşan hemodinamik yanıtlar üzerine deksmedetomidin'in etkisinin remifantanil ile karşılaştırılması

Amaç: Preoperatif tek doz deksmedetomidin kullanımının laringoskopi, entübasyon ve cerrahi insizyona verilen stres cevaba ve hemodinamik stabiliteye olan etkisinin gösterilmesi ve remifentanil ile karşılaştırılması amaçlandı. Gereç ve Yöntem: ASA I-II grubundan, elektif cerrahi geçirecek 60 hasta, randomize, plasebo kontrollü ve tek kör çalışmaya dâhil edildi. Grup D’ye 0.5 mg kg-1 deksmedetomidin iv, Grup R’ye 0.5 mg kg-1 remifentanil iv, Grup P’ye de eşit volümde % 0.09 NaCl iv olarak uygulandı. Uygulamanın bitiminden 1 dakika sonra sistolik arteryel kan basıncı (SAB), diyastolik arteryel kan basıncı (DAB), ortalama arteryel kan basıncı (OAB) ve kalp atım hızı(KAH) değerleri kaydedildi. Çalışma ilacı uygulanması ile indüksiyon arası toplam bekleme süresi 10 dakika olarak gerçekleştirildi. ‹ndüksiyonun 1 dakika öncesinde ve entübasyondan 1 dakika önce SAB, DAB, OAB ve KAH ölçümleri tekrarlandı ve endotrakeal entübasyon gerçekleştirildi. Ölçümlere, entübasyondan sonraki 1. dakikada, 5. dakikada, cerrahi insizyon öncesi 1. dakikada ve cerrahi insizyon sonrası 1. dakikada devam edildi. Bulgular: Cerrahi insizyon öncesine göre, cerrahi insizyon sonrası SAB artışı deksmedetomidin ve remifentanil grubunda, plasebo grubuna göre daha az bulundu (p0,05). Sonuç: Preoperatif deksmedetomidin uygulamasının anestezi indüksiyonunda kullanılan tiyopental gereksinimini azalttığını, entübasyon ve cerrahi uyarı ile ortaya çıkan hemodinamik yanıtları baskılamada etkili olduğunu düşünmekteyiz.

Anahtar Kelimeler:

Deksmedetodimin, Entübasyon, Hemodinamikler

Comparison of the effect of dexmedetomidine and remifentanly on the hemodynamic response to intubation

Objective: Aim of study was to evaluate the effect of a single dose of preoperative dexmedetomidine on the hemodynamic stress response of laryngoscopy, intubation and surgical incision when compare it with remifentanil. Methods: Sixty patients ASA I-II scheduled for elective surgery were randomised the placebo controlled single blinded study. Group D received 0.5 mg kg-1 dexmedetomidine iv, Group R received 0.5 mg kg-1 remifentanyl iv, Group P received equal amounts of 0.09 % NaCl iv sistolic arterial blood pressure (SABP), diastolic arterial blood pressure (DABP), mean arterial pressure (MAP), and heart rate (HR) values were measured 1 min after iv adminstration, and 10 minute after administration anaesthesia induction maintained. SABP, DABP, MAP, and HR values were measured 1 min before induction, 1 min before intubation, 1 and 5 minutes after intubation and 1 min before and after surgical incision. Results: SAB increase was lower at post surgical incision period in deksmedetomidine group when compared with placebo group (p<0,01). Regarding MAP there were no significant differences between all groups at periods of before and after intubation, before and after surgical incision, however increase in dexmedetomidine and remifentanyl groups were lower than plasebo group (p >0,05). Conclusion: Preoperative administration of dexmedetomidine effectively decreases the thiopental dose, and depresses the hemodynamic effects of intubation and surgical incision.

Keywords:

Dexmedetomidine, Intubation, Hemodynamics,

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