Tülin ÖZTÜRK, Aydan ÇAKAN, Şefket DERELİ, Güzin GÜLERÇE, Güven OLGAÇ, Ayşe ÖZSÖZ

Fiberoptik bronkoskopide propofol ve midazolam sedasyonunun karşılaştırılması

Çalışmanın amacı, propofol ve midazolamın fiberoptik bronkoskopi (FOB) sırasında sedasyon, periferik oksijen satürasyonu ve psikomotor aktivite üzerine etkilerini araştırmaktadır. FOB uygulanacak 36 olgu tam amacı ile rastgele 2 eşit gruba ayrıldı.Grup P' de (n=18) 1 mg $kg^{-}1$ $dk^{-}1$ başlangıçta ve işlem sırasında 0,5 mg $kg^{-}1$ $sa^{-}1$ hızında profopol, Grup M' de (n=18) ise 2 mg başlangıçta ve sedasyon sağlanıncaya kadar 1 mg ek midazolom ile i.v sedatize edildi.İşlem sırasında ise, gerektiğinde 5-10 mg propofol veya 0,5-1 mg midazolam ek olarak verildi.Periferik $O_2$ Saturasyonu işlem boyunca kaydedildi.Yeterli sedasyon durumu;sedasyon skorunun 1 olduğu durum kabul edilerek işlem başlatıldı.Diyagnostik işlem sırasında olguların sedasyonları değerlendirildi.Bronkoskopi işleminden hemen sonra olgunun FOB' a toleransı ve işlem sonrası 30. dakikada olgulara sorular sorularak anterograd amnezi değerlendirildi.Sedasyon öncesi ve işlem sonrası 15. ve 30. dakikalarda Digital Symbol Substitution Test (DSST) puanları ile psikomotor performans skorlandı.İki grup arasında demografik veriler, işlem zamanı ve FOB' a tolerans açısından anlamlı fark bulunamadı.Periferik oksijen satürasyonu her iki grupta işlem sırasında başlangıca göre düşme gösterdi, ancak bu anlamlı değildi (p=0.17).Grup P' de 49.5 , grup M' de ise 124 saniyede sedasyona ulaşıldı (p

Anahtar Kelimeler:

Bronkoskopi, Propofol, Bilinçli sedasyon, Midazolam, Psikomotor performans

Comparison of the sedative effects of propofol and midazolam during fiberoptic bronchoscopy

This study aims to investigate the effects of propofol and midazolam during fiberoptic bronchoscopy (FOB) in view to their influence to sedation, transcutane oxygen saturation (Spt $O_2$) and restoration of psychomot activity. 36 patient undergoing diagnostic bronchoscopy were randomized into two groups.Group P(n=18) received an initial bolus dose of 1 mg kg $minx^{-}1$ intravenous Profopol follewed by an infusion of 0,5 mg $kg^{-}1$ $h^{-}1$.Grup M (n=18) received 2 mg of intravenous Midazolam as an initial bolus dose, follewed by I mg as required.During procedure, groups received 5 to 10 mg of intravenous propofol or 0.5-1 mg of intravenous midazolam as an intermittent doses as required.When the sedation score of the patient was arrived to I, procedure was started.Arterial $SpO_2$ was recorded during the procedure.Patient tolerance and sedation was scored at the end of the procedure.Patients completed a questionnaire 30 min after the procedure, 15 min and 30 min after the end of the procedure.There were not significantly different between the two groups in regard to demographic datas, procedure time and patient tolerance.$O_2$ saturation decreased during the procedure for all patients in both groups.But this didn' t reach to statistical significance(p=0.17). The mean induction time was 49.5 sec in Group P, and 124 sec in Group M (p<0.05).Patient tolerance was high in both groups.DSST scores were significantly different between the two groups at 15 and 30 min in favor og Rgoup P (p<0.0001).At 30 min, 55.5 percent (n=10) of the midazolam group was fully recovered.Howerer, the propofol group was completely recovered (p<0.05). This study suggests that propofol and midazolam are useful sedating agents in fiberoptic bronchoscopy.But, the oncet of action and postbronchoscopy recovery are significantly faster with propofol.This allows for greater patient safety and improved efficiency.

Keywords:

Bronchoscopy, Propofol, Conscious Sedation, Midazolam, Psychomotor Performance,

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1. Prakas UBS, Stubhs SE. The bronchoscopy survey: some reflections. Chest 1991 ; 100:1660
2. Koshy G, Nair S, Norkus EP. Hertan HI, Pitciıumoni CS. Propofol versus midazolam and meperidine for concious sedation in GI endoscopy. Am J Gastroenterol 2000; 95:1476-9
3. Seifert H, Schmitt TH, Gultekin T. Caspary WF, Wehrmann T. Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study, Alliment Pharmacol Ther 2000; 14:1207-14
4. Clarkson K, Power CK, Conncl F, Pathmakanthan S, Burke CM. A comparative evaluation of propofol and midazolam as sedative agents in fiberoptic broncİıoscopy. Chest 1993; 104: 1029- 31
5. Crawford M, Pollock J, Anderson K, Glavin RJ, Macintyre D, Vernon D. Comparison of midazolam with propofoi for sedation in outpatient bronchoscopy BrJAnacsth 1993; 70:419-22
6. Rees PJ, Hay JG, Webb JR. Premeditation for fiberoptic bronchoscopy. Thorax 1983; 38:624- 7
7. Dreison RB, Albert RK, Talley PA, et all Flexible fiberoptic bronchoscopy in the thcaching hospital: yield and complication. Chest 1978;74:144-9
8. Aktoğlu S, Hasegeli S, Dereli MŞ. Fibcroptik bronkoskopide midazolam ve diyazepamin sedatif etkilerinin karşılaştırılması. Türk Anaest ve Rean Cem Mecmuası 1994; 22:157-60
9. Kızılarslan S, Şentürk Z, Akkoçlu A, Sağıroğlu E. Bronkoskopik işlemlerde midazolam ve diazepam ile sedasyon ve hemodinamik - solunumsal etkiler. Solunum Hastalıkları 1998;9:665-72
10. Bell GD, Reeve PA, Moshiri M, et al. Intravenous midazolam: a study of the degree of oxygen desaturation occuring during upper gastrointestinal endoscopy. Br J Clin Pharmachol 1987;23:703-8
11. Salisbury BG, Metzger LF, Altose MD, Stanley NN, Chemiuk NS. Effect of fiberoptic bronchoscopy on respiratory performance in patients with chronic airways obstruction. Thorax 1975;30:441-6
12. Webb AR, Doherty JF, Chester MR, et al. Sedation for fiberoptic bronchoscopy: comparison of alfentanil, papaveratum and diazepam. Respir Med 1989; 198:215- 7
13. Clyburn P, Kay NH, Me Kenzie PJ. Effects of diazepam and midazolam on recovery from anaesthesia in outpation. Br J Anaesth 1986;58:872
14. Maltais F, Laberge F, Laviolette M.A randomized, double blind, placebo-controlied study of lorazepam as premedication for bronchoscopy. Chest 1996; 109:1195-8
15. Ivaturi S, Venkatachala P, Butt F, Amin H. Sedation with midazolam during bronchoscopy: Clinical effectiveness and side effects. Chest 1997; 112(3S}:60- 1
16. Halton MQF, Allen MB, Vathenen AS, et al. Does sedation help in fiberoptic bronchoscopy? BMJ 1994; 309:1205-7
17. Puttinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest 1999;115:1437-40