Emine ARIK, Dilek YAZICIOĞLU, Aysun ÜLKER, Derya ÖZKAN, Uğur POLAT, Haluk GÜMÜŞ

Günübirlik artroskopik cerrahide desfluran ve izofluran anestezilerinde uyanma ve derlenme skorlarının karşılaştırılması

İnhalasyon anestezikleri, uygun farmakokinetik özellikleri nedeniyle günübirlik anestezide tercih edilmektedir. Biz bu çalışmada, ülkemizde en yeni olarak kullanılmaya başlanan desfluranı, izofluran ile karşılaştırarak etki profilini değerlendirmek ve "günübirlik anestezide desfluran ideal bir ajan mıdır?" sorusuna yanıt aramayı amaçladık. Prospektif randomize planlanan bu çalışmaya artroskopik menisküs onarımı yapılacak 51 hasta (desfluran n=33, izofluran n=18) alındı. Anestezi süresince hastaların kalp atım hızı, kan basıncı, anestezik ajanların inspire edilen ve end-tidal konsantrasyonları kaydedildi. Anestezi bitiminde öksürük refleks zamanı, ekstübasyon zamanı, kirpik refleks zamanı, sözlü uyarana göz açma yanıt zamanı, anestezi sonrası derlenme ve taburculuk skorları ölçüldü. İnhalasyon ajanlarının benzer düzeyde kullanıldığı çalışmamızda (her iki ajan için 0.53 MAC) desfluranm, izoflurana göre etkisinin başlaması ve bitmesi hızlı olmuştur. Hastaların uyanma, derlenme ve taburcu süreleri üzerinde anestezi süresinin etkisiz olduğu, hasta yaşının sadece derlenme süresini etkilediği gözlenmiştir. Desfluran grubunun öksürük refleksi zamanı, ekstübasyon zamanı ve göz açma yanıt zamanı, derlenme ve taburcu olma süresi izofluran grubuna göre çok daha kısadır. Sonuç olarak, desfluranm günübirlik anestezi şartlarında kullanım için uygun bir ajan olduğu düşüncesindeyiz.

Anahtar Kelimeler:

İzofluran, Günübirlik cerrahi işlemler, Anestezikler, inhalasyon, Artroskopi

Comparison of desflurane and isoflurane anaesthesias on the awakening and recovery scores in outpatient arthroscopic surgery

Due to their pharmacokinetic properties, volatile agents are the anaesthetics of choice in outpatient anaesthesia. Our aim is to find an answer for the question "Is desflurane ideal for outpatient anaesthesia" and to compare isoflurane with the most recent agent desflurane evaluating its effect profile. Fifty-one patients (desflurane n=33, isoflurane n=18) scheduled for arthroscopic knee surgery were enrolled in this prospective randomized study. Pulse rates, blood pressures, inspired and end-tidal concentrations of the anaesthetic agents were recorded during anaesthesia. Times for cough reflex, extubation, eyelash reflex, eye opening to verbal stimulus, recovery and discharge scores were measured. Inhalation agents are used in similar concentrations in our study (0.53 MAC for both agents). Desflurane's onset and emergence of anaesthesia is faster than isoflurane. Duration of anaesthesia has no effect on awakening, recovery and discharge times in short outpatient anaesthesia procedures. The age of the patient effects only the recovery time. The patients completed the recovery scores and discharge scores faster in the desflurane group compared to isoflurane, times for cough reflex, extubation and eye opening were also faster. Desflurane seems to be a proper agent for outpatient anaesthesia procedures.

Keywords:

Isoflurane, Ambulatory Surgical Procedures, Anesthetics, Inhalation, Arthroscopy,

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1. White PF, Smith I: Ambulatory anesthesia: Past, present and future. Int Anesthesiol Clin 1994; 32: 1.
2. Tsai SK, Lee C, Kwan WF, Chen BJ: Recovery of cognitive functions after anaesthesia with desflurane or isoflurane and nitrous oxide. Br J Anesth 1992; 69: 255-8.
3. Smith I, Taylor E, White PF: Comparison of tracheal extubation in patients deeply anesthetized with desflurane or isoflurane. Anesth Analg 1994; 79: 642-5.
4. Ghouri AF, Bodner M, White PF: Recovery profile after desflurane-nitrous oxide versus isoflurane-nitrous oxide in outpatients. Anesthesiology 1991; 74 (3): 419-24.
5. Loan PB, Mirakhur RK, Paxton LD, Gaston JH: Comparison of desflurane and isoflurane in anesthesia for dental surgery. Br J Anaesth 1995; 75 (3): 289-92.
6. Wolf AR, Lawson RA, Dryden CM, Davies FW: Recovery after desflurane anaesthesia in the infant: comparison with isoflurane. Br J Anaesth 1996; 76 (3): 362-4.
7. Jakobsson J, Rane K, Ryberg G: Anaesthesia during laparoscopic gynaecological surgery: a comparison between desflurane and isoflurane. Eur J Anaesthesiol 1997; 14(2): 148-52.
8. Patel SS; Goa KL: Desflurane. A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs 1995; 50 (4): 742-67.
9. Dupont J, Tavernier B, Ghosez Y et al: Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane. Br J Anaesth 1999; 82 (3): 355-9.
10. Solca M, Salvo I, Russo R et al: Anaesthesia with desflurane-nitrous oxide in elderly patients. Comparison with isoflurane-nitrous oxide. Minerva Anesthesiol 2000; 66 (9): 621-6.
11. Beaussier M, Tilleul P, Balladur P, Lienhart A: An observational evaluation of the rate of awakening after isoflurane or desflurane used in daily clinical practice. J Clin Anesth 2000; 12: 586-91.
12. Beaussier M, Deriaz H, Abdelahim Z et al: Comparative effects of desflurane and isoflurane in recovery after long lasting anaesthesia. Can J Anaesth 1998; 45: 429-34.
13. Juvin P, Vadam C, Malek L et al: Postoperative recovery after desflurane, propofol or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study. Anesth Analg 2000; 91: 714-9.
14. Ashworth J, Smith I: Comparison of desflurane with isoflurane or propofol in spontaneously breathing ambulatory patients. Anesth Analg 1998; 87: 312-8.
15. Rieker LB, Rieker MP: A comparison of the recovery times of desflurane and isoflurane in outpatient anesthesia. AANA J 1998; 66 (2): 183-6.
16. Patel N, Smith C, Pinchak AC et al: Desflurane is not associated with faster operating room exit times in outpatients. J Clin Anesth 1996; 8: 130-5.
17. TerRiet MF, DeSouza GJA, Jacobs JS et al: Which is most purgent: isoflurane, sevoflurane and desflurane? Br J Anaesth 2000; 85 (2): 305-7.
18. Michaloliakou C, Chung F: Does a modified postanesthetic discharge scoring system determine home-readiness sooner? Can J Anaesth 1993; 40: A 32.
19. Boswell MV, Collins VJ: Fluorinated ether anesthetics. Physiologic and pharmacologic bases of anesthesiology, Collins VJ (Ed). First edition. Pennsylvania, Williams-Wilkins 1996; 687-711.
20. Taylor RH, Lerman J: Minimum alveolar concentration of desflurane and hemodynamic responses in neonates, infants and children. Anesthesiology 1991; 79: 975.
21. Yasuda N, Lockhart SH, Eger EL 2nd et al: Kinetics of desflurane, isoflurane and halothane in humans. Anesthesiology 1991; 74:489-98.
22. Eger El: Desflurane animal and human pharmacology: Aspects of kinetics, safety and MAC. Anesth Analg 1992; 75: 53.
23. Eger El, Johnson BH: Rates of awakening from anesthesia with I- 653, halothane, isoflurane and sevoflurane: a test of the effects of anesthetic concentration and duration in rats. Anesth Analg 1987; 66:977-82.
24. Behne M, Wilke HJ, Lischke V: Recovery and pharmacocinetic parameters of desflurane, sevoflurane and isoflurane in patients undergoing urologic procedures. J Clin Anesth 1999; 11:460-5.
25. Montamat SG, Cusack BJ, Vestal RE: Management of drug therapy in the elderly. N Engl Med J 1989; 321: 303-9.