Kadir KAYA, OYA YALÇIN ÇOK, Ertan ÖZTÜRK, Berrin GÜNAYDIN

Histeroskopi girişimlerinde remifentanil infüzyonu ile paraservikal blok kombinasyonunda premedikasyonun etkisi: Erken dönem sonuçlarının değerlendirilmesi

Histeroskopiler analjezi gerektiren kısa süreli girişimlerdir. Bu çalışmada; remifentanil infüzyonu ile paraservikal blok (PSB) kombinasyonunun etkinliğini ve meperidin premedikasyonunun bu yönteme katkısını araştırmayı planladık. Histeroskopi planlanan, ASA I-II risk grubundan 50 mg meperidin im ile premedikasyon uygulanmış 13 hasta (Grup I: premedikasyonlu) ve premedikasyon uygulanmamış 12 hasta (Grup H; premedikasyonsuz) çalışma kapsamına alındı. Remifentanil infüzyonu (0.25 fig kg'1 dk') başlandıktan sonra ve hastalarda baş dönmesi geliştiğinde; servikste saat kadranının 12 hizasından tenekulum için 2 mL ve PSB için de 3 ile 9 hizasından 10 mL %1 lidokain uygulandı. Kalp atım hızı (KAH), ortalama arter basıncı (OAB), periferik oksijen satürasyonu (SpÖ2), end-tidal karbondioksit (ETCO2) basıncı; preoperatif, intraoperatif ve postoperatif 30. dakikaya kadar kaydedildi. Sedasyon ve ağrı şiddeti, hasta ve cerrah memnuniyeti belirlendi, intra ve postoperatif yan etkiler takip edildi. Her iki grupta kullanılan remifentanil miktarı ve yan etkiler kaydedildi. Grup II'de paraservikal blok sırasındaki KAH ile histeroskopi başlangıcında ve postoperatif 30 dk da kaydedilen O AB Grup V den istatistiksel olarak anlamlı şekilde yüksek bulundu (p

Anahtar Kelimeler:

Histeroskopi, Meperidin, Premedikasyon, Anestezi, obstetrik

Effect of premedication on intravenous remifentanil infusion with paracervical block combination for hysteroscopy: Evaluation of preliminary results

Hysteroscopy is a short procedure with predictable pain that has to be relieved. in the present study, we aimed to investigate the efficacy of intravenous remifentanil infusion with paracervical block (PCB) and the contribution of meperidine premedication on this technique in patients undergoing hysteroscopy. Twenty-five, ASA I-II patients scheduledfor hysteroscopy were divided into two groups as premedicated with im 50 mg meperidine (Group I, n=13) or unpremedicated (Group II, n=12). After the intravenous remifentanil infusion of 0.25 jıg kg' min, when the patient complained from dizziness, 2 mL of 1% lidocaine to the 12 o'clock and 10 mL to the 3 and 9 o'clock positions of the cervix were administered far PCB. Respiratory and cardiovascular functions including heart rate (HR), mean arterini pressure (MAP), peripheral oxygen saturation (SpO2), end tidal carbon dioxide (ETCO2) were recorded preoperatively and intraoperatively at specific time points up to 30 minutes postoperative. The degree of sedation and pain intensity were determined. Intra and postoperative side effects and the amount of remifentanil used were noted. HR recorded at the time of PCB and MAP at the onset of hysteroscopy and the postoperative 30"1 minute increased significantly in Group II (p<0.05). in Group II, SpO2 significantly decreased at the onset of remifentanil infusion, dizziness, and at the beginning of the hysteroscopy with respect to Group I, but they remained within normal clinical limits. ETCO2 values of Group II were significantly higher than those of Group I at certain time points (PCB, hysteroscopy onset, resection, end of hysteroscopy, postoperative 10 th and 2O th min). Median sedation scores and VAS were comparable in both groups. There were no significant differences in the incidence of intra and postoperative side effects between the groups. The combination of PCB with remifentanil infusion with or without meperidine premedication provided sufficient analgesiafor hysteroscopy without any major side effects and with high rates of patient and surgeon satisfaction.

Keywords:

Hysteroscopy, Meperidine, Premedication, Anesthesia, Obstetrical,

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