Sibel DEVRİM, Nurten BAKAN, Murat KARCIOĞLU, Melek ÇELİK

İntrakranyal cerrahide farklı dozlarda remifentanil infüzyonunun klinik etkileri

Remifentanil; kolay titre edilebilmesi, hızlı ve kısa etkili oluşu nedeniyle, operasyon sırasında oluşacak akut stres cevabın kontrolünde ve postoperatif nörolojik durumun erken değerlendirilmesinde önerilen bir ajandır. Çalışmamızda, remifentanilin akut stres dönemlerinde hemodinamik cevaba ve postoperatif derlenme üzerine olan etkilerini, İntrakranyal cerrahide değerlendirmeyi amaçladık. Elektif İntrakranyal cerrahi planlanan 56 hasta, remifentanil infüzyon hızına göre 3 gruba ayrıldı: Grup l (0.075 $mu$g kg-1dk-1), Grup II (0.15 $mu$g kg-1dk-1) ve Grup III (0.25 $mu$g kg-1dk-1). Tüm olgularda infüzyonlara anestezi indüksiyonundan sonra başlandı. Anestezi idamesinde %l-2 sevofluran ve O2lhava karışımı kullanıldı. Hemodinamik parametreler; entübasyon, çivili başlık uygulanması, skalp insizyonu ve kranyektomi dönemlerinde 5 dk aralarla takip edildi. Ortalama arter basıncının (OAB); remifen-tanil (0.5 $mu$g kg-1; IV), nitroprusit (100 $mu$g kg-1; IV ) veya efedrin (5-10 mg; IV) ilave bolusları ile 70-110 mmHg olması hedeflendi. Operasyon bitiminde, hemodinamik parametreler anestezisi tarafından (5=mükemmel-l=zayıf) değerlendirildi ve ekstübasyon-oryantasyon zamanları kaydedildi. Hemodinamik kontrol Grup II ve Grup III'de Grup I'e göre daha iyiydi (p

Anahtar Kelimeler:

Anestezi, ven içi, Piperidinler, Cerrahi işlemler, operatif

Clinical effects of different doses of remifentanil infusion during intracranial surgery

Remifentanil is an opioid suggested in the control of acute stress response to surgical operation and early evaluation of neurological status during postoperative period because of its fast, short and easy titratable effects. In this study, we aimed to evaluate the effects of remifentanil on hemodynamic response during acute stress and postoperative recovery in intracranial surgery. Fifty-six patients undergoing elective intracranial surgery were divided into three groups according to remifentanil infusi-on rate: Group I (0.075 $mu$g kg-1 min-1), Group II (0.1 $mu$g kg-1min-1) and Group III (0.25 $mu$g kg-1 min-1). Infusion of remifentanil was initiated after induction of anesthesia in all cases. Sevoflurane 1-2 % in air/oxygen was used in the maintenance of anesthesia. Hemodynamic parameters were recorded for every five minutes based on intubation, application of the head holder, scalp incision and craniectomy. Mean arteriel pressure was tried to be kept between 70-110 mmHg with supplemental boluses of remifentanil (0.5 $mu$g kg-1; IV), nitroprusside (100 $mu$g kg-1; IV) or ephedrine (5-10 mg; IV) as needed. Hemodynamic parameters were evaluated by an anesthesiologist at the end of operation (5=excellent, l=poor) and extubation-orientation times were recorded. Hemodynamic control was superior in Groups II and III compared to Group I (p<0.05). Mean arteriel pressure was kept within target limits in all groups. Supplemental remifentanil bolus doses and frequency of remifentanil dose were higher in Group I than in Group II and III (p<0.05). Extubation-orientation times were not different among the groups. In conclusion, remifentanil infusion doses of 0.15 $mu$g kg-1 min-1 and 0.25 $mu$g kg-1 min-1 provided better hemodynamic control than 0.07'5 $mu$g kg-1 min-1 in combination with sevoflurane in intracranial interventions.

Keywords:

Anesthesia, Intravenous, Piperidines, Surgical Procedures, Operative,

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