Ümran YAKICI, AHMET KEMALETTİN KOLTKA, Fatma DEMRCAN, Semra KÜÇÜKGÖNCÜ, Mukadder SUNGUR ORHAN, MELTEM SAVRAN KARADENİZ, TÜLAY ÖZKAN SEYHAN

İntravenöz enjeksiyon hızının fentanile bağlı öksürük oluşma insidansına etkisi

Amaç: Opioidlerin antitussif etkilerine rağmen fentanil enjeksiyonu öksürüğe neden olabilmektedir. Bu çalışmada iki farklı enjeksiyon hızının, fentanile bağlı öksürük insidansına etkisi incelenmiştir. Yöntem: Etik kurul ve hasta onamını takiben elektif cerrahi girişim geçirecek ASA I-III hastalar randomize iki gruba ayrıldı. Grup 5deki hastalara 2 μg kg-1 fentanil 5 saniyede, Grup 30daki hastalara ise 30 saniyede i.v. olarak uygulandı. Enjeksiyonu takiben 60 saniye içinde öksürüğün varlığı, şiddeti (hafif: 1-2, orta: 3-5, şiddetli: > 5 adet), ortaya çıkma zamanı ve vital parametreler kaydedildi. Çalışmaya Grup 5ten 493 ve Grup 30dan 488 hasta katıldı. Bulgular: Grup 5deki olguların 114ü (%23), Grup 30da ise 17si (%3,5) öksürdü (p< 0,0001). Grup 5 ve Grup 30da hafif şiddette öksüren hasta sayısı sırasıyla 41 ve 12 (p< 0,0001), orta şiddette öksürenlerin sayısı 54 ve 5 (p< 0,0001) olarak gözlenirken, şiddetli öksürük sadece Grup 5deki 19 hastada ortaya çıktı (p< 0,0001). Grup 5de 62 hasta (%54,4) enjeksiyon sonrası ilk 10 saniyede, 48 hasta (%42) 11-30. saniyeler arasında ve 4 hasta (%3,5) 30. saniyeden sonra öksürdü. Grup 30da ise 11 hasta (%64,7) ilk 10 saniyede ve 6 hastada (%35,3) 11-30. saniyeler arasında öksürdü. Grup 5deki hastalarda fentanil sonrası diyastolik kan basıncı ve solunum sayısında anlamlı azalmalar olduğu saptandı. Sonuç: Çalışmamız fentanil enjeksiyonunun 30 saniyede yapılmasının 5 saniyeye kıyasla öksürük sıklığını ve şiddetini azalttığını göstermiştir. Özellikle beyin ve göz cerrahisi gibi öksürük sonucu bölgesel basınç artışının istenmediği durumlarda bu uygulamanın yararlı olacağı görüşündeyiz.

The effect of the intravenous injection rate on the incidence of fentanyl induced cough

Objective: Although opioid agonists are known to possess antitussive effects administration of fentanyl may induce coughing. In this study, the effects of two different injection rates of fentanyl on fentanyl -induced cough was evaluated. Method: After having ethics committee approval and informed consent, ASA I-III patients undergoing elective surgery were randomized into two groups. In Group 5, 2 μg kg-1 fentanyl was injected in 5 seconds and in Group 30 in 30 seconds. The patients were observed for 60 seconds after the injection for the presence of coughing and its severity. The severity was graded depending on the number of coughs (Mild: 1-2, Moderate: 3-5, Severe: > 5). The time of coughing and vital parameters were also recorded. 493 patients from group 5, and 488 patients from group 30 were included into the study. Results: In Group 5, 114 patients (23%) coughed, whereas in Group 30 only 17 patients (3.5%) coughed (p< 0.0001). In Group 5, 41 and in Group 30 12 patients coughed mildly (p< 0.0001), 54 and 5 patients coughed moderately (p< 0.0001) and only 19 patients in Group 5 coughed severely(p< 0.0001). In Group 5 62 patients (54.4%) coughed in the first 10 seconds after fentanyl injection, 48 patients (42%) coughed between 11-30 seconds and 4 patients (3.5%) coughed after 30 seconds. In Group 30, 11 patients (64.7%) coughed in the first 10 seconds after fentanyl injection and 6 patients (35.3%) coughed between 11-30 seconds. Patients in Group 5 experienced statistically significant decreases in diastolic blood pressures and respiratory rate values after fentanyl injection. Conclusion: Our study has showed that the administration of fentanyl in 30 seconds compared to its injection in 5 seconds can reduce the incidence and severity of cough. We conclude that this application will be appropriate in neurosurgery and ophthalmic surgery where regional pressure increases are not desired as a result of coughing.

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