Mahmut ÖZEL, Alper YOSUNKAYA, Aybars TAVLAN, Ruhiye REİSLİ, Selmin ÖKESLİ

Kısa süreli cerrahi girişimlerde alfentanil ve remifentanilin TİVA'da karşılaştırılması

Çalışmamızda kısa süreli elektif cerrahi girişim geçirecek olgularda, total intravenöz anestezide (TIVA), propofol ile birlikte alfentanil veya remifentanil kullanarak, her iki ajanın anestezi indüksiyon, idame ve derlenme özelliklerini karşılaştırmayı amaçladık. Kısa süreli bir operasyondan 1-2 gün sonra taburcu edilmesi planlanan, ASA I-ll grubundan, yaşları 18-60 arasında değişen 50 olgu çalışmaya alındı. Olgular rastgele olarak iki eşit gruba ayrıldı. Olgulara iv bolus olarak I. grupta 20 $mu$g kg -1 alfentanil, ll. grupta 1 $mu$g kg -1 remifentanil; her iki grupta 2 mg kg-1 propofol ve 0.15 mg kg-1 vekuronyum uygulandı. Takiben 90 $mu$g kg-1 dk-1 propofol infüzyonu ile 2 $mu$g kg-1 dk-1 alfentanil veya 0.5 $mu$g kg-1 dk-1 remifentanil infüzyonu hemen başlandı. Trakeal entübasyondan 5 dakika sonra alfentanil ve remifentanil infüzyonu yarıya, propofol infüzyonu ise başlandıktan 30 dakika sonra 60 $mu$g kg-1 dk-1 dozuna indirildi. Olgular operasyon süresince %100 O2 ile solutuldu. Olguların sistolik, diyastolik, ortalama arter basınçları ve kalp atım hızları; anesteziden önce, alfentanil ve remifentanil uygulamasından l, 3, 5 dk sonra, entübasyon ve cilt insizyonundan sonra ve operasyon süresince her 10 dakikada bir kaydedildi. Entübasyon, cilt insizyonu ve cerrahi stimulasyona hemodinamik ve somatik yanıtlar saptandı. Operasyonun sonunda derlenme süreleri ve istenmeyen olaylar kaydedildi. Trakeal entübasyon ve cilt insizyonuna hemodinamik yanıt, Grup ll'de Grup l'e oranla daha az iken, her iki grup arasında istatistiksel önemli fark saptanmadı. Operasyon süresince cerrahi stimulasyona hemodinamik yanıt benzerdi. Grup ll'de daha az sayıda olgu Grup I'e göre ek dozeopiyoide gereksinim gösterdi (p

Anahtar Kelimeler:

Anestezi, Alfentanil, Analjezikler, opioid, Anestezikler, ven içi

Comparison of alfentanil and remifentanil at total intravenous anesthesia in short-term elective surgery

In our study, adding alfentanil as an opioid analgesic to propofol for total intravenous anesthesia in short-term elective surgery was compared to remifentanil. We aimed to study the anesthesia induction, maintenance and recovery characteristics of the two drugs. This study was carried out on 50 patients in ASA I-II group. They were between the ages of 18-60 and they were planned to be discharged from the hospital in 1-2 days. They were randomised into two groups, 20 $mu$g kg-1 alfentanil was given to group I and 1 $mu$g kg-1 remifentanil iv to group II patients as bolus injection, 2 $mu$g kg-1 min-1 alfentanil and 0.5 $mu$g kg-1 min-1 remifentanil iv infusion was also started respectively. Following this, these two group of patients were intubated by applying 2 mg kg-1 propofol+0.15 mg kg-1 vecuronium iv bolus and 90 $mu$g kg-1 min-1 iv propofol infusion. Alfentanil and remifentanil infusions were halfened 5 min after tracheal intubation and propofol infusion was decreased to 60 $mu$g kg-1 min-1 30 min after beginning. All patients were vetilated with 100 % O2 during the operation. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heart rate measurements were recorded before anesthesia, 1, 3, 5 min after remifentanil or alfentanil application, after the intubation and skin incision, and during surgery every 10 min. The haemodynamic and somatic responsens to intubation-skin incision and surgical stimulation were identified. After operation, recovery time and adverse events were recorded. The response to tracheal intubation and skin incision was less in remifentanil group than in alfentanil group, statistically considerable difference was not identified. No differences were compared in the evaluation of times, seeing reponse to surgical. A smaller proportion of remifentanil patients than alfentanil patients had required addition opioid doses during maintenance (p<0.05). When comparing the recovery period of each group, it was significantly shorter in the remifentanil group than in the alfentanil group (p<0.05). These two groups were similar in the aspect of observing postoperative adverse events. As a result, we think that remifentanil can be prefered to alfentanil as an addition opioid agent in TIVA which is applied for short-term surgical procedures because a smaller remifentanil patients require a study opioid adjustments needed to treat light anesthesia responses and remifentanil provides rapid recovery.

Keywords:

Anesthesia, Alfentanil, Analgesics, Opioid, Anesthetics, Intravenous,

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