Semra DEMİRBİLEK, NURÇİN GÜLHAŞ, Erdoğan ÖZTÜRK, A. Kadir BUT, Ülkü ASLAN, M. Özcan ERSOY

Kontrollü hipotansiyonda remifentanil ile birlikte uygulanan propofol, desfluran ve sevofluranın etkinliği

Bu çalışmada, septoplasti veya septorinoplasti geçirecek olgularda, remifentanil ile birlikte uygulanan propofol, desfluran ve sevofluranın intraoperatif kontrollü hipotansiyon sağlanması, cerrahi alan kalitesi ve derlenme üzerine olan etkilerinin karşılaştırılması amaçlandı. ASA I grubu, 18-47 yaş arası 54 olgu rasgele üç gruba ayrılarak, l$mu$g $kg^{-1}$ bolus doz sonrası 0.25 $mu$g $kg^{-1}$ $dk^{-1}$ remifentanil infüzyonuna başlandı. Propofol grubuna, l.5-2 mg $kg^{-1}$ propofol ve sonrasında 100-200 $mu$g $kg^{-1}$ $dk^{-1}$ propofol infüzyonu; sevofluran grubuna %7 sevofluran %100 O2 ile indüksiyon sonrası %l-2 sevofluran ve hava-02 karışımı; desfluran grubuna propofol 1.5-2 mg $kg^{-1}$ verildikten sonra %4-6 desfluran ve hava-O2 karışımı uygulandı. Cerrahi süresince sistolik arter basıncını (SAB) 80-100 mmHg arasında tutacak şekilde ilaç dozları ayarlandı. Kontrollü hipotansiyon döneminde SAB, desfluran ve sevofluran grubunda propofol grubuna göre, ortalama arter basıncı (OAB) sevofluran grubunda diğer gruplara göre anlamlı düşüktü (p

Anahtar Kelimeler:

Anestezikler, inhalasyon, Anestezikler, birlikte kullanım, Hipotansiyon, kontrollü, Propofol, Anestezikler, ven içi

The efficacy of remifentanil combined with either propofol, sevoflurane or desflurane during controlled hypotension

The aim of this study was to compare the effects of a combination of remifentanil with propofol, desflurane or sevoflurane on intraoperative controlled hypotension, quality of the surgical field and recovery characteristics in patients undergoing nose surgery. ASA physical status 1,18-47 yr of age, 54 patients were randomly divided to three groups and received remifentanil l$mu$g $kg^{-1}$ as a bolus dose followed by a continuous infusion of 0.25 $mu$g $kg^{-1}$ $min^{-1}$. In propofol group, anesthesia was induced 1.5-2 mg $kg^{-1}$ of propofol and maintained with a continuous infusion of 100-200 $mu$g $kg^{-1}$ $min^{-1}$. In sevoflurane group, anesthesia was induced with 7% sevoflurane in 100% oxygen, and was maintained with 1-2% sevoflurane and air in oxygen. In desflurane group, anesthesia was induced 1.5-2 mg kg'1 of propofol and maintained with 4-6% desflurane and air in oxygen. The study drug titration was adjusted to keep the systolic blood pressure (SBP) between 80-100 mmHg during surgery. During controlled hypotension, while SBP was significantly lower in desflurane and sevoflurane groups than in propofol group, mean blood pressure (MBP) was significantly lower in sevoflurane group than in other groups (p<0.05). Supplemental hypotensive agent was administered to 2 patients in propofol group and 1 patient in desflurane group. After extubation, MBP and heart rate (HR) significantly increased in propofol group, HR significantly increased in sevoflurane group, SBP, MBP and HR significantly increased in desflurane group according to preinduction values (p<0.05)Estimated blood loss and surgical field score was similar in all three groups. The time to extubation and early recovery was significantly shorter in desflurane group than in sevoflurane and propofol groups (p<0.05). We concluded that since all three anesthetic techniques provided hemodynamic stability and good visualization of the surgical field, they may be used for controlled hypotension management. However, sevoflurane-remifentanil combination may be preferable, because it did not cause any increase in blood pressure after extubation.

Keywords:

Anesthetics, Inhalation, Anesthetics, Combined, Hypotension, Controlled, Propofol, Anesthetics, Intravenous,

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