Zeliha DİŞLİ KORKMAZ, Nalan ÇELEBİ, Özgür CANBAY, Bilge ÇELEBİOĞLU

Koroner arter baypass cerrahisi postoperatif dönemde, hasta kontrollü analjezi cihazı ile morfin ve deksmedetomidinin etkinliğinin karşılaştırılması

Giriş: Bu çalışmada koroner arter bypass greftleme postoperatif dönemde, hasta kontrollü analjezi makinesi ile morfin ve deksmedetomidinin analjezik etkinliğini; postoperatif erken ekstübasyona etkisini karşılaştırmayı amaçladık. Yöntem: Koroner arter bypass greftleme yapılacak ASA II-IV, 30-70 yaşları arasında 60 hasta prospektif randomize çift-kör çalışmaya dahil edildi. Operasyon bittikten sonra, toraks kalp damar cerrahisi yoğun bakıma alınan hastalara hasta kontrollü analjezi makinesi takıldı. 100 ml salin içinde; 1 mg ml -1 morfin (Grup 1), 5 mcg ml-1 deksmedetomidin (Grup 2), 0,5 mg ml-1 morfin+ 2,5 mcg ml deksmedetomidin (Grup 3) konularak 1ml saatden bazal infüzyon, 1ml bolus doz ve 15 dakika kilit süresi ile 48 saat boyunca devamlı infüzyon şeklinde verildi. Postoperatif, hemodinamik parametreler (kalp hızı, kan basıncı, oksijen saturasyonu), solunum sayısı, görsel analog skala, sözel değerlendirme skalası, sedasyon düzeyi, ekstübasyon süresi, verilen ilaç miktarı, derlenme zamanı, servise çıkma zamanları, taburculuk zamanları; 30. ve 120. dakika, 6., 24. ve 48. saatlerde kaydedildi. Bulgular: Grup1 ve Grup 3 arasında anlamlı fark olmamasına rağmen, Grup 2nin ekstübasyon süreleri Grup 1 ve Grup 3e göre anlamlı olarak kısa bulundu (p=0.003). Diğer parametreler karşılaştırıldığında ise istatistiksel olarak anlamlı sonuçlar görülmedi (p>0,05). Sonuç: Bu çalışmadan yola çıkarak, deksmedetomidinin kardiyovasküler cerrahide postoperatif olarak, erken ekstübasyonda yararlı olabileceğini düşünüyoruz.

Comparison of morphine and dexmedetomidine delivered by patient-controlled analgesia device during the Postoperative period of coronary artery bypass surgery

Objective: In this study, we aimed to compare the analgesic effects of dexmedetomidine and morphine infusion delivered by patient-controlled analgesia device after coronary artery bypass surgery on early postoperative extubation. Method: Sixty ASA II-IV patients aged 30-70 years who had undergone elective coronary artery bypass grafting between 2009, and 2010 were included in this prospective, randomized, double blind study. All patients were connected to patient-controlled analgesia device in the intensive care unit after cardiothoracic surgery. In 100 ml saline, 1 mg ml morphine (Group 1), 5 mcg ml dexmedetomidine (Group 2) and 0.5 mg ml morphine + 2.5 mcg ml dexmedetomidine mixture (Group 3) were added, and delivered as baseline infusion at a dose of 1ml/hr, 1 ml bolus dose, 15 minute-lock time, and finally as a continuous infusion for 48 hours. Hemodynamic parameters (heart rate, blood pressure, oxygen saturation), respiratory rate, visual analogue and verbal rating scale scores, level of sedation, time to extubation, amount of drugs used, recovery time, time to transfer to the service, and discharge were checked, and recorded at 30. and 120. min, 6., 24., and 48.hr, postoperatively. Results: Extubation times were not significantly different between Groups 1, and 3, however in Group 2 they were found to be significantly shorter when compared to Groups 1 and 3 (p=0.003). There were insignificant differences when the other parameters were compared statistically (p>0.05). Conclusions: We have concluded that postoperative use of dexmedetomidine in patients who have undergone coronary artery bypass grafting may allow for earlier extubation.

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