Ahmet KÖROĞLU, ENDER GEDİK, NURÇİN GÜLHAŞ, Hüseyin İ. TOPRAK, Kazım KARAASLAN, M. Özcan ERSOY

Koroner arter bypass cerrahisinde total intravenöz anestezi: Midazolamla birlikte remifentanil veya fentanil infüzyonunun hemodinamik etkilerinin karşılaştırılması

Çalışmamızda; koroner arter bypass cerrahisinde midazolam ile birlikte remifentanil veya fentanil infüzyonunun endotrakeal entübasyon, cerrahi uyanlara yanıt ve intraoperatif hemodinami üzerine etkisini değerlendirmeyi amaçladık. Çalışmaya alınan 60 olgunun anestezi indüksiyonunda 0.5-3 mg $kg^-1$ tiyopental sodyuma ilave olarak grup R'de (n=31) 2 $mu$g $kg^-1$ remifentanil, grup F'de (n=29) 15 $mu$g $kg^-1$ fentanil kullanıldı. Anestezi idamesinde 0.15 mg $kg^-1$ $sa^-1$ midazolama ilave olarak grup R'de l $mu$g $kg^-1$ $dk^-1$ remifentanil, grup F'de 0.15 ug $kg^-1$ $dk^-1$ fentanil infüzyonu yapıldı. Ortalama arter basıncı (OAB) ve kalp atım hızı (KAH), entübasyondan ve cerrahi uyarılardan l, 3, 5 dk sonra ve operasyon süresince 5dk aralarla kaydedildi. Ayrıca entübasyon zamanı ile ortaya çıkan komplikasyonlar kaydedildi. Anestezi indüksiyonu sonrası KAH grup R'de F'ye göre daha düşük, opiyoid infüzyonu sırasında hem OAB hem de KAH grup R'de F'ye göre daha düşüktü. Cilt insizyonu, sternotomi ve internal mammarian arter diseksiyonu sonrası OAB ve KAH grup F'de R'ye göre daha yüksekti. Cilt insizyonu, sternotomi ve internal mammarian arter diseksiyonuna hipertansif yanıt veren hasta sayısı grup F'de R'ye göre daha fazlaydı. KPB sırasındaki hipertansiyon sıklığı ve nitrogliserin gereksinimi grup R'de F'ye göre daha azdı. Sonuç olarak, anestezi indüksiyonunda tiyopental sodyum ve midazolam ile birlikte remifentanil veya fentanilin entübasyona yanıtı engellemediği, anestezi idamesinde midazolamla birlikte remifentanil infüzyonunun cerrahi uyarılara yanıtı fentanile göre daha iyi engellediği kanaatine varıldı.

Anahtar Kelimeler:

Midazolam, Fentanil, Karşılaştırmalı çalışma, Anestezi, ven içi, Koroner arter köprüleme

The comparison of hemodynamic effects of remifentanil or fentanyl addition to midazolam infusion for total intravenous anesthesia in coronary artery bypass surgery

We aimed to determine the effects of remifentanil orfentanyl infusion with midazolam on response to endotracheal intubation, surgical stimulus and intraoperative hemodynamics in coronary artery bypass surgery. Anesthesia was induced with thiopental sodium 0.5-3 mg $kg^-1$ and 2 $mu$g $kg^-1$ remifentanil (Group R, n=31), or 15 $mu$g $kg^-1$ fentanyl (Group F, n=29) in 60 cases included into the study. Anesthesia was maintained with 1 $mu$g $kg^-1$ $min^-1$ remifentanil in group R or 0.15 $mu$g $kg^-1$ $min^-1$ fentanyl in group F in addition to the midazolam infusion 0.15 mg $kg^-1$ $h^-1$ . Mean arterial pressure (MAP), heart rate (HR) were recorded at l, 3 and 5 min after intubation and surgical stimulus and 5 min intervals during surgery. Also time to intubation and complications were recorded. Heart rate was lower in group R after anesthesia induction. During opioid infusion both MAP and HR decreased more in group R than F. After skin incision, sternotomy and internal mamarian artery dissection MAP and HR were higher in group F than R. Hypertensive response to sternotomy, skin incision, internal mamarian artery dissection was lowen in group R than group F. Freguency of hypertension and requirement of nitroglycerin were lower in group R than group F during CPB. We concluded that thiopental sodium with remifentanil or fentanyl in anesthesia induction did notprevent the hypertensıve response to intubation. However maintenance with remifentanil and midazolam infusion was more effective m preventing surgical stimuli.

Keywords:

Midazolam, Fentanyl, Comparative Study, Anesthesia, Intravenous, Coronary Artery Bypass,

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