Savaş ZEYDANOĞLU, Ayten BİLİR, Serdar EKEMEN, Belkıs TANRIVERDİ

Koroner arter bypass greftleme cerrahisinde remifentanil ile fentanil anestezisinin erken ekstübasyon ve derlenme sürelerinin karşılaştırılması

Çalışmamızda, elektif koroner arter bypass greftleme operasyonu geçiren hastalarda, remifentanil kullanımının düşük dozfentanil kullanımına göre hemodinamik değişiklikler, ekstübasyon zamanı, postoperatif analjezik ihtiyacı ve yoğun bakım ünitesinde kalış sürelerini karşılaştırmayı amaçladık . ASA HI-IV grubu 40 hasta rastgele 20'şer kişilik iki gruba ayrıldı. Anestezi indüksiyonunda etomidat ve rokuronyum ile birlikte, birinci gruba remifentanil, ikinci gruba ise fentanil intravenöz bolus olarak uygulandı. İdamede sevofluran kullanılıp, birinci grupta remifentanil, ikinci grupta ise fentanil infüzyonları başlandı. Hastaların ameliyat öncesi, ameliyat sırasında ve sonrasında kalp atım hızları, sistolik, diyastolik ve ortalama arteriyel kan basınçları kaydedildi. Ameliyat sonrası dönemde ise yine her iki gruba da intravenöz hasta kontrollü analjezi yöntemi ile morfin uygulandı ve Ramsey sedayon skalası, verbal ağrı skorlaması, oryantasyon skorlaması, morfin tüketimleri ve toplam maliyetler belirlendi. Remifentanil grubunda, fentanil grubuna göre arteriyel kan basıncı değerlerindeki değişiklik istatistiksel olarak anlamlı değilken (p>0.05), kalp atım hızları anlamlı yüksek bulundu (p

Anahtar Kelimeler:

Anesteziden uyanma dönemi, Koroner arter köprüleme, Anestezikler, ven içi, Fentanil

Comparison of remifentanil and fentanyl on early extubation and recovery at coronary artery bypass grefting

This study was designed to compare the effects of low doses offentanyl with remifentanil on extubation time, hemodynamic changes, postoperative analgesic requirement and the duration of intensive care unit stay in patients undergoing coronary artery bypass grafting surgery. Forty patients, ASA physical status III-IV, were randomly and equally allocated to one of two groups. All of the patients received standardized anesthesia induction with etomidate and rocuronium. Anesthesia was maintained with sevoflurane along with remifentanil infusion in Group I andfentanyl infusion in Group II. The heart rates, systolic, diastolic and mean arterial pressures of the patients were recorded in preoperative, intraoperative and postoperative periods. Patients received intravenous morphine by patient controlled analgesia method and the Ramsey sedation scale, verbal pain scale, orientation scores, morphine consumption and total cost were evaluated in postoperative period. While changes in arterial pressures were insignificant in the remifentanyl group (p>0.05), heart rates were significantly higher than with thefentanyl group (p<0.05). Extubation time was shorter in the remifentanil group (p<0.05) Ramsey sedation scores, verbal pain scores, orientation scores and morphine consumption were similar in both groups (p>0.05). Fentanyl in small doses and remifentanil both provided good anesthetic depth, and hemodynamic stability in coronary artery bypass grafting operations. We concluded that remifentanil provided earlier extubation than fentanyl and there was no difference in cost.

Keywords:

Anesthesia Recovery Period, Coronary Artery Bypass, Anesthetics, Intravenous, Fentanyl,

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