Dilek YAZICIOĞLU, Ercan SÖNMEZ, İbrahim ÖZTÜRK, Taylan AKKAYA, Haluk GÜMÜŞ, Murat SAYIN

KRANİYOTOMİLERDE ESMOLOL VE REMİFENTANİLİN HEMODİNAMİK ETKİLERİNİN VE DERLENME ÖZELLİKLERİNİN KARŞILAŞTIRILMASI

Amaç: Kraniyotomi yapılan hastalarda esmolol ve remifentanil infüzyonlarının perioperatif hemodinamik değişikliklerin kontrolü, fentanil tüketimi ve derlenme süresi üzerine olan etkilerinin karşılaştırılmasıdır. Yöntem: Elektif kraniyotomi yapılan, ASA I-II, 40 erişkin hasta, rastgele 2 gruba ayrıldı. Grup Remifentanil’e 1 µg kg-1 yükleme ardından 0,25-1µg kg-1 dk1 remifentanil infüzyonu, Grup Esmolol’e 500 µg kg-1 yükleme ardından 100-300 µg kg1dk1 esmolol infüzyonu yapıldı. Esmolol ve remifentanil infüzyon hızı, belirlenen hedef kalp hızı ve kan basıncı (başlangıç değerlerin %20’si) değerlerine göre titre edildi. Bulgular: Kalp hızı (KH) ve ortalama arter basıncı (OAB) remifentanil ve esmolol yükleme dozunun verilmesinden sonra her iki grupta da düştü. KH ve OAB’de operasyonun 2. saatinden itibaren remifentanil grubunda daha fazla düşme tespit edildi. Ekstübasyondan sonra remifentanil grubunda KH ve OAB daha yüksek bulundu. Hedef KH ve OAB’nin sağlanabilmesi için; esmolol 100 (0,06) µg kg-1dk-1, remifentanil 0,195 (0,06) µg kg-1dk-1 infüzyon yapıldı, remifentanil grubunda ilaç infüzyon hızında daha fazla değişiklik yapılmış ve daha fazla fentanil kullanılmıştır. Esmolol grubunda derlenme daha hızlı idi (Aldrete skoru ≥9 süresi, Grup R: 15,05 (4,45) dk, Grup E: 11,50 ( 3,12) dk p=0,005). [Değerler ortalama (standart sapma)]. Sonuç: Kraniyotomi yapılan hastalarda esmolol infüzyonu remifentanil infüzyonuna göre perioperatif dönemde hemodinamik stabiliteyi daha iyi korur ve erken derlenme sağlar. Remifentanil kullanımı ise intraoperatif ve erken postoperatif dönemde daha fazla yan etki oluşması ile ilişkilidir.

COMPARISON OF HEMODYNAMIC EFFECTS AND RECOVERY PROFILES OF ESMOLOL AND REMIFENTANIL IN CRANIOTOMY OPERATIONS

Objective: The aim of this study is to compare esmolol and remifentanil infusions with respect to their effect on perioperative hemodynamic stability, fentanyl consumption and recovery time in craniotomy patients. Methods: Forty ASAI-II adults scheduled for elective craniotomy were randomised into two groups. Group Remifentanil received 1 µg kg-1 loading and 0.25-1 µg kg-1 min-1 remifentanil infusion, Group Esmolol received 500 µg kg-1 loading, 100-300 µg kg1 min-1 esmolol infusion. The esmolol and remifentanil infusions were titrated according to target heart rate (HR) and mean arterial pressure (MAP) (whithin 20% of baseline values). Results: HR and MAP decreased in both groups after the loading dose. The decrease in HR and MAP was significantly more in group remifentanil after the second hour of surgery. After the extubation the HR and MAP increased significantly in group remifentanil. The required esmolol infusion rate was 100 (0,06) µg kg-1 min-1 and remifentanil infusion rate was 0,195 (0,06) µg kg-1 min-1 to achieve the targeted HR and MAP. The number of drug infusion rate changes and fentanyl consumption was higher in group remifentanil conmpared to group esmolol. The recovery was faster in group esmolol compared to group remifentanil (Time to Aldrete score ≥9, Group R: 15,05 (4,45) min, Group E: 11,50 ( 3,12) min p=0,005). [Values are mean (standart deviation)]. Conclusion: Esmolol infusion is superior to remifentanil in providing hemodynamic stability and early recovery in the perioperative period in craniotomy operations. On the other hand, remifentanil infusion is associated with intraoperative and early postoperative complications.

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