Fatiş ALTINTAŞ, Pervin BOZKURT, Şener DEMİROLUK, Ebru ATİLLA, Güner KAYA

Kronik böbrek yetmezliği olan olgularda rokuronyumun nöromusküler bloğa ve entübasyon koşullarına etkisinin değerlendirilmesi

Bu çalışmada; kronik böbrek yetmezliği olan 21 olgu (Grup B) ile 20 sağlıklı olguda (Grup N) rokuronyumun etki başlama zamanı, klinik gevşeme süresi ve entübasyon koşullarını karşılaştırdık. Propofol 2 mg.kg-1 ve fentanil 2µg.kg-1 ile indüksiyonu takiben, kas gevşemesi 0.6 mg.kg-1 rokuronyum ile sağlandı. Nöromusküler ileti TOF-GUARD kullanılarak, adduktor pollisis kasında dörtlü uyarı (TOF) ile değerlendirildi. Rokuronyum verildikten 60 sn sonra trakeal entübasyon denendi. Laringoskopi sırasında, hareket eden olgularda, entübasyon 30 sn ertelendi. Entübasyon koşulları; çene gevşekliği, vokal kordların durumu ve diafragma yanıtına göre; mükemmel, iyi, zayıf ve kötü olarak derecelendirildi. Rokuronyum verildikten 60 sn sonra, Grup B'de 4 olgu (%19) ve Grup N'de 5 olgu (%25) entübe edildi. Entübasyon koşulları mükemmeldi. Geriye kalan olgular, 60.sn'de laringoskopi sırasında hareket ettikleri için, rokuronyum verildikten 90 sn sonra entübe edildiler. Her iki grupta, entübasyon koşulları mükemmel ve mükemmele yakın idi. Grup B ve Grup N'de etki başlama zamanı sırasıyla; 91 sn (min: 58 sn, maks: 186 sn) ve 103.5 sn (min: 36 sn, maks: 218 sn), klinik gevşeme süresi ise sırasıyla 40 dk (min: 10 dk, maks: 130 dk) ve 37 dk (min: 20 dk, maks: 64 dk) idi. Gruplar arasında, nöromusküler ileti ve entübasyon koşulları açısından istatistiksel fark saptanmadı.

Anahtar Kelimeler:

Böbrek yetmezliği, kronik, Varyans analizi, Entübasyon, Nöromüsküler blokaj, Renal diyaliz

Evaluation of the effects of rocuronium bromide on neuromuscular block and intubation conditions in patients with chronic renal failure

We have compared the onset time, duration of clinical relaxation and intubation conditions of rocuronium bromide in 21 patients with chronic renal failure (Group B) and in 20 healthy patients (Group N) in this study. Following induction provided with propofol 2 mg.kg-1 and fentanyl 2 µg.kg-1, neuromuscular relaxation was achieved by 0.06 mg.kg-1 rocuronium. Neuromuscular transmission was assessed by train of four (TOF) at the adductor pollicis muscle using a TOF-GUARD monitor. Sixty seconds after rocuronium administration, tracheal intubation was performed. Intubation was postponed 30 seconds in patients moved during laryngoscopy. Intubation conditions were graded as excellent, good, fair or poor according to jaw relaxation, position of vocal cords and diaphragmatic response. Sixty seconds after administration of rocuronium, 4 patients in Group B and 5 patients in Group N were intubated. Intubation conditions were excellent. The rest of the patients who has moved during laringoscopy 60 sec after rocuronium administration, were intubated 90 sec after rocuronium administration. Onset time and duration of clinical relaxation were 91 sec (min: 58 sec, max: 186 sec) and 103.5 sec (min: 36 sec, max: 218 sec); and 40 min (min: 10 min, max: 130 min) and 37 min (min: 20 min, max: 64 min) for groups B and group N, respectively. In both groups, intubation conditions were excellent or almost excellent. Differences between neuromuscular block and intubation conditions were not statistically significant in both groups.

Keywords:

Kidney Failure, Chronic, Analysis of Variance, Intubation, Neuromuscular Blockade, Renal Dialysis,

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