Aysun POSTACI, Işıl KARABEYOĞLU, Taner AYERDEM, GÜLAY ERDOĞAN KAYHAN, Canan ÜN, Beyazıt DİKMEN

Laringoskopi ve endotrakeal entübasyona bağlı gelişen hemodinamik yanıtların önlenmesinde remifentanil,alfentanil ve esmolol

Amaç: Laringoskopi ve endotrakeal entübasyona karşı gelişen hemodinamik yanıtların önlenmesinde tek doz remifentanil, alfentanil ve esmololün etkinliğini karşılaştırmayı amaçladık. Yöntem: ASA I-II grubu, 18-65 yaş arası, elektif cerrahi planlanan 60 olgu çalışma kapsamına alındı. Rastgele üç gruba ayrılan olgulardan Grup A’ya 20 µg kg1 alfentanil, Grup E’ye 2 mg kg-1 esmolol ve Grup R’ye 2 µg kg-1 remifentanil anestezi indüksiyonundan 1 dakika sonra uygulandı. Hemodinamik veriler; indüksiyon öncesi (K), indüksiyon sonrası (‹), araştırma ilacından 1 dakika sonra (A1), entübasyondan 1, 3, 5 ve 10 dakika sonra (E1, E3, E5, E10) kaydedildi. Bulgular: Sistolik arter basıncı (SAB) değerleri entübasyon sonrası 1, 3 ve 5. dakikalarda, esmolol grubunda alfentanil ve remifentanil grubuna göre istatistiksel olarak anlamlı yüksek iken (p0.05). Kalp atım hızlarında (KAH) ise üç grup arasında anlamlı fark yoktu (p>0.05). SAB değerleri entübasyon so- nu 1. dakikada, remifentanil ve esmolol grubunda kontrole göre anlamlı değişirken (p0.05). KAH’larında ise alfentanil grubunda kontrol değere göre istatiksel anlamlı fark bulunurken (p 0.05). Sonuç: Remifentanil ve alfentanil, direkt laringoskopi ve entübasyona hemodinamik yanıtı önlemede çalışmamızda kullanılan dozlarıyla esmolole göre daha etkili bulunmuştur.

Remifentanil,alfentanil and esmolol in preventing hemodynamic responses to laryngoscopy and endotracheal intubation

Objective: We aimed to compare the effects of bolus remifentanil, alfentanil and esmolol on cardiovascular responses to laryngoscopy and tracheal intubation. Method: ASA I-II physical status: sixty patients aged 18-65 and scheduled for elective surgery were included in the study. Patients were randomly divided into three groups. Group A received 20 µg kg1 alfentanil, Group E received 2 mg kg-1 esmolol, and Group R received 2 µg kg-1 remifentanil one minute after induction. Hemodynamic values were noted before (control) and after induction of anesthesia, one minute after the study drug, and 1, 3, 5 and 10 minutes after intubation. Results: SAP values significantly increased in Group E compared with Groups A and R at 1, 3 and 5 min after intubation (p<0.001), whereas there was no significant difference between alfentanil and remifentanil (p>0.05). There were no significant differences in heart rate between the groups (p>0.05). SAP values were significantly changed in Group R and Group E compared with the baseline one min after intubation (p<0.001) whereas there was no significant change in Group A (p>0.05). Heart rate increased significantly in Group A compared with the baseline after intubation (p<0.01), whereas there was no statistically difference in Group R and Group E (p>0.05). Conclusion: We found that with laboring doses of remifentanil and alfentanil in our study are more effective than esmolol in preventing hemodynamic responses to direct laringoscopy and intubation.

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1. Gal TJ. Airway Management. In: Miller’s Anesthesia (Miller RD ed) 6rd ed., Philadelphia, Churchill Livingstone. 2005: 1647.
2. Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth 1996; 8: 63-79.
3. Miller DR, Martineau RJ, O’Brien H ve ark. Effects of alfentanil on the hemodynamic and catecholamine response to tracheal intubation. Anest Analg 1993; 76: 1040-6.
4. Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma cathecholamine response to tracheal intubation. Br J Anaesth 1983; 55: 855-60.
5. Schaffer J, Karg C, Piepenbrock S. Esmolol als bolus zur prophylaxe der sympathikoadrenergen reaktion wahrend der narkoseausleitung. Anaesthesist 1994; 43: 723-9.
6. Helfman SM, Gold MI, De Lisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: Lidocain, fentanil, or esmolol? Anesth Analg 1991; 72: 482-6.
7. Barclay K, Kluger MT. Effect of bolus dose of remifentanil on hemodynamic response to tracheal intubation. Anaesth Intens Care 2000; 28: 403-7.
8. Kelsaka E, Barış S, Karakaya D, Karaçuha R, Sarıhasan B, Tür A. Laringoskopi ve trakeal entübasyona bağlı hemodinamik yanıtın önlenmesinde lidokain, magnezyum ve fentanilin karşılaştırılması. Türk Anest ve Rean Cem Mecmuası 2002: 30; 369-75.
9. Derbyshire DR, Smith G, Achola KJ. Effect of topical lignocaine on the sympathodrenal responses to tracheal intubation. Br J Anaesth 1987: 59; 300-4.
10. Menkhaus PG, Reves JG, Kissen I, ve ark. Cardiovascular effects of esmolol in anaestetized humans. Anesth Analg 1985; 64: 327-34.
11. Ellenbogen K, Mc Carthy E, Pritchett E. Effects of bolus injection of esmolol in healthy exercising subjects. Clin Pharmacol Ther 1987; 41: 455-9.
12. Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 1999; 89 (4 Suppl): S7-14.
13. Hanel F, Werner C. Remifentanil. Anaesthesist 1997; 46: 897-908.
14. O’Hare R, Mc Atamney D, Mirakhur RK, Hughes D, Carabine U. Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. Br J Anaesth 1999; 82: 283-5.
15. Rosow CE. An overview of remifentanil. Anesth Analg 1999; 89:1-3.
16. Joo HS, Salasidis GC, Kataoka MT ve ark. Comparison of bolus remifentanil versus fentanyl for induction of anesthesia and tracheal intubation in patient with cardiac disease. J Cardiothorac Vasc Anesth 2004; 18: 263-8.
17. McAtamney D, O’Hare R, Hughes D, Carabine U, Mirakhur R. Evaluation of remifentanil for control of haemodynamic response to tracheal intubation. Anaesthesia 1998; 53: 1223-7.
18. Şener ER, Barış S, Kocamanoğlu S, Karakaya D, Tür A. Remifentanil ve alfentanilin direkt endoskopik laringoskopiye refleks hemodinamik yanıt, uyanma, komplikasyonlar ve maliyet açısından karşılaştırılması. Anestezi Dergisi 2003;11: 23-7.
19. Gong Z, Luo A. Effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Chin Med Sci J 1999; 14: 189-92.
20. Oxorn D, Knox JW, Hill J. Bolus doses of esmolol for the prevention of perioperative hypertension and tachycardia. Can J Anaesth 1990; 37: 206-9.
21. Maguire A, Thompson JP, Guest C, Sadler PJ, Strupish JW, West KJ. Comparison of the effects of intravenous alfentanil and esmolol on the cardiovascular response to double-lumen endobronchial intubation. Anaesthesia 2001; 56: 319-25
22. Jhaveri R, Joshi P, Batenhorst R, Baughman V, Glass PS. Dose comparison of remifentanil and alfentanil for loss of consciousness. Anesthesiology 1997; 87: 253-9.
23. Alexander R, Booth J, Olufolabi AJ, El-Moalem HE, Glass PS. Comparison of remifentanil with alfentanil or suxamethonium following propofol anaesthesia for tracheal intubation. Anaesthesia 1999; 54: 1032-6.