Remifentanil, midazolam ve propofol kombinasyonu ile kas gevşeticisiz endotrakeal entübasyonun değerlendirilmesi

Araştırmamızda, remifentanil - midazolam - propofol kombinasyonu ile kas gevşetici kullanmadan ve kas gevşetici (süksinilkolin) kullanarak entübasyon şartlarını değerlendirdik. Hastanemiz etik kurulu izni alındıktan sonra, ASA I ve II risk grubundan, 16-65 yaş arası, genel anestezi altında, elektifmikrocerrahi ile endoskopik larinks biyopsisi uygulanacak her iki cinsten 40 olgu çalışmaya alındı. Olguların anestezi indüksiyonunda sırasıyla, remifentanil 3 $mu$g $kg^-1$ 90sn'de, midazolam 0.15 mg $kg^-1$ 30sn'de, propofol l mg $kg^-1$ 30 sn de bolus şeklinde verildi. Remifentanil 0.25 $mu$g $kg^-1$ $dk^-1$' ve propofol 100 $mu$g $kg^-1$ $dk^-1$ dozla infüzyona başlandı. Çalışma grubunda hastalar, yüz maskesiyle 5 dk %100 O2 solutulduktan sonra entübe edildi. Kontrol grubunda ise, entübasyondan 30 saniye önce l mg $kg^-1$ süksinilkolin verilip hastalar entübe edildi. Endotrakel entübasyon şartları, entübasyon skorlaması kullanılarak değerlendirildi. Kontrol grubunda %100, çalışma grubunda %90 klinik olarak uygun entübasyon şartları sağlandığı görüldü. Çene hareketi, maske ventilasyonu açısından iki grup arasında istatistiksel olarak anlamlı fark bulunmazken (p>0.05), vokal kord görünümü, vokal kord pozisyonu ve hasta hareketi açısından gruplar arasında istatistiksel olarak anlamlı fark bulundu (p

Anahtar Kelimeler:

Propofol, Analjezikler, opioid, Anestezi, ven içi, Süksinilkolin, Nöromüsküler depolarizasyon ajanları, Midazolam, İlaç kombinasyonları

The evaluation of endotracheal intubation using remifentanil, midazolam and propofol without muscle relaxant

This study was designed to compare the intubation conditions in remifentanil - midazolam - propofol anesthesia two groups which used vs. not used myorelaxant agent. After institutional ethic committee approval, 40 patients undergoing endoscopic larynx microsurgery were prospectively enrolled. The patients were 16-65 years old and ASA l-ll risk status. All of the cases were intravenously administered remifentanil 3 $mu$g $kg^-1$ (in 90 seconds), midazolam 0.15 mg $kg^-1$ (in 30 seconds), and propofol 1 mg $kg^-1$ (in 30 seconds). The anesthesia was maintenanced with remifentanil 0.25 $mu$g $kg^-1$ min, propofol 100 $mu$g $kg^-1$ min and O2 100%. After 5 minutes, tracheal intubation was performed in the study group. In the control group, succinylcholine (1 mg $kg^-1$) was administered 30 seconds before tracheal intubation. The conditions of intubation were evaluated using intubation scoring scale. The success of suitable intubation conditions were 100% in the control group and 90% in the study group. There was not statistically significant difference between both groups for jaw movement and ventilation via mask (p>0.05). But, there was a statistically significant difference between both groups for vocal cord and patient movements (p<0.05). The intubation conditions were clinically similar in the both groups. In our opinion, remifentanil - midazolam - propofolanesthesia may be used for procedures in which using myorelaxant agents are not desired.

Keywords:

Propofol, Analgesics, Opioid, Anesthesia, Intravenous, Succinylcholine, Neuromuscular Depolarizing Agents, Midazolam, Drug Combinations,

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