Elif Bengi ŞENER, SİBEL BARIŞ, Serhat KOCAMANOĞLU, DENİZ KARAKAYA, Ayla TÜR

Remifentanil ve alfentanilin direkt endoskopik laringoskopiye refleks hemodinamik yanıt, uyanma, komplikasyonlar ve maliyet açısından karşılaştırılması

Direkt endoskopik laringoskopi (DL) gibi günübirlik girişimlerde, akut hemodinamik yanıtın kontrolünün yanı sıra erken derlenme de önemlidir. Çalışmamızda DL sırasında, hemodinamik yanıt, uyanma süresi, komplikasyonlar ve maliyet yönünden remifentanil ve alfentanili karşılaştırmayı amaçladık. ASA I ve II 40 olgu 2 gruba ayrıldı. 20 olguya 1 $mu$g kg remifentanil (grup 1), 20 olguya 5 $mu$g $kg^-1$ alfentanil (grup U) iv. indüksiyon öncesi uygulandı. 2-3 mg $kg^{-1}$ propofol ve 1.5 mg $kg^{-1}$ süksinilkolin i.v. ile entübasyon gerçekleştirildi. 02 + % 66 N2O ve % 2 sevofluran ile idame sağlandı. Her olgunun preoperatif, opioid sonrası, entübasyon sonrası, DL'nin 1., 5., 10., 15. dakikası ve ekstübasyon sonrası kalp atım hızları (KAH), sistolik arter basınçları (SAB), oksijen satürasyonlan (SaO2) kaydedildi. Toraks rijiditesi, solunum depresyonu, kusma, öksürük, laringospazm gibi komplikasyonlar, uyanma süreleri ve opioid maliyetleri (TL) araştırıldı. Opioid sonrası, entübasyon ve DL'nin L, 5. dakikasında gruplararası KAH farklılığı görülmedi. Grup II'de entübasyon sırasında preoperatif değere göre anlamlı KAH artışı görüldü (p

Anahtar Kelimeler:

Alfentanil, Günübirlik cerrahi işlemler, Analjezikler, Piperidinler, Süksinilkolin, Laringoskopi

The comparison of remifentanil and alfentanil for reflex hemodynamic responses to direct endoscopic laryngoscopy, awakening times, complications and costs

Early recovery is also important in addition to control of acute hemodynamic response, during out-patient surgery as direct endoscopic laryngoscopy (DL). In our study, we aimed to compare remifentanil and alfentanil for hemodynamic responses, awakening times, complications and costs during DL. Fourty ASA physical status I-II patients were randomly divided into two groups. Group I patients were given 1 $mu$g kg remifentanil and Group I patients 5 5 $mu$g $kg^{-1}$ alfentanil i.v. before induction. Anesthesia was induced with 2-3 2-3 mg $kg^{-1}$ propofol and 1.5 mg $kg^{-1}$ succinylcholine and intubation was performed. Anesthesia was maintained with O2+ 66% N2O and 2% sevoflorane. For each patient, heart rate (HR), systolic arterial pressure (S.A.P) and peripheric oxygen saturation (SpO2) were recorded at the preoperative period, after opioid injection, following intubation, the 1., 5., 10., 15. minutes of DL, following extuhation. The complications such as thorax rigidity, respiratory depression, vomiting, cough, laryngospasm, and awakening times, opioid costs (TL) were investigated. HR was similar between groups after opioid injection, following intubation, first and fifth minutes of DL. HR was higher at intubation in Group II than preoperative value (p< 0.01). The awakening time was shorter in Group I than Group II (p<0.05). The incidence of thorax rigidity was higher in Group I than Group II (p< 0.005). The opioid costs was lower in Group I than Group II (p< 0.001). In conclusion, remifentanil is superior to alfentanil because of its adequate suppression of hemodynamic responses, short awakening time and cost-effectiveness in out-patient surgery as DL.

Keywords:

Alfentanil, Ambulatory Surgical Procedures, Analgesics, Piperidines, Succinylcholine, Laryngoscopy,

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