Seda B. AKINCI, Fatma SARICAOĞLU, Meral KANBAK, Aygün GÜLER, Ülkü AYPAR

Remifentanil ve fentanilin yoğun bakım hastalarında analjezi bazlı sedasyonda karşılaştırılması

Yoğun bakım ünitelerinde analjezi bazlı sedasyon teknikleri gün geçtikçe önem kazanmaktadır. Bu çalışmanın amacı mekanik ventilasyon ihtiyacı gösteren postoperatif erişkin hastalarda remifentanil vefentanil infüzyonlarının analjezik etkinliklerinin karşı-laştırılmasıdır. Etik komite izni alındıktan sonra çalışma, prospektif, randomize ve çift kör olarak uygulanmıştır. 44 erişkin yoğun bakım has¬tasına remifentanil 0.1 jıg kg1 dk' veyafentanil 0.025]ug kg'1 dk1 eşit hacimlerde hazırlanarak kodlanmış enjektörlerde verilmiştir. Analjezik infüzy onu Davranışsal Ağrı Skalasında (Behavioral Pain Scale, BPS) tanımlanmış olan analjezi seviyesine (BPS > 3) göre titre edilmiştir. Davranışsal ağrı skoru 3 olduğu halde sedasyonun yeterli olmadığı durumlarda propofol eklenmiştir. Gruplar arasında demografik veriler ve trakeal ekstubasyon süreleri açısından istatistiksel olarak anlamlı farklılık bulunmamıştır. İnfüzy o-nun başlangıcı sırasında remifentanil daha etkin analjezi sağlarken, infüzyonun sonlandırılmasından sonra fentanil daha etkin analjezi sağlamıştır. Gruplar arasında bulantı-kusma, konstipasyon, apne, desaturqsyon, 24 saat içerisinde tekrar entübasyon oranları benzer olarak bulunmuştur. Sonuç olarak postoperatif erişkin yoğun bakım hastalarında remifentanilin fentanil ile benzer derecede analjezi sağladığını tespit ettik.

Anahtar Kelimeler:

Fentanil, Anestezikler, ven içi, Solunum, yapay, Erişkin, İleriye dönük çalışma, Yoğun bakım

Remifentanil versus fentanyl for analgesia based sedation in mechanically ventilated patients

Analgesia based sedation techniques are becoming more established in the ICU setting. The aim of this study was to com¬pare remifentanil andfentanyl infusions for postoperative analgesia in ICU patients. After receiving ethic committee approval, a prospective randomised, double-blind study was performed. 44 ICU patients received either remifentanil 0.1 jig kg' min' or fentanyl 0.025 jug kg1 min' infusions diluted to the same volume. Analgesic infusion was titrated to predefined levels of analgesia (Behavioural pain scale (BPS) score of 3). Propofol was added if sedation was unsatisfactory (Riker Sedation agitation Scale>4) after BPS score 3 had been achieved. There were no differences in groups regarding demographics, tracheal extubation times and pain scores of the patients. The incidences of nausea, vomiting, apnea, desaturation, reintubation within 24 hours, constipation were also similar between the two groups. We conclude that remifentanil infusion provides clinically comparable analgesia to fentanyl infusion in mechanically ventilated patients. The two drugs are suitable for analgesia based sedation in ICU patients.

Keywords:

Fentanyl, Anesthetics, Intravenous, Respiration, Artificial, Adult, Prospective Studies, Intensive Care,

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