Oğuz SARIYILDIZ, MENŞURE KAYA, Gülçin ÖZALP, Nihal KADIOĞULLARI

Rokuronyum ve atrakuryum prekürarizasyonlarının karşılaştırılması

Bu çalışmada, süksinilkoline bağlı fasikülasyonları ve miyaljiyi önlemek için rokuronyum ve atrakuryum ile yapılan prekürarizasyon yöntemleri değerlendirildi. Elektif tiroidektomi ve yapılacak 60 kadın hasta randomize çift-kör olarak alındı.Olgular üç prekürarizasyon grubuna ayrıldı ve I.Gruba serum fizyolojik 0.1 mI $kg^{-}1$ , II.Gruba atrakuryum 0.1 mg $kg^{-}1$ ve II.Gruba rokuyonyum 0.1 mg $kg^{-}1$ uygulandı.Anestezi indüksiyonuna fentanil 15 $mu$ $kg^{-}1$ ile başlandı.Fentanilden iki dakika sonra prekürarizasyon ilaç ve tiyopental 6 mg $kg^{-}1$ verildi.Prekürarizasyon ilacından 30 saniye sonra süksinilkolin 1.5 mg $kg^{-}1$ enjekte edildi. Süksinilkolin enjeksiyonundan 30 saniye sonra, trakeal entübasyon yapılarak entübasyon kolaylığı değerlendirildi.Olgularda fasikülasyonların varlığı ve şiddeti gözlendi.Miyalji postoperatif 1,2 ve 3. günlerde kaydedildi. Fasikülasyon rokuronyum grubunda, plasebo ve atrakuryum gruplarından daha düşük bulundu (p0.05).Üç grubun entübasyon şartlarında farklılık görülmedi.Postoperatif 1.günde; plasebo grubunda 7, atrakuryum grubunda 5 olguda miyalji yakınması oldu.Rokuronyum grubunda ise hiçbir olguda miyalji saptanmadı (p0.05).Postoperatif 2. ve 3. günlerde miyalji insidansı ve şiddetli gruplar arasında farklılık göstermedi. Prekürarizasyon yöntemi ile uygulanan rokuyonyumun, entübasyon koşullarında değişikliğe neden olmaksızın, süksinilkoline bağlı fasikülasyonları ve miyaljiyi azalttığı saptandı.

Anahtar Kelimeler:

Atrakuriyum, Çift kör metot, Süksinilkolin, Tiroidektomi, Cerrahi işlemler, elektif, Nöromüsküler blokaj

Comparison of precurarization of rocuronium and atracurium

In this study, precurarization methods using rocuronium to prevent succinylcholine fasciculations and myalgia have been evaluated. Sixty female patients scheduled for elective thyroidectomy were studied in a double blind randomized study.Cases were divided to three precurarization groups and 0.1 ml.$kg^{-}1$ normal saline was administered to the first group,0.1 mg $kg^{-}1$ atracurium was administered to the second group and 0.1 mg $kg^{-}1$ rocuronium was administered to the third group.The induction of anaesthesia commenced with 1.5 $mu$ $kg^{-}1$ fentanyl. Precurarization was administered two minutes later, followed by 6 mg $kg^{-}1$ thiopental and 30 sec later 1.5 mg $kg^{-}1$ succinylcholine was injected.At 30 sec after injection of succinylcholine, the trachea was intubated and the ease of intubation was assessed.The patients were observed for the presence and severity of fasiculations.Miyalgias were recorded on postoperative days 1,2 and 3. The fasciculation in the rocuronium group was lower than atracurium or placebo groups.There was no difference in the intubating conditions among the three groups.Seven patients in the placebo and five patients in the atracurium group experienced myalgia in the first postoperative day.There was no myalgia in any patients in the rocuronium group (p<0.05).On postoperavite days 2 and 3,there was no difference and severity of myalgia among the three groups. The precurarization method using rocuronium reduces succinylcholine induced fasciulations and myalgia, causing no changes in the intubation conditions.

Keywords:

Atracurium, Double-Blind Method, Succinylcholine, Thyroidectomy, Surgical Procedures, Elective, Neuromuscular Blockade,

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