Hakkı ÜNLÜGENÇ, Mehmet ÖZALEVLİ, Tayfun GÜLER, Geylan IŞIK

Sedoanaljezide farklı dozda remifentanil uygulaması

Çalışmamızda sedoanaljezi amacıyla, remifentanilin bolus ile devamlı infüzyon şeklindeki uygulamalarını analjezik etki ve güvenirlilik açısından karşılaştırmayı amaçladık. Fakülte etik kurul ve hasta onayı alındıktan sonra elektif meme veya koltukaltı lenf nodu biyopsisi uygulanacak 60 hasta çalışmaya alındı. Operasyon öncesi tüm hastalar periferik oksijen satürasyonu (SpO2), solunum sayısı (SS), sistolik ve diyastolik kan basıncı (SKB-DKB) ve kalp atım hızı (KAH) yönünden monitorize edildikten sonra, intravenöz 0.15 mg kg-1 midazolam ile premedike edildi. Hastalar rastgele 3 gruba ayrıldı. I. grupta remifentanil (30-60 saniyede) 1 $mu$g kg-1 bolus uygulamayı takiben gerektikçe 0.5 $mu$g kg-1 dozlarında bolus olarak uygulandı. II. grupta 1 $mu$g kg-1 remifentanil, bolus uygulamayı takiben 0.1 $mu$g kg-1 dk-1 devamlı infüzyon şeklinde uygulandı. III. grupta ise 1 $mu$g kg-1 remifentanil, bolus uygulamayı takiben 0.2 $mu$g kg-1 dk-1 infüzyon şeklinde uygulandı. Tüm hastalarda uygulama öncesi ve uygulamadan sonra 1, 5 ve 15. dakikalarda verbal ağrı skalası, hasta konforu, sedasyon düzeyleri, hemodinamik parametreler ve komplikasyonlar kaydedildi. Tüm gruplarda solunum hızı preoperatif kontrol değerlere göre 1. ve 5. dakikalarda istatistiksel olarak önemli derecede düşük olmasına karşın kalp atım hızı yalnızca 1. dakikada düşük bulundu (p

Anahtar Kelimeler:

Analjezikler, opioid, Cerrahi işlemler, operatif, Bilinçli sedasyon, Analjezi, Anestezi, lokal

Comparison of different doses of remifentanil in brief surgical procedures

This study was designed to compare the safety and analgesic effectiveness of remifentanil when administered as intermittent bolus injections or a single bolus injection followed by two different dosages of continuous infusion during brief painful procedures. Sixty adult patients undergoing breast or lymph node biopsy were premedicated with intravenous 0.15 mg kg-1 midazolam following haemodynamic and respiratory monitoring Patients were randomly assigned to one of the three modes of remifentanil administration. Group I received 1 $mu$g kg-1 bolus of remifentanil at 30-60 seconds followed by intermittent 0.5 $mu$g kg-1 bolus of remifentanil as needed. Group II received 1 $mu$g kg-1 bolus of remifentanil followed by a continuous infusion of remifentanil at a rate 0.1 $mu$g kg-1 min-1 Group III received 1 $mu$g kg-1 bolus of remifentanil followed by a continuous infusion of remifentanil at a rate 0.2 $mu$g kg-1 min-1 Discomfort, pain, sedation scores, haemodynamic variables and complications were recorded at pretreatment and 1, 5 and 15 minutes after administration. In all groups, respiratory rate was significantly lower than preoperative control values at 1 and 5 min (p<0.05), whereas heart rate was only lower at 1 min (p<0.05) There were no differences in oxygen saturation and blood pressure (systolic-diastolic) among the groups. Patient comfort and VAS were superior in the 0.2 $mu$g kg-1 min-1 remifentanil group (p<0.05) whereas sedation scores and incidence of O2 desaturation were higher than group I and II during the procedures (p<0.05). Both bolus injections and continuous infusions of remifentanil provided effective analgesia for pain control during brief surgical procedures without using local anaesthetic but was complicated by a high incidence of O2 desaturation at higher doses of 0.2 $mu$g kg-1 min-1

Keywords:

Analgesics, Opioid, Surgical Procedures, Operative, Conscious Sedation, Analgesia, Anesthesia, Local,

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