Septoplasti yapılan olgularda bilinçli sedasyon

Bu çalışmada lokal anestezi altında septoplasti yapılan olgularda bilinçli sedasyon için kullanılan midazolam + serum fizyolojik, midazolam + fentanil ve midazolam + tramadol kombinasyonlarının etkilerini hemodinami, hasta-cerrah memnuniyeti ve maliyet açısından karşılaştırmayı amaçladık. Çalışmamıza elektif şartlarda, lokal anestezi ile septoplasti uygulanan, ASA I-II grubunda 45 hasta dahil edildi. Olgular rastgele seçimle midazolam + serum fizyolojik (Grup M, n=15), midazolam + fentanil (Grup F, n=15), ve midazolam + tramadol (Grup T, n=15) olarak üç gruba ayrıldı. Preoperatif sedasyon dereceleri belirlenen olgulara herhangi bir premedikasyon uygulanmadı. Lokal anestezik uygulanmasından önce M grubuna 0.05 mg $kg^-1$ midazolam + SF, F grubuna 2 $mu$g $kg^-1$ fentanil + 0.05 mg $kg^-1$ midazolam, T grubuna ise tramadol 100 mg iv. bolus + 0.05 mg $kg^-1$ midazolam iv. bolus olarak uygulandı. Olguların sedasyon derecesi Ramsey Sedasyon Skalasma göre 2 olacak şekilde midazolam verildi. Intraoperatif olarak sedasyon derecesini bu düzeyde tutmak amacıyla 1 mg'lık ek dozlarda midazolam uygulandı. Lokal anestezi için 1/200.000 adrenalin içeren lidokain solüsyonu kullanıldı. Operasyon sırasında hemodinamik veriler, operasyon sonrası hasta-cerrah memnuniyeti, uygulanan midazolam, fentanil ve tramadol dozlarının maliyetleri, perioperatif komplikasyonlar ve hastaların postoperatif derlenme skoru kaydedildi. Verilerin istatiksel değerlendirmelerinde varyans analizi (Ordinary Anova), repeated Anova, Ki-kare, Fisher'in kesin ki-kare testi ve nonparametrik ki-kare testi kullanıldı. p

Anahtar Kelimeler:

Fentanil, Midazolam, Bilinçli sedasyon, Anestezi, lokal, Tramadol, Hasta memnuniyeti

Conscious sedation for local septoplasty operations

In this study we aimed to compare the efficiency of midazolam (Group M) + serum physiologic, midazolam + fentanyl (Group F), midazolam + tramadol (Group T) combinations on haemodynamic changes, patient and surgeon satisfactions and to evaluate their costs during septoplasty. In this study, ASA l-ll class, 45 healthy patients of either sex, between the ages 15-60 years scheduled for elective septoplasty under local anesthesia were included. Patients were randomly allocated into 3 groups (M,F,T). No premedication was given. After the determination of sedation level, in group M patients were given 0.05 mg $kg^-1$ midazolam + serum physiologic, in group F received iv 2 $mu$g $kg^-1$ fentanyl + 0.05 mg $kg^-1$ midazolam amount iv and in group T patients 100 mg tramadol + 0.05 mg $kg^-1$ midazolam amount were applied before local anesthesia. To maintain the patients sedation level at 2 according to Ramsey Sedation Scale intraoperatively additional 1 mg incremental of midazolam were applied intravenously when it was necessary. For local anesthesia lidocain with adrenaline combination was used. During the operation haemodynamic data were recorded and after the operation, patients and surgeon's satisfactions, the cost effectiveness of midazolam, fentanyl and tramadol, perioperative complications and postoperative performance scores were recorded. The results were statistically evaluated using ANOVA test, repeated ANOVA, chi-square and Fisher's exact test non-parametric chi-square test and Mann-Whitney U test. Surgeon satisfaction was higher in T and than the other groups patient satisfaction was similar in all three groups. And there was no statistically significant difference between the groups in cost of drugs. Although surgeon's satisfaction was higher in T-group than other groups, patient's satisfaction was similar among the groups and midazolam was cheaper than other combinations. As a result, midazolam can be adequate for conscious sedation for elective septoplasty operations alone under local anaesthesia.

Keywords:

Fentanyl, Midazolam, Conscious Sedation, Anesthesia, Local, Tramadol, Patient Satisfaction,

___

1. Whitwam JG. Anxiolysis, Sedation and Anesthesia in Principles and practice of sedation. Ed(s): Whitwam JG, Mccloy RF. Black-well Science Ltd. 1998; 3-8.
2. Ramsay MAE, Savage TM, Simpson BRJ,et al. Controlled sedation with alphaxalone-alphadolone. BMJ 1974; 2: 656-9.
3. Hanaoka K, Namiki A, Dohi S, Koga Y, et al. A dose-ranging study of midazola for postoperative sedation of patients: a randomized, double- blind, placebo-controlled trial. Crit Care Med 2002; 30:1256-60.
4. Carrasco G, Molina R, Costa J, Soler JM, Cabre L. Propofol vs midazolam in short-, medium, and long-term sedation of critically ill patients. Chest 1993; 103: 557-64.
5. Nilsson A, Persson MP, Hartvig P. Effects of benzodiazepine antagonist flumazenil on postoperative performance following total intravenous anesthesia with midazolam and alfentanil. Acta Anaesthesiol Scand 1988; 32:441.
6. Smith I, Avramor M, white PR A comparisonof propofol and remifentenil during monitored anesthesia care. J Clin Anesth 1997; 9: 148-54.
7. Runes J, Strom C. Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases. Swed Dent J 1996; 20: 29-33.
8. Ferrante FM. Opioids in Postoperative Pain Management Ed(s): Ferrante FM, VadeBoncouer TR. Churchill Livingstone 1993; 145-211.
9. Milgrom P, Weinsteia P, Fiset L, Beirne OR. The anxiolytic effects of intravenous sedation using midazolam alone or in multiple drug techniques. J Oral Maxillofac Surg 1994; 52: 219-24.
10. Ochs MW, Tucker MR, White RP. A comparison of amnesia in outpatients sedated with midazolam or diazepam alone or in combination with fentanyl during oral surgery. J Am Dent Assoc 1986; 113: 894-7.
11. Nadin G, Coulthard P. Memory and midazolam conscious sedation. British Dental Journal 1997; 183: 399-407.
12. Mackenzie N. Sedation during regional anesthesia: indications, advantages and methods. European J Anaesthesiol 1996; 3 (supp. 13): 2-7.
13. Bailey PC, Pace NL, Ashburn MA et al. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73: 826-30.
14. Rodrigo MR, Rosenquist JB. Effect of conscious sedation with midazolam on oxygen saturation. J Oral Maxillofac Surg 1988; 460:746-50.
15. Nagahama H, Kikuchi S, Shimazaki K, Tateda T, Aoki T, Takahashi K. The use of low dose midazolam for the management of spinal anesthesia. Masui 1996; 45: 593-8.