Selma OĞUZ, A. Tülin AKILLI, Rüstem ALBAYRAK, Nihal KADIOĞULLARI

Sevofluran ve propofol indüksiyonlarının rokuronyumun nöromuskuler bloğuna etkisi

Bu çalışmada; 0.6 mg.kg-1 rokuronyum uygulanan olgularda sevofluran veya propofol indüksiyonunun entübasyon koşullarına etkisi karşılaştırıldı. Elektif cerrahi yapılacak, ASA I-II grubu 40 olgu rasgele iki gruba ayrıldı. Preoksijenasyondan sonra; anestezi indüksiyonu I. Grupta (n=20) 10 microg.kg-1 alfentanil ve 2.5 mg.kg-1 propofol ile, II.Grupta (n=20) 10 µg.kg-1 alfentanil ve % 7 konsantrasyonda sevofluranın oksijen içinde vital kapasite tekniği uygulanması ile sağlandı. Daha sonra her iki gruba da 0.6 mg.kg-1 rokuronyum verildi ve bunu takip eden 60. saniyede laringoskopiye başlandı. Entübasyon, kullanılan indüksiyon ajanlarını bilmeyen deneyimli bir anestezist tarafından yapıldı. Entübasyon koşulları, laringoskopinin kolaylığı, vokal kordların durumu ve diyaframa yanıtını içeren bir skorlama sistemi kullanılarak mükemmel, iyi, orta veya kötü olarak değerlendirildi. Sevofluran grubunda entübasyon koşulları 13 olguda mükemmel, 7 olguda iyi, propofol grubunda 17 olguda mükemmel, 2 olguda iyi, ve bir olguda orta olarak saptandı. İki grup arasında anlamlı farklılık bulunmadı. Sonuç olarak 0.6 mg.kg-1 rokuronyum ile hızlı indüksiyon sırasında elde edilen entübasyon koşullarının, sevofluran ve propofol indüksiyonunda benzer olduğuna karar verildi.

Anahtar Kelimeler:

Nöromüsküler blokaj, Propofol, Laringoskopi, Entübasyon, Ses telleri, Alfentanil

Effects of inductions with sevoflurane and propofol on the neuromuscular block of rocuronium

In this study, the effects of sevoflurane and propofol on intubating conditions for rapid sequence induction with 0.6 mg.kg-1 rocuronium, were compared. ASA I-II, 40 patients scheduled for elective surgery were randomly allocated in to two groups. Following preoxygenation, anesthesia was induced by 10 microg.kg-1 alfentanil and 2.5 mg.kg-1 propofol in group I (n=20), and in group II (n=20) 10 µg.kg-1 alfentanil with an inhalational induction with sevoflurane 7 % in oxygen, using vital capacity technique. Rocuronium 0.6 mg.kg-1 was then administered in both groups, followed by laringoscopy 60 s later. Intubating conditions were evaluated by a blinded, experienced anesthetist. Intubating conditions were graded as excellent, good, fair, or poor on the basis of ease of laryngoscopy, condition of the vocal cords and diaphragmatic response. In the sevoflurane group, intubating conditions were scored as excellent in 13 patients, good in 7 patients. In the propofol group, intubating conditions were excellent in 17 patients, good in 2 patients and fair in the remaining patients. The difference between the two groups was not significant. In conclusion, intubating conditions during a rapid sequence induction with 0.6 mg.kg-1 rocuronium were similar following sevoflurane and propofol inductions.

Keywords:

Neuromuscular Blockade, Propofol, Laryngoscopy, Intubation, Vocal Cords, Alfentanil,

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