NECMİYE HADİMİOĞLU, Arif YEĞİN, Fatma ERTUĞRUL, Murat YILMAZ, Zeki ERTUĞ

Tek doz mivakuryumun entübasyon koşullarına ve nöromusküler derlenme üzerine olan etkilerinin erişkin ve çocuk hastalarda karşılaştırılması

Bu çalışmada propofol ile TİVA uygulanan erişkin ve çocuk olgularda entübasyon için verilen tek doz mivakuryumun entübasyon koşulları ve nöromusküler derlenme üzerine olan etkilerinin araştırılması amaçlanmıştır. Yaşları 18-60 arasında değişen ÂSA I-II risk grubu 30 erişkin ve yaşları 3-10 arasında değişen ASA I-II risk grubu 30 çocuk olgu çalışmaya alındı. Tüm olgularda anestezi indüksiyonunda 1 mg kg' lidokain, 2 mg kg' propofol, 2 μg kg' fentanil verildi. İndüksiyonu takiben nöromusküler blok monitorize edildi ve train-of-four (TOF) uyarısı ile değerlendirildi. Entübasyon için hem çocuk hem de erişkin olgularda 0.2 mg kg'1 dozda mivakuryum tek doz olarak intravenöz yoldan verildi. Anestezi idamesinde ise olguların tümüne 0.1-0.2 mg kg''dk' pro-pofol infüzyonu ile % 50 N2O/O2 verildi. TOF stimülasyonuna birinci yanıt (Tj) % 90 bloke olduğunda endotrakeal entübasyon uygulandı. Entübasyon süresi ve entübasyon skorları kaydedildi. T {in % 25, % 50, % 75 ve % 90 derlenmesi ile T4ITl oranının % 50, % 70 ve % 90 değerleri kaydedildi. Olguların tümünde entübasyon skorlamasına göre kabul edilebilir entübasyon koşulları sağlandı. Mivakuryumun maksimum blok zamanı çocuk olgularda erişkinlere göre anlamlı olarak daha uzun iken, TV in % 25, % 50, % 75 ve % 95 derlenme süreleri ve T4ITj oranlarının % 50, %70ve% 95 değerlerinin anlamlı olarak daha kısa olduğu saptandı (p

Anahtar Kelimeler:

Çocuk, Karşılaştırmalı çalışma, Erişkin, Anesteziden uyanma dönemi, Nöromüsküler nondepolarizasyon ajanları, İzokinolinler

The effect of a single dose of mivacurium on intubating conditions and neuromuscular recovery in children and adults

In this study, the effects of a single dose of mivacurium on intubation conditions and the neuromuscular recovery were compared in adults and children who underwent TIVA using propofol. We studied 30 adult patients ASA I-II, aged 18-60, and 30 children in ASA I-II, aged 3-10. The induction of anesthesia was performed with 1 mg kg' lidocain, 2 mg kg' propofol and 2 μg kg' fentanyl. Neuromuscular blockage was monitored and train-of-four (TOF) measurements were determined after induction. A 0.2 mg kg'1 single dose of mivacurium was given for intubation and anesthesia was maintained using a continuous infusion of 0.1-0.2 mg kg'dkr' propofol and SO % N2OIO2 inhalation in all patients. Endotracheal intubation was performed, when the neuromuscular blockage reached the level of 90 %. Intubation times and scores were recorded. The time from miva-curium injection to 25 %, 50 %, 75 %, and 90 % recovery; and the return ofTJT1 to 50 %, 70%, and 90% were recorded. Acceptable intubation conditions developed in all patients according to the scores of the endotracheal intubating conditions. The time of maximal neuromuscular blockage was significantly longer in children. The times to 25 %, 50 %, 75 % and 95 % recovery and T4IT1 ratios of 50%, 70% and 90% for mivacurium were significantly shorter in children than adults (p<0.05). In conclusion, the time of maximal neuromuscular blockage was longer but recovery time was faster in children than adults patients who underwent TIVA with propofol after a single dose of mivacurium.

Keywords:

Child, Comparative Study, Adult, Anesthesia Recovery Period, Neuromuscular Nondepolarizing Agents, Isoquinolines,

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