Güldem TURAN, Asu ÖZGÜLTEKİN, Mustafa BAFALI, Nur AKGÜN

Yoğun bakımda sedasyon uygulamasında midazolam, propofol, remifentanilin karşılaştırılması

Yoğun bakımda sedasyon için kullanılan midazolam, propofol ve remifentanilin hemodinami, ekstübasyon zamanı ve maliyet üzerine etkileri karşılaştırıldı. Çalışmaya mekanik ventilasyon uygulanan 33 hasta alındı. Grup M (n=11); Midazolam; 0,15 mg $kg^-1$ bolus, 0,1-0,25 mg $kg^-1$ $sa^-1$, Grup P (n=11) Propofol 2 mg $kg^-1$ bolus, 2-4mg $kg^-1$ sa, Grup R (n=11) Remifentanil 1mg $kg^-1$ bolus, 0,15-0,25 mg $kg^-1$ $dk^-1$ infüzyon uygulandı. Sedasyon düzeyi Ramsey skalasına göre 2-3 arasında tutuldu. Sistolik, diastolik arter basınçları, kalp hızı 2 saat ara ile kaydedildi. T parçasına geçiş, ekstübasyon zamanı,ek ilaç gereksinimi, yan etkiler kaydedildi ve maliyet hesabı yapıldı. Grupların demografik özellikleri, APACHE II skorları, sedasyon zamanları arasında fark saptanmadı. T parçasına geçiş ve ekstübasyon süresi Grup R'de en kısa (p

Anahtar Kelimeler:

Propofol, Entübasyon, Masraflar ve maliyet analizi, Midazolam, Yoğun bakım üniteleri

Comparison of midazolam, propofol and remifentanyl sedation in intensive care unit

In this study, midazolam, propofol and remifentanil which are used for sedation were compared regarding the extubation time, hemodynamic parameters and the cost. 33 patients who received mechanical ventilation were included in this study. Group M(n=11), received midazolam 0,15 mg $kg^-1$ bolus and 0,1-0,25 mg $kg^-1$; Group P(n=11) received propofol 2 mg $kg^-1$ bolus and 2-4 mg $kg^-1$ $h^-1$ ; and Group R(n=11) received remifentanil 1mg $kg^-1$ bolus and 0,15-0,25 mg $kg^-1$ $min^-1$. Sedation levels were maintained in the range of Ramsey Scala 2 and 3. Systolic and diastolic blood pressures and the heart rates were recorded in every 2 hours. The time from interruption of sedation to the first T-bridge trial and to extubation was noted. The side effects and the costs were also recorded. T-bridge trial time and the extubation time were significantly short in Group R (p<0,001); and although there were no statistically significant difference in between Group M and P, these time measurements were shorter in Group P when compared with Group M. Following the induction, hypotension was recorded in 3 patients of group M and R and 1group P patient; and apnea were noted in 2 Group M, 4 Group P and 8 Group R patients. 3 patients of each group required additionally sedation. During maintenance, hypotension in 2 patients of each group, apnea in 5 Group R patients, tolerance in 1 and amnesia in 6 Group M patients were noted. As a conclusion, since there was no difference of hemodynamic parameters among groups and propofol was found to be more expensive; midazolam and especially remifentanil which provides a rapid extubation can be preferred in the intensive care units for sedation.

Keywords:

Propofol, Intubation, Costs and Cost Analysis, Midazolam, Intensive Care Units,

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