Başak AKÇA, Aysun YILBAŞ ANKAY, Nalan ÇELEBİ

Intravenous acetaminophen in combination with remifentanil / nitrous oxide on post- tonsillectomy nausea-vomiting and pain in children-a randomised controlled trial

Amaç: Birçok anestezist hem yan etki profili nedeniyle hem de kısa etkili bir opioid olanremifentanilin kullanıma girmesiyle günlük pratiklerinde nitröz oksit kullanımındanvazgeçmişlerdir. Bu çalışmada amacımız, intraoperatif dönemde intravenöz (i.v.) yoldanuygulanan parasetamol beraberinde nitröz oksit veya remifentanilin çocuk hastalarda tonsillektomisonrası ağrıya etkisinin incelenmesidir.Method: Adenotonsillektomi planıyla cerrahiye alınan 68 pediyatrik yaş grubunda hasta 34hastalık iki gruba ayrıldı. Her iki grupta da %8 sevofluran ile indüksiyon yapıldı. Nitröz oksitgrubunda (Grup 1) %30/70 oksijen-nitröz oksit karışımı içinde sevofluran konsantrasyonu %1,5-2olacak şekilde idame edildi. Remifentanil grubunda ise (Grup 2) %30/70 oksijen-hava karışımıiçinde sevofluran konsantrasyonu %1,5-2 olacak şekilde idame edildi. Grup 2 hastalarında i.v.remifentanil infüzyonu (0.1-0.3 µg/kg/dk) yapıldı. Her iki grupta da cerrahi insizyon başlamadanönce i.v. asetaminofen (15 mg/kg) uygulandı. Ayılma ünitesinde ve 24. saatte ağrı skorlarıdeğerlendirildi.Bulgular: Demografik veriler iki grupta da benzerdi. Grup 1de 23 hastanın Grup 2de ise 7hastanın ek analjezik ihtiyacı oldu ve operasyon çıkışından ilk analjezik ihtiyacına kadar geçensüre Grup 2de daha uzundu. Grup 1de 33 hasta (%97,1), Grup 2de ise 20 hastanın (%58,8) evetaburculuğunda analjezi ihtiyacı oldu. Grup 2de ayılma ünitesinde ve postoperatif 24. saattetelefonla aranarak değerlendirilen ağrı skorları belirgin olarak daha düşüktü.Sonuç: Günübirlik cerrahi olarak yapılan adenotonsillektomi operasyonlarında i.v. asetaminofenve remifentanil kombinasyonunun nitröz oksite göre daha uygun bir tercih olduğu kanısındayız.

Çocuklarda tonsillektomi sonrası bulantı, kusma ve ağrı üzerine remifentanil/nitröz oksitle kombine intravenöz asetaminofen

Objective: Many anesthesiologists have quit using nitrous oxide in their daily practice because ofits side effects and also the introduction of short-acting opioids such as remifentanil. Our aim is tocompare the effects of intraoperative remifentanil vs nitrous oxide in combination with ivacetaminophen on post-tonsillectomy pain in childrenMethod: Sixty-eight, pediatric patients undergoing adenonsillectomy operations were randomizedinto two groups of thirty-four each. General anaesthesia was induced by inhalation of sevoflurane(8%) in both groups. The nitrous oxide group (group I) received sevoflurane at an end-tidalconentration of 1.5-2, delivered with 70% nitrous oxide in oxygen. The remifentanil group (groupII) also received sevoflurane in the same way but delivered in an oxygen-air gas mixture. Group IIalso received an intravenous (i.v.) infusion of remifentanil at 0.1-0.3 µg/kg-1 min-1. Both of thegroups received i.v. acetaminophen infusions before surgical incision. Pain scores in the PACUand during the first 24 h were assessed.Results: Demographics were similar among the groups. Twenty three patients in group I and 7patients in group II have required rescue analgesia and time to first analgesia was longer in groupII. Thirty-three (97.1%) patients in group I and 20 (58.8%) patients in group II needed analgesicsat home. Pain scores in the PACU and at 24. hr were significantly lower in group II.Conclusion: Combination of i.v. acetaminophen with remifentanil rather than nitrous oxide seemsto be more suitable for outpatient adenotonsillectomy operation.

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