Mehmet KORKMAZ, Alp GURBET, Şükran ŞAHİN, Özden Özkurt PÜRCÜ

Rejyonel anestezi sırasında midazolam ve deksmedetomidin’in sedatif etkilerinin karşılaştırılması

Amaç: Bu çalışmada, spinal anestezi altında artroskopik diz cerrahisi uygulanacak olgulara sedasyon amacıyla deksmedetomidin ve midazolam uygulamasının etkilerini karsılaştırmayı amaçladık. Gereç ve yöntem: Yaşları 18-65 yıl arasında değişen 50 olgu randomizasyon ile iki gruba ayrıldı: Grup M’deki olgulara midazolam 0.04 mg/kg intravenöz (iv) uygulandıktan sonra Ramsay sedasyon skoru (RSS) 3-4 olacak şekilde 0,5 mg ek dozlarla işleme devam edildi. Grup D’deki olgulara deksmedetomidin 1 μg kg/sa olacak şekilde 10 dakika yükleme dozu uygulandı. Takiben olguların RSS 3-4 olacak şekilde 0,2-0,7 μg/kg/sa deksmedetomidin infüzyonuna başlandı. Operasyon süresince olguların vital bulguları kaydedildi. Olguların derlenmeleri modifiye Aldrete skoru (MAS) ile belirlendi. Ağrı değerlendirmesinde sözel nümerik skala (VRS) kullanıldı. Postoperatif VRS ve derlenme kalite skorları (QoR) kaydedildi. Olgulardan 4 sorudan oluşan geri bildirim anketini doldurmaları istendi. Olgu memnuniyeti VRS ile değerlendirildi. Bulgular: Grup D’de kalp hızları Grup M’ye göre düşük bulundu (p0.05). Sonuç: Bu çalışmada, uyguladığımız deksmedetomidin ile hemodinamik ve solunumsal parametreler üzerine olumsuz bir etki olmadan, midazolama eşdeğer kalitede derlenme kriterleri ve olgu memnuniyeti sağlayarak sedasyon uygulaması yapılabileceği gösterilmiştir.

Comparison of the sedative effects of midazolam and dexmedetomidine during regional anaesthesia

Objective: The aim of this study was to compare the efficacy of dexmedetomidine versus midazolam for sedation under spinal anesthesia for arthroscopic knee surgery. Materials and methods: Fifty adult patients, 18 to 65 years, were randomized into two groups: Group M received 0.04 mg/kg iv bolus midazolam followed by administration of 0.5 mg boluses to provide Ramsay sedation Scale (RSS) 3-4. Group D received dexmedetomidine loading dose of 1 μg/kg/h over 10 minutes and the maintenance dose of 0.2-0.7 μg/kg/h to achieve an adequate level of RSS 3-4. Recovery was evaluated with Modified Aldrete Scale. Pain was scored using Verbal rating scale (VRS). Postoperative VRS and Quality of Recovery (QoR) were recorded. Patients were asked to fill the questionnaire that included 4 questions, and patient satisfaction was rated with VRS. Results: Heart rate and mean blood pressure values were found to be decreased in group D when compared with Group M (p<0.05). Pain scores and patients’ satisfaction VRS values and QoR scores were not different between groups (p>0.05). Conclusion: The present study showed that dexmedetomidine provided similar parameters of recovery and patient satisfaction equivalent to midazolam without negative effects on hemodynamic and respiratory functions. Key words: Regional anesthesia, midazolam, dexmedetomidine, sedation.

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