Bebek ve Çocuk Hastalarda Ambulatuar Manyetik Rezonans Görüntüleme Uygulamalarında Propofol Sedasyonuna Farklı Doz Ketamin Eklenmesinin Etkileri

Amaç: Çalışmanın amacı, manyetik rezonans görüntüleme uygulamalarında bebek ve çocukhastalarda kombine propofol infüzyon + bolus propofol ile farklı doz ketamin-propofolkombinasyonunun, sedasyon uygulaması , derlenme süresi ve yan etki profili ile toplampropofol tüketimi, verimliliğini ve etkinliğini değerlendirmektir. Yöntem: Çalışmaya etik kurul onayı alındıktan sonra anestezi altında manyetik rezonansgörüntüleme işlemi yapılacak olan 1 ay – 12 yaş arası, ASA I-III 142 hasta dahil edildi ve 4gruba ayrıldı. 6 aydan büyük çocuklara 0,5 mg/kg dan intranazal midazolam ile premedikasyonyapılmıştır. Grup 1 olgulara 1 mg/kg’dan bolus propofol uygulandıktan sonra100 μq/kg/dk danpropofol infüzyonu başlandı. Grup 2; 0,5 mg/kg dan bolus ketamin; Grup 3; 1 mg/kg’danketamin Grup 4; 1,5 mg/kg’dan bolus ketamin’i takiben da 100 μq/kg/dk dan propofol infüzyonubaşlandı. Hastaların kalp atım hızı, sistoloik/diyastolik kan basıncı, oksijen satürasyonu, endtidal karbondioksit değeri ve Ramsey sedasyon skoru 5’er dakikalık aralıklarla kaydedildi. İşlemsüresi, kullanılan propofol miktarı, Aldrete skorlaru 9’a ulaşma zamanı, toplam ve gerekli ekpropofol dozları kaydedildi. Ajitasyon, desatürasyon, bradikardi ve hipotansiyon gibi yan etkilerkaydedildi. Bulgular: Grupların demografik özellikleri arasında anlamlı bir farklılık saptanmadı. Grup 1ile karşılaştırıldığında kalp atım hızı ketamin alan gruplarda 25.,65., 70. ve 75. dakikalarda daha yüksekti (p

Anahtar Kelimeler:

Propofol, ketamin, MRG sedasyon, çocuklar, ayaktan (günlük vaka)

THE EFFECTS OF DIFFERENT DOSE KETAMINE ON PROPOFOL SEDATION FOR INFANTS AND CHILDREN UNDERGOING AMBULATORY MAGNETIC RESONANCE IMAGING

Objective: The aim of this study was to evaluate the efficiency and effectiveness of the sedation practice, recovery time, and adverse event profile and total propofol consumption combined propofol infusion plus bolus propofol with different doses of ketamine -propofol combinations for infants and children sedation undergoing ambulatory magnetic resonance imaging. Methods: After obtaining approval from the University Ethics Committee, This double-blind, randomized trial enrolled American Society of Anesthesiology (ASA) Class I - III patients, aged 1 month to 12 years requiring MRI under deep sedation. One hundred and forty two patients were included in the study and were divided into 4 groups, prospectively. Premedication consisted of intranasal midazolam 0.5 mg/ kg over six month children. Group I received 1 mg/kg propofol intravenously (IV), bolus followed by a 100 μq/kg/min infusion. Group II, III, IV received IV ketamine bolus of 0.5mg/ kg, 1mg/kg and 1.5mg/kg respectively and then patients received an infusion of a solution containing propofol 100 μq/kg/min augmented with additional propofol boluses as needed. Blood pressure, heart rate, Ramsey sedation scores, oxygen saturation and end-tidal CO2 levels were recorded once every five minutes. Duration of the procedure, total amount of propofol used, time until Aldrete scores reached 9 and additional propofol doses needed were also recorded, as were complications like agitation, desaturation, bradycardia and hypotension. Results: There were no differences between the demographic properties of the groups. Twentyfive, 65, 70 and 75th minute heart rates were higher in ketamine groups when compared to Group 1, the difference was significant (p

Keywords:

Propofol, ketamine, MRI sedation, children, outpatient (day-case),

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Gozal D, Gozal Y. Pediatric sedation/anaesthesia outside the operating room. Curr Opin Anaesthesiol . 2008; 21: 494-498.

Bell C, Sequeira P. Nonoperating room anaesthesia for children. Curr Opin Anaesthesiol. 2005; 18 : 271-276.

Taghon T, Bryan Y, Kurth D. Pediatric radiology sedation and anesthesia. Int. Anaesthesiol Clin. 2006; 44:65-79.

Pitetti R, Davis PJ, Redlinger R, White J, Wiener E, Calhoun KH. Effect on hospital-wide sedation practices after implementation of the 2001 JCAHO procedural sedation and analgesia guidelines. Arch Pediatr Med. 2006; 160:211-216.

Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81:1005-43.

Kessler P, Alemdag Y, Hill M. et al. Intravenous sedation of spontaneously breathing infants and small children before magnetic resonance tomography. A comparison of propofol and methohexital. Anaesthesist 1996; 45:1158-66.

Kennedy RM, Porter FL, Miller JP, Jaffe DM. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics 1998; 102:956- 63.

Ramsay MA, Savege TM, Simpson BR controlled sedation with alphaxalone-alphadolone. BMJ 1974; 2:656-659

Aldrete JA , Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49:924-934.

Malviva S, voepel-Lewis T, Eldevik OP,Rockwell DT,Wrong JH, Tait AR. Sedation and general anaesthesiain children undergoing MRİ and CT: adverse events and outcomes. Br J Anaesth 2000; 84: 743 – 748.

Işık B, Tekgül ZT. Hurler sendromlu olguda magnetik rezonans görüntüleme sırasında anestezi yaklaşımımız. İnönü Üniversitesi Tıp Fakültesi Dergisi 2004;11: 259–63.

Levati A, Colombo N, Arosio EM, Savoia G, Tommasino C, Scialfa G, Boselli L. Propofol anaesthesia in spontaneously breathing paediatric patients during magnetic resonance imaging. Acta Anaesthesiol Scand 1996; 40: 561-565.

Srinivasan M, Turmelle M, Leanne M. Procedural sedation for diagnostic imaging in children by pediatric hospitalist using propofol. J Pediatr 2012; 160: 801-6.

Tomatır E, Atalay H, Gürses E, Erbay H, Bozkurt P. Effects of low dose ketamine before induction on propofol anesthesia for pediatric magnetic resonance imaging. Pediatric Anesthesia 2004. 14:845-850.

Green SM, Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M et al. Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an invidiual-patient data metaanalysis of 8,282 children. Ann Emerg Med 2009; 54: 158-68.

Guit JB, Koning HM, Coster ML, Niemeijer RP, Mackie DP.. Ketamine as analgesic for total intravenous anaesthesia with propofol. Anaesthesia 1991; 46: 24–27.

Montero RF. The effects of small dose ketamine on propofol sedation , respiration, postoperative mood, perception. Anesth Analg 2001; 92: 1465-1469.

Özdamar D, Hoşten T, Gürkan Y, Toker K, Solak M;effects of propophol and ketamine during pediatric magnetic resonance imaging: Turkish Anesth Rean J 2010; 38(2):91- 100.

Gad-Bar Joseph . Yoav Guilburd, M.D., Ada Tamir, Ph.D., and Joseph N. Guilburd, M.D. Paediatric Critical Care and Paediatric Neurosurgery, Meyer Children‟s Hospital, Rambam Medical Center; and Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension Neurosurg Pediatrics 4:40–46, 2009.

Mason KP, Fontaine PJ, Robinson F, Zgleszewski S. Pediatric sedation in a community hospital-based outpatient MRİ center. AJR Am J Roentgenol. 2012; 198:448-452.