Filiz AKASLAN, Ayça Tuba ÖZCAN DUMANLI, Şeyda CANLI, Fatma KARAKOÇ

Çocuklarda kas gevşeticisiz trakeal entübasyon

Amaç: Kas gevşeticisiz trakeal entübasyon genellikle alfentanil, propofol ve sevofluran ile gerçekleştirilmektedir. Alfentanil 5-40 μg/kg, propofol 2.0-4.0 mg/kg, sevofluran 1.0 MAK uygulanarak mükemmel-iyi entübasyon koşulları sağlanabilmektedir. Hipnotik ajan olarak midazolamın, alfentanil-sevofluran (1.0 MAK) ile kombine edilmesinin hemodinamik parametreler ve entübasyon koşullarına etkisi değerlendirildi. Gereç ve Yöntem: Entübe edilecek 40 çocuk randomize olarak iki gruba ayrıldı. Standart monitorizasyon sonrası Grup PAda 3 mg/kg propofol ve 0.03 mg/kg alfentanil; Grup MAda 0.1 mg/kg midazolam ve 0.03 mg/kg alfentanil ile indüksiyon sağlandı. Her çocuğa, sevofluran 1 MAK değerine ulaşılana kadar inhalasyon anestezisi uygulandı. Kirpik refleksi kaybolduktan sonra entübe edildiler. Hemodinamik parametreler entübasyon sırasında, cerrahi süresince kaydedildi. Göz açma ve ekstübasyon süreleri ve komplikasyonlar gözlemlendi. Helbo-Hansen Raulo ve Trap- Anderson sistemi ile entübasyon koşulları değerlendirildi. İstatistiksel analiz ile p0.05). Benzer şekilde entübasyon koşulları, cerrahi ve entübasyon süreleri, ekstübasyon ve uyanma süreleri açısından gruplar arası istatistiksel olarak fark gözlemlenmedi (p>0.05). Ancak entübasyon zamanı ile cerrahi başlama süresi grup PAda MA grubuna göre daha kısaydı (p=0.03). Sonuç: İndüksiyon ajanı olarak midazolam alt abdominal cerrahisine alınan çocuklarda entübasyon sırasında stabil hemodinami ve yeterli entübasyon koşullarını sağlamıştır.

T racheal intubatı̇on wı̇thout muscle relaxants in chı̇ldren

Aim: Tracheal intubation without muscle relaxants is usually performed with alfentanil and propofol or sevoflurane. Alfentanil 5 to 40 μg/kg, propofol 2.0-4.0 mg/kg sevoflurane up to 1 MAC provide excellent or good intubation conditions. Effect of midazolam as a hypnotic agent which is combined with alfentanil and 1 MAC sevoflurane, on hemodynamic parameters and intubation conditions is evaluated. Materials and Methods: Forty children to be intubated were randomized into two groups. During induction following the standart monitoring, 3 mg/kg propofol and 0.03 mg/kg alfentanil were used in Group PA, whereas 0.1 mg/kg midazolam and 0.03 mg/kg alfentanil were used in group MA. Each child received inhalation induction with sevoflurane 1 MAC. Hemodynamic values were recorded as well as intubation valuation, duration of surgery, time to extubation and eye opening and complications. The conditions of intubation were evaluated applying the scoring system devised by Helbo-Hansen Raulo and Trap-Anderson. p<0.05 values were accepted as significant after statistical analysis. Results: No statistical difference related to age, gender, weight, ASA, additional health condition or mallampati scores were detected between the groups (p>0.05). Similarly, intubation conditions in terms of intubation conditions, duration of surgery and intubation, time to extubation and to awakening and need for additional medication, no meaningful statistical difference was observed (p>0.05). However, the time between intubation and surgical intervention was decreased in Group MA compared to Group PA (p=0.03). Conclusion: Midazolam as a hypnotic agent provided clinically acceptable intubation conditions and hemodynemics during tracheal intubation in children undergoing inferior abdominal surgery.

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