Yasemen HÖBEK AYDIN, Dilek ÖZTÜRK KAZANCI

Fentanil ve Remifentanil’in perkütan nefrolitotomi vakalarında inraoperatif hemodinami ve postoperatif derlenmeye etkileri

Amaç: Perkütan nefrolitotomi (PCNL) uygulanan hastalarda fentanil veya remifentanilin intraoperatif hemodinamik etkileri ve postoperatif derlenme üzerine etkilerini karşılaştırmak.Gereç ve Yöntemler: Çalışmamız randomize, ve prospektif olarak yapıldı. Çalışmaya Amerikan Anestezist Derneği (ASA) I-II ile PCNL uygulanan 40 hasta dahil edildi. Uygulanan anestezi tekniği aynı olup remifentanil-fentanil ilaç kullanımına göre tüm hastalar 2 gruba ayrıldı. Her iki grupta anestezi indüksiyonu bolus dozda propofol 2mg/kg ile idame sevofluran (MAC 2) ile sağlandı. Kas gevşemesi 0,6 mg/kg rokuronyum ile elde edildi. Grup 1’e anestezi indüksiyonu sırasında tek doz halinde 1 μgr/kg remifentanil, Grup 2’ye anestezi indüksiyonu sırasında tek doz olarak fentanil 2µg/kg verildi. Hemodinamik stabiliteyi sağlamak amaçlı Grup 1’de remifentanil infüzyon şeklinde (0.05 μg/kg/dk.), grup 2’de ise 45 dk. da bir fentanil 0,5 μg/kg iv puşe verildi. İntraoperatif hemodinamik parametreler ve iyileşme verileri kaydedildi. Aldrete Skoru, Ramsay Sedasyon Skalasında 15, 60, 360. dakikalardaki değerler ameliyat sonrası kaydedildi. Ağrı değerlendirmesi için görsel analog skala (VAS0-10) kullanıldı.Bulgular: İntraoperatif hemodinamik ölçümler Grup 1’de daha stabildi. Nitro-gliserin ihtiyacı Grup 2’de anlamlı olarak arttı (p <0,05). Aldrete skorları, Ramsay sedasyon ölçekleri ve VAS gruplar arasında anlamlı farklılık göstermedi. Derlenme Grup 1’de Grup 2’den anlamlı olarak erkendi (p<0,05).Sonuç: PCNL sırasında fentanile kıyasla Remifentanil ile stabil hemodinamik durum ve daha güvenli iyileşme sağlanabilir.

Anahtar Kelimeler:

Fentanil, perkütan nefrolitotomi, remifentanil, görsel analog skor.

Effects of Fentanyl and Remifentanil on intraoperative hemodynamics and postoperative recovery in percutaneous nephrolithotomy cases

Objective: To compare the effects of fentanyl or remifentanil on intraoperative hemodynamic effects and postoperative recovery in patients undergoing percutaneous nephrolithotomy (PCNL).Material and Methods: Randomized and prospective study was conducted. Forty patients who underwent PCNL with the American Society of Anaesthesiologists (ASA) I-II enrolled into the study. All patients were divided into 2 groups according to administered anaesthesiology technique and drugs, which are remifentanil and fentanyl. Induction of anesthesia was same in both groups. Induction of anesthesia was obtained with a bolus dose of propofol (1-2 mg/kg), maintenance was achieved with sevoflurane (MAC2). Muscle relaxation was achieved with rocuronium. Group 1 was consisted of patients who were administered remifentanil and they received 1 μgr/kg of remifentanil as a single dose during the induction of anaesthesia Group 2 was received fentanyl 2 μg/kg as a single dose during the induction of anaesthesia. Group 1 received remifentanil 0.05 μgr/kg per minute as an infusion throughout the procedure for providing intraoperative hemodynamic stability, in group 2 fentanyl was given at a dose of 0.5 μg/kg iv bolus every 45 minutes. Intraoperative hemodynamic parameters and recovery data were recorded. Aldrete score, Ramsay sedation scale 15, 60, 360 minutes were noted after surgery. Visual analogue scale (VAS0-10) was used for pain evaluation.Results: Intraoperative hemodynamic measurements were more stable in Group 1. The need for nitro-glycerine was significantly increased in Group 2 (p<0.05). The Aldrete scores, Ramsay sedation scales and VAS did not differ significantly between the groups. Immediate recovery was significiantly earlier in Group 1 than Group 2 (p<0.05).Conclusion: Stable hemodynamic status and safer recovery can be provided with remifentanil compared to fentanyl during PCNL.

Keywords:

fentanyl, percutaneous nephrolithotomy, remifentanil, visual analog score,

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Referans 1: C. J. Andrews, M. Sinclair, C. Prys-Roberts, and A. Dye, ‘Ventilatory effects during and after continuous infusion of fentanyl or alfentanil’, Br. J. Anaesth., vol. 55 Suppl 2, pp. 211S-216S, 1983.
Referans 2: T. G. Monk, M. Mueller, and P. F. White, ‘Treatment of Stress Response during Balanced Anesthesia Comparative Effects of Isoflurane, Alfentanil, and Trimethaphan’, Anesthesiology, vol. 76, no. 1, pp. 39–45, Jan. 1992, doi: 10.1097/00000542-199201000-00006.
Referans 3: X. Deng and T. Zhu, ‘Clinical comparison of propofol-remifentanil TCI with sevoflurane induction/maintenance anesthesia in laparoscopic cholecystectomy’, Pak. J. Med. Sci., vol. 30, no. 5, Dec. 1969, doi: 10.12669/pjms.305.5196.
Referans 4: N. Nooh, A. A. Abdelhalim, W. A. Abdullah, and S. A. Sheta, ‘Effect of remifentanil on the hemodynamic responses and recovery profile of patients undergoing single jaw orthognathic surgery’, Int. J. Oral Maxillofac. Surg., vol. 42, no. 8, pp. 988–993, Aug. 2013, doi: 10.1016/j.ijom.2013.02.001 . Referans 5: P. S. A. Glass, T. J. Gan, and S. Howell, ‘A Review of the Pharmacokinetics and Pharmacodynamics of Remifentanil’, Anesth. Analg., vol. 89, no. 4S, p. 7, Oct. 1999, doi: 10.1097/00000539-199910001-00003.
Referans 6: T. D. Egan et al., ‘The Pharmacokinetics of the New Short-acting Opioid Remifentanil (GI87084B) in Healthy Adult Male Volunteers’, Anesthesiology, vol. 79, no. 5, pp. 881–892, Nov. 1993, doi: 10.1097/00000542-199311000-00004.
Referans 7: P. S. A. Glass et al., ‘Preliminary Pharmacokinetics and Pharmacodynamics of an Ultra-Short-Acting Opioid: Remifentanil (GI87084B)’, Anesth. Analg., vol. 77, no. 5, p. 1031???1040, Nov. 1993, doi: 10.1213/00000539-199311000-00028.
Referans 8: W. E. Goodwin, ‘Percutaneous Trocar (Needle) Nephrostomy In Hydronephrosıs’, J. Am. Med. Assoc., vol. 157, no. 11, p. 891, Mar. 1955, doi: 10.1001/jama.1955.02950280015005.
Referans 9: I. Fernström and B. Johansson, ‘Percutaneous Pyelolithotomy: A New Extraction Technique’, Scand. J. Urol. Nephrol., vol. 10, no. 3, pp. 257–259, Jan. 1976, doi: 10.1080/21681805.1976.11882084.
Referans 10: P. N. Rao, ‘Fluid Absorption During Urological Endoscopy’, Br. J. Urol., vol. 60, no. 2, pp. 93–99, Aug. 1987, doi: 10.1111/j.1464-410X.1987.tb04940.x.
Referans 11: K. Sugai, Y. Sugai, Y. Azuma, Y. Tanaka, and M. Miyazaki, ‘Vascular Absorptıon Of Irrıgatıon Solutıon In Percutaneous Nephro-Ureterolıthotomy’, Br. J. Anaesth., vol. 61, no. 4, pp. 516–517, Oct. 1988, doi: 10.1093/bja/61.4.516-a.
Referans 12: Ş. Atıcı, S. Zeren, and A. Arıboğan, ‘Hormonal and hemodynamic changes during percutaneous nephrolithotomy.’, Int. Urol. Nephrol., vol. 32, no. 3, pp. 311–314, 2001, doi: 10.1023/A:1017527126481.
Referans 13: V. Billard et al., ‘Desflurane-remifentanil-nitrous oxide anaesthesia for abdominal surgery: optimal concentrations and recovery features’, Acta Anaesthesiol. Scand., vol. 48, no. 3, pp. 355–364, Mar. 2004, doi: 10.1111/j.0001-5172.2004.0324.x.
Referans 14: S. H. Kim, N. Stoicea, S. Soghomonyan, and S. D. Bergese, ‘Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review’, Front. Pharmacol., vol. 5, May 2014, doi: 10.3389/fphar.2014.00108.
Referans 15: L. E. Mather, ‘Clinical Pharmacokinetics of Fentanyl and its Newer Derivatives’:, Clin. Pharmacokinet., vol. 8, no. 5, pp. 422–446, 1983, doi: 10.2165/00003088-198308050-00004.
Referans 16: J. P. Thompson and D. J. Rowbotham, ‘Remifentanil-an opioid for the 21st century’, Br. J. Anaesth., vol. 76, no. 3, pp. 341–343, Mar. 1996, doi: 10.1093/bja/76.3.341.
Referans 17: C. L. Westmoreland, J. F. Hoke, P. S. Sebel, C. C. Hug, and K. T. Muir, ‘Pharmacokinetics of Remifentanil (GI87084B) and Its Major Metabolite (GI90291) in Patients Undergoing Elective Inpatient Surgery’, Anesthesiology, vol. 79, no. 5, pp. 893–903, Nov. 1993, doi: 10.1097/00000542-199311000-00005.
Referans 18: S. W. Jellish, T. Sheikh, W. H. Baker, E. K. Louie, and S. Slogoff, ‘Hemodynamic Stability, Myocardial Ischemia, and Perioperative Outcome After Carotid Surgery with Remifentanil/Propofol or Isoflurane/Fentanyl Anesthesia’:, J. Neurosurg. Anesthesiol., vol. 15, no. 3, pp. 176–184, Jul. 2003, doi: 10.1097/00008506-200307000-00004.
Referans 19:G. Balakrishnan et al., ‘A Comparison of Remifentanil and Fentanyl in Patients Undergoing Surgery for Intracranial Mass Lesions’:, Anesth. Analg., vol. 91, no. 1, pp. 163–169, Jul. 2000, doi: 10.1097/00000539-200007000-00030.
Referans 20: G. Kostopanagiotou, S. L. Markantonis, M. Polydorou, A. Pandazi, and G. Kottis, ‘Recovery and cognitive function after fentanyl or remifentanil administration for carotid endarterectomy’, J. Clin. Anesth., vol. 17, no. 1, pp. 16–20, Feb. 2005, doi: 10.1016/j.jclinane.2004.03.008.
Referans 21: R. S. Twersky, B. Jamerson, D. S. Warner, L. A. Fleisher, and S. Hogue, ‘Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients’, J. Clin. Anesth., vol. 13, no. 6, pp. 407–416, Sep. 2001, doi: 10.1016/S0952-8180(01)00292-6.
Referans 22: W. Wilhelm, N. Schlaich, J. Harrer, S. Kleinschmidt, M. Müller, and R. Larsen, ‘Recovery and neurological examination after remifentanil–desflurane or fentanyl–desflurane anaesthesia for carotid artery surgery’, Br. J. Anaesth., vol. 86, no. 1, pp. 44–49, Jan. 2001, doi: 10.1093/bja/86.1.44.
Referans 23: C. Motamed et al., ‘Postoperative pain scores and analgesic requirements after thyroid surgery: Comparison of three intraoperative opioid regimens’, Int. J. Med. Sci., pp. 11–13, 2006, doi: 10.7150/ijms.3.11.
Referans 24 : S. Albrecht, J. Schuttler, and J. Yarmush, ‘Postoperative Pain Management After Intraoperative Remifentanil’, Anesth. Analg., vol. 89, no. 4S, p. 40, Oct. 1999, doi: 10.1097/00000539-199910001-00008.
Referans 25: H. R. Vinik and I. Kissin, ‘Rapid Development of Tolerance to Analgesia During Remifentanil Infusion in Humans’:, Anesth. Analg., vol. 86, no. 6, pp. 1307–1311, Jun. 1998, doi: 10.1097/00000539-199806000-00033.
Referans 26: E. Kochs et al., ‘Postoperative pain management and recovery after remifentanil-based anaesthesia with isoflurane or propofol for major abdominal surgery. Remifentanil Study Group’, Br. J. Anaesth., vol. 84, no. 2, pp. 169–173, Feb. 2000, doi: 10.1093/oxfordjournals.bja.a013398.

Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2020
Yayıncı: ENDOÜROLOJİ DERNEĞİ

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