Gülsen KESKİN, Sumru ŞEKERCİ, Murat SAYIN, Berna TAŞ ÖNAL, Haluk GÜMÜŞ

Fast-Track Kardiyak Anestezide İntratekal Morfin Uygulaması

Amaç: Fast-track (Erken derlenme) kardiyak anestezi protokolünde 10 µgkg-1 dozunda intratekal morfin uygulamasının postoperatif analjezi ve erken derlenme üzerine etkisini araştırmayı planladık. Materyal ve Metod: Elektif koroner bypass greftleme (KABG) operasyonu planlanan ASA I-III grubundan 42 hasta, kapalı zarf usulü ile intratekal morfin (İTM) ve kontrol (K) grubu olarak iki gruba ayrıldı. İTM grubuna indüksiyondan önce 10 µgkg-1 dozundan morfin intratekal olarak uygulandı. Her iki gruba aynı anestezi indüksiyon ve idame yöntemi kullanıldı. Yoğun bakımda her iki gruba hasta kontrollü analjezi (HKA) ile tramadol başlandı. İntraoperatif hemodinamik parametreler, ekstübasyon süresi, sedasyon skoru, VAS skoru, postoperatif akciğer kapasitesi, VAS skoru, yoğun bakım ve hastanede kalış süresi kaydedildi. Bulgular: Her iki grubun demografik verileri ve intraoperatif verileri arasında fark yoktu (p>005). Ekstübasyon zamanı İTM grubunda 192±42.4 dakika, kontrol grubunda 254.3±88.4 dakika bulundu (p<0.05). Postoperatif ağrı skorları, tramadol tüketimi, akciğer volümleri ve yoğun bakımda kalış süresi ITM grubunda daha iyi bulundu (p<0.05). Hastanede kalış süreleri benzerdi. Sonuç: 10 µgkg-1 dozunda intratekal morfin uygulaması, kardiyak cerrahi sonrası çok iyi analjezi, akciğer volümlerinde daha erken derlenme ve daha kısa yoğun bakım kalış süresi sağladı.

Anahtar Kelimeler:

Kardiyak anestezi, Fast-track, İntratekal morfin, Desfluran, Remifentanil

Intrathecal Morphine Administration in Fast-Track Cardiac Anesthesia

Background: We aimed to investigate the effect of 10 µg/kg intrathecal morphine administration in the fast-track cardiac anesthesia protocol on postoperative analgesia and fast-tracking.Materials and Methods: 42 patients from ASA I-III group undergoing elective coronary bypass grafting (CABG) were divided into two groups as intrathecal morphine (ITM) and control (K) groups by closed envelope method. Morphine at a dose of 10 µg/kg was intrathecally administered to the ITM group before induction. The same method of anesthesia induction and maintenance was used in both groups. Patient controlled analgesia (PCA) and tramadol were started in both groups in the intensive care unit. Intraoperative hemodynamic parameters, extubation time, sedation score, VAS score, capacity of lung, analgesia, time of intensive care and hospital stay were recorded.Results: There was no difference between demographic data and intraoperative data of both groups (p> 005). The extubation time was 192 ± 42.4 minutes in the ITM group and 254.3 ± 88.4 minutes in the control group (p <0.05). Postoperative pain scores, tramadol consumption, lung volumes and length of stay in intensive care were better in the ITM group (p<0.05). Length of stay in the hospital was similar.Conclusion: Intrathecal morphine administration at a dose of 10 µg/kg provided very good analgesia after cardiac surgery, earlier recovery in lung volumes and shorter intensive care stay.Key Words: Cardiac anesthesia, Fast-track, Intrathecal morphine, Desflurane, Remifentanil

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