D&C operasyonlarında sedoanaljezi için propofol ile kullanılan farklı opioidlerin karşılaştırılması

Amaç: Dilatasyon ve uterus küretajı (D&C) yaygın bir günübirlik obstetrik ve jinekolojik prosedürdür. Biz bu çalışmada sedoanaljezi için propofol ile kullanılan farklı opioidlerin derlenme ve hemodinamik parametreler üzerine etkilerini araştırmayı amaçladıkGereç ve Yöntem: Bu çalışma D&C operasyonu yapılacak hastalarda gerçekleştirildi. Anestezi indüksiyonu Grup-PR’de 1.5 mg/kg propofol+1 mcg/kg remifentanil ile, Grup-PF’de 1.5 mg/kg propofol+1 mcg/kg fentanil ile ve Grup-PP’de 1.5 mg/kg propofol+1 mg/kg petidin ile sağlandı. Anestezi süresi, Modifiye Aldret Skoru (MAS), hemodinamik parametreler (indüksiyon sonrası 5.,10., 15. dakikalar ve postoperatif 0., 5., ve 10.dakikalarda) ve ek propofolverilen hastaların sayısı kaydedildi. Ayrıca operasyon sonunda cerrah memnuniyeti, yan etki ve komplikasyonlar kayıt edildi.Bulgular:Çalışmamızda kalp hızı indüksiyon sonrası Grup PR’de diğer gruplardan daha düşüktü(p<0.05). Postoperatif dönemde Grup PR, kalp hızı üzerine Grup PP ile benzer etki gösterdi fakat Grup PR’de Grup PF’den daha çok baskılandı(p<0.05). Ortalama arter basıncı (OAB) Grup PR’de Grup PF’ye göre intraoperatif dönemde daha düşük iken postoperatif dönemde fark yoktu (p<0.05).OAB açısından Grup PF ile Grup PP karşılaştırıldığında postoperatif 0. dakikada Grup PP’de daha düşük olduğu görülürken diğer zamanlarda fark yoktu (p<0.05). Cerrah memnuniyeti Grup PP’deki hastalara göre hem Grup PR ve hem de Grup PF’de daha iyiydi (p<0.05). Ayrıca Grup PR’de diğer gruplar ile karşılaştırıldığında daha erken derlenme sağlandı ve ek propofol ihtiyacı olanların sayısı diğer gruplardan daha azdı (p<0.05).Sonuç: Çalışmamızda propofol ile remifentanil; fentanil ve petidine göre daha erken derlenme ve yüksek cerrahi memnuniyet sağlamıştır.

Anahtar Kelimeler:

Fentanil, küretaj, propofol, remifentanil

Comparison the Different Opioids with Propofol for Sedoanalgesia in D&C Operation

Aim: Dilatation and curettage (D&C) is a common day-careprocedure in obstetrics and gynecology. In this study weaimed to investigate the effect of different opioids withpropofolon recovery and its effects on hemodynamicparameters combination for sedoanalgesia.Materials and Methods: This study was conducted in 105patients who undergoing D & C operations. Anesthesiainduction were ensured with 1.5 mg/kg propofol+1 mcg/kgremifentanil in Group PR, 1.5 mg/kg propofol+1 mcg/kgfentanyl in Group PF and 1.5 mg/kg propofol+1 mg/kgpethidine in Group PP. Duration of anesthesia, ModifiedAldrete Score (MAS), hemodynamic parameters (afterinduction 5., 10., 15. minutes and postoperative 0, 5, and 10minutes) and the number of patients receiving additionalpropofol were recorded. Also surgeon satisfaction, sideeffects and complications were recorded at the end ofsurgery.Results: Heart rate was significantly lower in Group PR thanother groups (p<0.05). Group PR and Group PP showedsimilar effects on heart rate postoperative period but inGroup PR more was suppressed than Group PF (p<0.05).There was no difference in the postoperative period whilemean arterial pressure (MAP) was significantly lower inGroup PR than Group PF in intraoperative period (p<0.05).There was no difference between the groups at other times,while MAP was significantly lower in Group PP than GroupPF in postoperative 0. minute (p<0.05). According to thegroup PP surgeon satisfaction were better in both Group PRand Group PF. Also compared with other groups in GroupPR were provided earlier recovery and the number of thosewho need additional propofol was less than (p<0.05).Conclusion: In our study propofol plus remifentanil ensuredearlier recovery and higher surgeon satisfaction whencompared with fentanyl and pethidine.

Keywords:

Fentanyl, curettage, propofol, remifentanil,

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Tas A, Mıstanoglu V,Darcın S,Kececioglu M.Tramadol versus fentanyl during propofol-based deepsedationfor uterinedilatation and curettage: a prospective study.J Obstet Gynaecol Res.2014;40:749-53.
Siddiqui KM, Chohan U. Tramadol versus nalbuphine in total intravenous anaesthesia for dilatation and evacuation. J Pak Med Assoc 2007;57:67–70.
Castillo T, Avellanal M, Garcia de Lucas E. Bolus application of remifentanil with propofol for dilatation and curettage. Eur J Anaesthesiol 2004;21:408–411.
Toledano RD, Kodali BS, Camann WR. Anesthesia drugs in the obstetric and gynecologic practice. Rev Obstet Gynecol 2009;2:93–100.
Uerpairojkit K, Urusopone P, Somboonviboon W. A randomised controlled study of three targets of propofol plasma concentration in patients undergoing uterine dilatation and curettage. J Obstet Gynaecol Res 2003;29:79–83.
Vanlersberghe C, Camu F. Propofol. Handb Exp Pharmacol 2008;182:227–252.
Kungys G, Kim J, Jinks SL, Atherley RJ, Antognini JF. Propofol produces immobility via action in the ventral horn of the spinal cord by a GABAergic mechanism. Anesth Analg. 2009;108:1531-7.
Lawrence B. Cohen, MD, Charles D. Hightower, BA, Daniel A. Wood, BS, et al. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam Gastrointest Endosc. 2004;59:795-803
Haytural C, Aydınlı B, Demir B, Bozkurt E, Parlak E, Dişibeyaz S, et al. Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP BioMed Research International Volume 2015 (2015), Article ID 465465, 5 pages http://dx.doi.org/10.1155/2015/465465
Kücük M, Uğur B, Oğurlu M. Comparing the administrationof fentanyl 1 μg kg−1 and fentanyl 0.5 μg kg−1 in dilatation andcurettage procedures. Gynecol Endocrinol 2012;28:736–739.
Seitsonen ER, Cohen-Larogue ES, van Gils MJ, Korttila KT,Neuvonen PJ, Yli-Hankala A. Propofol versus alfentanil toprevent movement responses during uterine curettage. ActaAnaesthesiol Scand 2007;51:751–758.
Oğurlu M, Küçük M, Bilgin F et al. Comparison of bolus remifentanil-propofol versus bolus fentanyl-propofol fordilatation and sharp curettage. Clin Exp Obstet Gynecol 2010;37:209–212.
Sahin L, Sahin M, Aktas O, Kilic E, Mandollu E. Comparisonof propofol/ketamine versus propofol/alfentanil for dilatationand curettage. Clin Exp Obstet Gynecol 2012;39:72–75.
Scott LJ, Perry CM. Tramadol: A review of its use inperioperative pain. Drugs 2000;60:139–176.
Yamanaka T, Sadikot RT. Opioid effect on lung. Respirology 2013;18:255–262.
Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013;19:463-81.
Sclar DA. Remifentanil, fentanyl, or the combination in surgical procedures in the United States: predictors of use in patients with organ impairment or obesity. Clin Drug Investig. 2015;35:53-9.
Egan TD. Remifentanil pharmacokinetics and pharmacodynamics. A preliminary appraisal. Clin Pharmacokinet. 1995;29:80–94.
Glass PSA, Hardman D, Kamiyama Y, Quill TJ, Marton G, Donn KH, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioids: Remifentanil (GI87084B). Anesth Anal. 1993;77:1031–40.
Reid JE, Mirakhur RK. Bradycardia after administration of remifentanil. Br J Anaesth. 2000;84:422–3.
Kojima A, Ito Y, Kitagawa H, Matsuura H, Nosaka S. Remifentanil has a minimal direct effect on sinoatrial node pacemaker activity in the Guinea pig heart. Anesth Analg. 2013;117:1072–7.
DeSouza G, Lewis MC, TerRiet MF. Severe bradycardia after remifentanil. Anesthesiology. 1997;87:1019–20
Ryu J-H, Kim J-H, Park K-S, Do S-H. Remifentanil-propofol versus fentanyl-propofol for monitored anesthesia care during hysteroscopy. Journal of clinical anesthesia. 2008;20:328-32.
Marinangeli F, Ciccozzi A, Antonucci S, Iovinelli G, Colangeli A, Varrassi G. Use of remifentanil in ambulatory obstetric-gynecologic surgery. A dose-effect study. Minerva Anestesiol.1999;65:491-7.
Cruz Pardos P, Garutti Martínez I. Usefulness of meperidine in anesthesiology Rev Esp Anestesiol Reanim. 2000;47:168-75; quiz 175-6.
Açmaz G, Bayraktar E, Aksoy H, Başer M, Yilmaz MO, Müderris İİ. Effect of paracetamol, dexketoprofen trometamol, lidocaine spray, pethidine & diclofenac sodium application for pain relief during fractional curettage: A randomized controlled trial Indian J Med Res 142, 2015;142:399-404
Dogan S, Celikbilek M, Baldane S, Torun E, Gursoy S. Meperidine: a safe analgezic option for percutaneous liver biopsy. Eur J Gastroenterol Hepatol. 2011;23:1078
Howard R, Karageorge G, van Harselaar K, Bell M, Basford P, Schultz M, et al. Post-procedure surveillance in liver biopsy: how long is long enough? NZ Med J. 2008;121:8–14.
Pan A, Alansari M, Lubcke R, Schlup M, Williams M, Fraser M, et al. Use of pethidine for percutaneous liver biopsy-a randomised, placebo-controlled, double blind study BMC Gastroenterol. 2015;19:15:33.
Fanti L, Agostoni M, Gemma M, Gambino G, Facciorusso A, Guslandi M, et al. Remifentanil vs. meperidine for patient-controlled analgesia during colonoscopy: a randomized double-blind trial. Am J Gastroenterol. 2009;104:1119-24
Thomas WF, Macario A. The postanaesthesia care unit. In: Miller RD. (ed) Anaesthesia. 6th ed Philadelphia, Churchil Livingston 2006:2703-27
Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy. Gastrointestinal endoscopy. 2003;57:657-63.
Uğur B, Oğurlu M, Odabaşı Ar, Yüksel H, Gezer E, Aydın ON. Probe Küretaj Uygulamalarında Remifentanil-Propofol ve Fentanil-Propofol Kombinasyonlarının Karşılaştırılması. Turkiye Klinikleri Journal Of Gynecology And Obstetrics. 2007;17:30-6.