Hayrettin DAŞKAYA, Harun UYSAL, Ferda YILMAZ İNAL, Asım ESEN, Kazım KARAASLAN

Endoskopik ultrasonografi yapılan olgularda propofole ketamin veya fentanil ilavesinin sedo-analjezi kalitesi üzerine etkileri

Amaç:Endoskopik ultrasonografi işlemleri genellikle pron pozisyonunda ve sedo-analjezi altında yapılmaktadır. Bu prospektif çalışmada tanısal endoskopik ultrasonografi yapılan hastalarda propofol+ketamin ve propofol+fentanil kombinasyonları ile yapılan sedo-analjezinin etkinliği, hasta memnuniyeti ve endoskopist memnuniyeti farklılıklarının incelenmesi amaçlanmaktadır.Gereç-yöntem: Sedo-analjezi ile endoskopik ultrasonografi işlemi planlanmış 111 hasta çalışmaya dâhil edildi. Tüm hastalara 1mg/kg Lidokain ve 0,01 mg/kg Atropin yapıldıktan sonra Propofol+ketamin grubuna (Grup K) 1,5 mg.kg-1 Propofol, 1 mg.kg-1 Ketamin, Propofol+fentanil grubuna (Grup F) da 1,5 mg.kg-1 Propofol, 1 mcg. kg-1 Fentanil ile sedo-analjezi sağlandı. Hastaların intraoperatif dönemde Richmond Ajitasyon Skoru, kalp atım hızı, sistolik-diyastolik-ortalama kan basıncı, periferik oksijen saturasyonu total işlem süresi ve bu esnada tüketilen toplam propofol miktarı kaydedildi. Tüm hastalarda Numerik Rank Skoru, vizüel ağrı skoru ve Aldrete derlenme skoru kaydedildi. İşlem bittikten sonra endoskopistten ve hastadan memnuniyetini 0-4 arsında puanlandırması istenip kaydedildi.Bulgular: Her iki grupta demografik veriler ve total operasyon süreleri benzerdi. Toplamda tüketilen tüketilen Propofol düzeyi grup F’de daha düşüktü (p<0.001). Grup F’de derlenme ünitesinde kalış süresi daha kısa gözlendi (p<0.001). Endoskopist memnuniyetinde herhangi bir fark gözlenmezken, hasta memnuniyetinde anlamlı fark tespit edildi (p:001). Grup K’da İntraoperatif kalp atım hızı ve tansiyon arteriyalde anlamlı artışlar gözlenirken, grup F’de bu değerler daha stabil seyr etti. Derlenme ünitesi giriş kalp atım hızları ve tansiyon değerleri grup K’da daha yüksek gözlendi.Sonuç: Endoskopik girişim yapılan hastaların büyük çoğunluğunun ileri yaş ve ek hastalık mevcudiyeti bulunmaktadır. Bu hastalarda anestezi ile yapılan işlemlerde anestejik ajan seçimi önem arz etmektedir. Bu açıdan bakıldığında endoskopik girişimlerde sedo-analjezi uygulanmalarında fentanil propofol kombinasyonunun avantajlı olduğunu düşünmekteyiz.

Anahtar Kelimeler:

endoskopik ultrasonografi, sedo-analjezi, ameliyathane dışı anestezi

Effects of ketamine or fentanyl addition to propofol on the quality of sedo-analgesia during endoscopic ultrasonography

Aim: Endoscopic ultrasonography procedures are usually performed in prone position with sedation. In this prospective study we investigated efficacy, patient and endoscopist satisfaction of sedation with propofol + ketamin or propofol + fentanyl combinations on patients who underwent diagnostic EUS.Materials and methods: 111 patients were included in the study who were planned for EUS with sedation. All patients received 1 mg/kg Lidocaine and 0.01 mg / kg Atropine. Propofol + ketamine group (Group K) sedated with 1,5mg/kg propofol, 1 mg/kg ketamine and propofol + fentanyl group (Group F) sedated with 1,5mg/kg propofol, 1mcg/kg fentanyl. In absence of sedation an additional dose of 0,2 mg/kg Propofol was applied in both groups. During intraoperative period patients were recorded with Richmond agitation score, heart rate, systolic-diastolic-mean blood pressure, peripheric oxygen saturation 5 minutes interval. Total time of the procedure and total amount of propofol consumed during this period were recorded. Postoperative nausea, vomiting Numeric Rank Score, for pain visual pain score and aldrete score were recorded. Endoscopist and patient satisfaction scores were requested between 0-4 and recorded.Results: Each group has similar demographic data and operation time. Total amount of propofol usage was lower in group F (p<0.001). Group F has shorter Post-Anesthesia Care Unit stay (p<0.001). While endoscopist satisfaction were same, patient satisfaction were significantly different (p:001). Intraoperative heart rate and blood pressure were significantly increased in Group K while these values were more stable in Group F. Post-Anesthesia Care Unit entrance blood pressure and heart rates were higher in group K. Intraoperative SpO₂ were not significantly different. Conclusıon: Considering that the majority of patients undergoing endoscopic procedures has comorbid conditions and elderly and statistically significant differences has in group K and group F; we think that combination of fentanyl and propofol is more advantageous for the sedation in endoscopic ultrasonography cases for esophagus, stomach and pancreas-biliary system

Keywords:

endoscopic ultrasonography, sedo-analgesia, outpatient anesthesia,

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