Remifentanil-Propofol versus Fentanyl-Propofol for Circumcision Operations in Pediatric Ambulatory Surgical Patients

Circumcision is the most frequent surgical procedure performed worldwide. The present study aimed to compare the efficacy and safety of fentanyl vs. remifentanil in pediatric patients undergoing circumcision procedure. A total of 120 boys, who were ASA (American Society of Anesthesiologists) I-II and underwent circumcision procedure, were retrospectively evaluated. Induction for anesthesia was provided using propofol that using 0,5-1 μg kg-1 (n=60) in Group F and using remifentanil 0,5-1 μg kg-1 (n=60) in Group R. After monitoring the patients and recording hemodynamic parameters and complications the findings every 30 minutes in peroperative and the recovery room, the patients were then followed for 6 hours. A total of 120 boys at the age of 0-2 years old who were underwent circumcision procedure, were retrospectively evaluated. The groups were comparable in terms of age, body weight, height, ASA physical status and duration of surgery that was not statistically significant.Recovery time from anesthesia was statistically significantly shorter in the remifentanil-propofol (Group R) as compared to the fentanyl-propofol (Group F). While vomiting was the most common complication in Group F, bradycardia was the most common complication in Group R. Comparison of the frequencies of complications between the groups revealed no difference in terms of bradycardia, bronchospasm, respiratory depression and allergic reaction. In conclusion, based on the results of the present study, we recommend using remifentanil-propofol in this pediatric age group but also underline the necessity of close monitoring of these patients for the potential side effects.

Pediatrik Ambulatuar Cerrahi Hastaların Su nnet Operasyonlarında Remifentanil-Propofole karşı Fentanil Propofol

: Sünnet dünya genelinde en sık uygulanan cerrahi işlemdir. Fentanil, remifentanil ve propofol pediatri pratiğinde bu amaç için en yaygın kullanılan ilaçlardır. Bu çalışmada sünnet yapılan çocuk hastalarda fentanil veya remifentatil uygulamasının etkinliğini ve güvenirliliğinin karşılaştırılması amaçlandı. Sünnet cerrahisi uygulanan ASA I-II, 120 erkek çocuk (American Society of Anesthesiologists), retrospektif olarak çalışmaya alındı. Hastalara propofol 2-3 mg kg -1 sonrasında Grup F’ye fentanil 0,5-1 μg kg1 (n=60), Grup R’ye remifentanil 0.5-1 μg kg-1 (n=60) kullanılarak indüksiyon yapıldı. Anestezi idamesinde sevofluran 4 L dk -1 %50 hava ve oksijen %3-4 kullanıldı. Peroperatif ve derlenme ünitesinde hemodinamik verileri ve komplikasyon kayıtları alındıktan sonra hastalar 6 saat boyunca çocuk cerrahi servisinde takip edildi. Sünnet cerrahisi uygulanan 0-2 yaş, 120 erkek çocuk hastanın gruplar arasında yaş, vücut ağırlığı, boy, ASA fiziksel durumu ve operasyon süreleri arasında istatistiksel olarak fark yoktu. Remifentanil-propofol alan Grup R hastalar, Grup F alanlara göre uyanma süresi istatistiksel olarak önemli oranda kısaydı. Grup F’de kusma en sık görülen komplikasyon iken, Grup R’de ise bradikardiydi. Gruplar komplikasyon gelişimi sıklığı bakımından karşılaştırıldığında bradikardi, bronkospazm, solunum depresyonu ve alerjik reaksiyon sıklığı açısından gruplar arasında fark gözlenmedi. Sonuç olarak sünnet cerrahisi uygulanan pediatrik hastaları değerlendirdiğimiz bu çalışmada; remifentanil-propofol kullanımının bu yaş grubunda önermekle birlikte olası yan etkiler açısından hastaların yakından izlenmesinin gerekliliğini de vurgulamayı amaçladık.

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