Fleksibl fiberoptik bronkoskopide deksmedetomidin ile propofolün etkisinin karşılaştırılması

Amaç: Fleksibl fiberoptik bronkoskopinin (FFB) lokal anestezi altında yapılmasına karşılık hastalar sık sık öksürük, ağrı ve boğulma hissinden yakınırlar. Propofol iyi bir sedasyon düzeyi, hemodinamik stabilite, amnezi ve hızlı derlenme sağlar. Deksmedetomidin santral etkili bir a2 adrenoreseptör agonisttir, solunum depresyonu yapmadan amnezi ve analjezi sağlar. Bu çalışmada FFB işleminde kullanılan deksmedetomidinin ve propofolün amnezi, tolerans ve hasta memnuniyeti üzerindeki etkileri karşılaştırılmıştır. Gereç ve yöntem: Prospektif, çift kör, randomize olan bu çalışmaya diagnostik FFB yapılacak 30 hasta dahil edildi. Hastalar Grup D (deksmedetomidin, n=15) ve Grup P (propofol, n=15) olarak ayrıldılar. Sedasyon düzeyi Ramsey sedasyon skalası 3 olacak şekilde planlandı. FFB bitiminde hastalar, bir kez anestezist, işlemden sonra da bronkoskopist tarafından amnezi, FFB işlemine tolerans ve hasta memnuniyeti açısından değerlendirildiler. Bulgular: Prosedürler, FFB işlemi sırasında sistolik ve diyastolik kan basınçları ile derlenmede kalış süreleri benzerdi (p>0.05). Grup D?de diğer gruba göre kalp hızı daha düşük, periferik oksijen satürasyonu daha yüksekti ancak bu fark istatistiksel olarak anlamlı değildi (p>0.05). Gruplar karşılaştırıldığında amnezi, tolerans (ağrı, öksürük ve boğulma hissi) ve hasta memnuniyeti benzerdi (p>0.05). Çalışma süresince sadece Grup P?de bir hasta desatüre oldu ama oksijen desteğinin artırılmasıyla periferik oksijen satürasyonu normal değerlerine yükseldi. Sonuç: FFB?de sedasyon süresince propofol ve deksmedetomidin benzer hemodinamik, solunumsal, amnezik özellikler göstermiş, işleme tolerans ve kabul edilebilirlik üzerinde benzer etkileri olmuştur. Bu nedenle FFB süresince sedasyon tercih ediliyorsa, deksmedetomidin propofole alternatif olarak kullanılabilir.

Comparison of deksmedetomidin and propofol effects during flexible fiberoptic bronchoscopy

Aim: Eventough flexible fiberoptic bronchoscopy (FFB) is performed under local anesthesia, patients frequently complain of cough, pain and sensation of asphyxiation. Propofol supply a good sedation level, hemodynamic stability, amnesia and quick recovery. Dexmedetomidine is a centrally effective a2 adrenoreceptor agonist, it provides amnesia and analgesia without respiratory depression. The effects of dexmedetomidine and propofol usage during FFB on amnezia, tolerance and patient satisfaction are compared in this study. Material and methods: Thirty patients undergoing diagnostic FFB were included in this prospective, randomized, double-blind study.. Patients were assigned to have either Grup D (dexmedetomidine n=15) or Grup P (propofol, n=15). The level of the sedation was adjusted to reach Ramsey sedation score 3. At the end of FFB, patients were first interrogated by the anesthezist and then by the bronchoscopist, about amnesia, tolerance and patient satisfaction for FFB. Results: Demographic data, pulmonary function tests, diagnostic procedures, systolic and diastolic BP during FFB procedure and duration of recovery room staying were similar between two groups (p>0.05). Heart rate was lower and SO2 was higher in group D compared to group P but these differences were not statistically significant (p>0.05). In comparison of the groups, both dexmedetomidine and propofol shown similar effects on amnesia, tolerance (pain, cough, sensation of asphyxiation) and patient acceptance. One patient in Group P was desaturated during study, but peripheral oxygen saturation increased to baseline values with increasing oxygen supply. Conclusion: Both propofol and dexmedetomidine had similar effects in cardiovascular and respiratory system, on amnesia, analgesia, cough, sensation of asphyxiation and pain during sedation on FFB. If sedation is preferred during FFB, dexmedetomidine can be used as an alternative to propofol.

Kaynakça

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Kaynak Göster

Solunum
  • ISSN: 1302-4922
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018

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