Timpanoplasti olgularında kontrollü hipotansiyon: Remifentanil ve alfentanil-sodyum nitroprusid kombinasyonunun karşılaştırılması
Amaç: Remifentanil ile alfentanil-sodyum nitroprusid kombinasyonunun kontrollü hipotansiyon ve cerrahi alanda kanama üzerindeki etkinlikleri karşılaştırıldı.Hastalar ve Yöntemler: Timpanoplasti uygulanacak, ASA I-II, 30 hasta rasgele iki gruba ayrıldı. Remifentanil grubuna n=15 indüksiyonda remifentanil, propofol, roküronyum ve idamede remifentanil ve propofol infüzyonları; sodyum nitroprusid grubuna n=15 indüksiyonda alfentanil, propofol, roküronyum ve idamede alfentanil, propofol ve sodyum nitroprusid infüzyonları uygulandı. Olgular %33 O2 ve %66 N2O karışımıyla havalandırıldı. İnvaziv ortalama arter kan basıncı, kalp hızı, periferik oksijen satürasyonu, cerrahi alandaki kanama miktarı, kan gazı değerleri kaydedildi.Bulgular: Ameliyat süresince her iki grupta ortalama arter basıncı değerleri yaklaşık 60±5 mmHgʼde stabildi. Kalp hızı remifentanil grubunda kontrol değerinden düşük p0.05 . Kan kaybı ve cerrahi alanın kuruluğu her iki grupta benzerdi. İki grup arasında, ameliyat sırasında birinci ve ikinci saatlerle, ameliyat sonrası 30. dk pH ve PaCO2 değerlerinde anlamlı fark bulundu p
Anahtar Kelimeler:
Anestezi, genel, kan basıncı, hipotansiyon, kontrollü, sodyum nitroprusid, opioid analjezik, timpanoplasti
Controlled hypotension for tympanoplasty: comparison between remifentanil and combination of alfentanil and sodium nitroprusside
Objectives: We compared the efficacy of remifentanil and the combination of alfentanil and sodium nitroprusside on controlled hypotension and bleeding at surgical site.Patients and Methods: Thirty ASA l-ll patients undergoing tympanoplasty were randomly assigned to remifentanil and alfentanil-sodium nitroprusside groups, equal in number.Anesthesia was induced with remifentanil or alfentanil combined with propofol and rocuronium, and maintained with remi fentanil or alfentanil-sodium nitroprusside infusions combined with propofol. AH patients were ventilated with a mixture of 33% O2 and 66% N2O. Invasive mean arterial blood pressure, heart rate, peripheral oxygen saturation, the amount of bleeding at surgical site, and blood gas values were recorded.Results: Controlled hypotension was achieved at a target mean arterial pressure of 60±5 mmHg in both groups.Compared to the baseline levels, heart rate values were lower in the remifentanil group p<0.05 , and similar in the sodium nitroprusside group p>0.05 . The amount of bleeding and the dryness of the surgical site were similar in two groups. PaCO2 and pH values differed significantly betvveen the two groups at perioperative 1 and 2 hours and in the postoperative 30th minute p<0.05 , but the dif- ference was not clinically significant.Conclusion: Our results suggest that remifentanil is effec-tive in obtaining controlled hypotension vvithout an additional potent hypotensive agent and provides appropriate surgical conditions by reducing the amount of bleeding.
Keywords:
Anesthesia general, blood pressure, hypoten sion, controlled, sodium nitroprusside, analgesics, opioid, tympanoplasty,
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- Saarnivaara L, Brander P. Comparison of three hypo- tensive anaesthetic methods for middle ear microsur- gery. Acta Anaesthesiol Scand 1984;28:435-42.
- Degoute CS, Ray MJ, Manchon M, Dubreuil C, Banssillon V. Remifentanil and controlled hypoten- sion; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth 2001;48:20-7.
- Eberhart LH, Folz BJ, Wulf H, Geldner G. Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope 2003;113:1369-73.
- Degoute CS, Ray MJ, Gueugniaud PY, Dubreuil C. Remifentanil induces consistent and sustained con- trolled hypotension in children during middle ear surgery. Can J Anaesth 2003;50:270-6.
- Sivrikaya GU, Erol MK, Hancı A, Kılınç LT, Dobrucalı H. Orta kulak cerrahisinde hipotansif anestezide remifentanil-sevofluran ve remifentanil-propofol kombinasyonlarının karşılaştırılması. Türk Anest Rean Der Dergisi 2005;33:300-5.
- Miller ED. Deliberate hypotension. In: Miller RD, editor. Anesthesia. 2nd ed. New York: Churchill Livingstone; 1986. p. 1949-70.
- Degoute CS, Dubreuil C, Ray MJ, Guitton J, Manchon M, Banssillon V, et al. Effects of posture, hypotension and locally applied vasoconstriction on the middle ear microcirculation in anaesthetized humans. Eur J Appl Physiol Occup Physiol 1994;69:414-20.
- Newton MC, Chadd GD, O’Donoghue B, Sapsed-Byrne SM, Hall GM. Metabolic and hormonal responses to induced hypotension for middle ear surgery. Br J Anaesth 1996;76:352-7.
- Dietrich GV, Heesen M, Boldt J, Hempelmann G. Platelet function and adrenoceptors during and after induced hypotension using nitroprusside. Anesthesiology 1996; 85:1334-40.
- Pilli G, Guzeldemir ME, Bayhan N. Esmolol for hypotensive anesthesia in middle ear surgery. Acta Anaesthesiol Belg 1996;47:85-91.
- Tinker JH, Michenfelder JD. Sodium nitroprus- side: pharmacology, toxicology and therapeutics. Anesthesiology 1976;45:340-54.
- Blau WS, Kafer ER, Anderson JA. Esmolol is more effective than sodium nitroprusside in reducing blood loss during orthognathic surgery. Anesth Analg 1992; 75:172-8.
- Guy J, Hindman BJ, Baker KZ, Borel CO, Maktabi M, Ostapkovich N, et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supra- tentorial space-occupying lesions. Anesthesiology 1997;86:514-24.
- Philip BK, Scuderi PE, Chung F, Conahan TJ, Maurer W, Angel JJ, et al. Remifentanil compared with alfen- tanil for ambulatory surgery using total intravenous anesthesia. The Remifentanil/Alfentanil Outpatient TIVA Group. Anesth Analg 1997;84:515-21.
- Schuttler J, Albrecht S, Breivik H, Osnes S, Prys-Roberts C, Holder K, et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia 1997;52:307-17.
- Saitoh K, Suzuki H, Hiruta A, Igarashi T, Fukuda H, Hirabayashi Y, et al. Induced hypotension for endo- scopic sinus surgery. Masui 2002;51:1100-3. [Abstract]
- Ali SS, Dubikaitis A, al Qattan AR. The relationship between end tidal carbon dioxide and arterial carbon dioxide during controlled hypotensive anaesthesia. Med Princ Pract 2002;11:35-7.
- Marchal JM, Gomez-Luque A, Martos-Crespo F, Sanchez De La Cuesta F, Martinez-Lopez MC, Delgado-Martinez AD. Clonidine decreases intraop- erative bleeding in middle ear microsurgery. Acta Anaesthesiol Scand 2001;45:627-33.
- Davis PJ, Lerman J, Suresh S, McGowan FX, Cote CJ, Landsman I, et al. A randomized multicenter study of remifentanil compared with alfentanil, isoflurane, or propofol in anesthetized pediatric patients under- going elective strabismus surgery. Anesth Analg 1997;84:982-9.
- Ornstein E, Young WL, Ostapkovich N, Matteo RS, Diaz J. Deliberate hypotension in patients with intra- cranial arteriovenous malformations: esmolol com- pared with isoflurane and sodium nitroprusside. Anesth Analg 1991;72:639-44.
- Preckel MP, Ferber-Viart C, Leftheriotis G, Dubreuil C, Duclaux R, Saumet JL, et al. Autoregulation of human inner ear blood flow during middle ear surgery with propofol or isoflurane anesthesia during controlled hypotension. Anesth Analg 1998;87:1002-8.
- Guiha NH, Cohn JN, Mikulic E, Franciosa JA, Limas CJ. Treatment of refractory heart failure with infusion of nitroprusside. N Engl J Med 1974;291:587-92.
- Wildsmith JA, Marshall RL, Jenkinson JL, MacRae WR, Scott DB. Haemodynamic effects of sodium nitro- prusside during nitrous oxide-halothane anaesthesia. Br J Anaesth 1973;45:71-4.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi
Sayıdaki Diğer Makaleler
G. Ulufer SİVRİKAYA, Ayşe HANCI, Tuncay KARAHAN, Ayda BAŞGÜL, Berna USLU COŞKUN
Mustafa KAZKAYASI, Can DİNÇER, Osman Kürşat ARIKAN, Rahmi KILIÇ