Bahadır DAĞLAR, Haşim ÜSTÜNSOY, Hakkı KAZAZ, Mehmet Adnan CELKAN, Ünsal ÖNER, Sıtkı GÖKSU, Atilla TUTAK, Hasan KOÇOĞLU

Kardiyak cerrahide fentaline midazolam eklenmesinin ısınma sırasındaki terleme ve farkında olma üzerine etkileri

Amaç: Kardiyopulmoner bypassın ısınma döneminde hastalarda sıklıkla terleme görülmekte ve farkında olma riski artmaktadır. Bu çalışmada, fentanil ve izofluran anestezisi uygulanmış kardiyak cerrahi olgularında, anesteziye midazolam eklenmesinin ısınma döneminde görülen terleme ile farkında olma üzerine olan etkilerinin ve bu iki parametre arasındaki olası korelasyonun araştırılması amaçlandı. Materyal ve Metod: Açık kalp ameliyatı uygulanacak 44 olgu. Grup l [fentanil grubu (n = 22)] ve Grup 2 [midazolam grubu (n = 22)] olarak rasgele 2 gruba ayrıldı. Grup l olgularında fentanil (30 mg/kg, İV), Grup 2 olgularında ise midazolam (0.1 mg/kg, İ.V.) ve fentanil (20 g/kg, İV) ile indüksiyon sağlandı. İdamede her iki grupta fentanil infüzyonu (0.1 mg/kg/dak) ve %100 oksijen içinde %0.8 konsantrasyonunda izofluran uygulandı. Grup 2'de ısınma başlangıcında hastaya ek midazolam (0.1 mg/kg, İV) yapıldı. Isınma süresi, oda ısısı, ısınma periyodu boyunca her beş dakikada bir rektal ısı ve terleme miktarı (O = terleme yok, l = alında ter, 2 = alında ve yüzde ter, 3 = yüz, boyun ve saçlı deride yaygın ter) her iki grupta kaydedildi. Postoperatif birinci günde farkında olma testi yapıldı. Gruplar terleme ve farkında olma açısından karşılaştırıldı ve terleme ile farkında olma arasındaki korelasyon araştırıldı. Bulgular: Isınma sırasında fentanil grubunda 14 olguda (%63.55) (derecesi 2.28), midazolam grubunda 18 olguda (derecesi 2) terleme gözlendi, ancak bu fark anlamlı bulunmadı. Grup l'de 12 olguda, Group 2'de iki olguda farkında olma kaydedildi ve gruplar arası karşılaştırmada bu fark anlamlı idi (p < 0.05). Terleme ve farkında olma arasında korelasyon saptanmadı (p > 0.05). Sonuç: Kardiyak cerrahide, ısınma sırasında görülen terleme ile farkında olma arasında korelasyon olmadığı, fentanil ve izofluran anestezisine midazolam ilavesinin farkında olmayı azalttığı, ancak terleme derecesini etkilemediği kanısına varıldı.

The impact of midazolam addition to fentanly anesthesia on awareness and sweating during rewarming in cardiac surgery

Background: Restoration of brain temperature during CPB rewarming may cause patient to sweat, and may result in inadequate depth of anaesthesia. The aim of this study was to investigate the possible correlation between sweating and awareness, and the effect of midazolam on both. Methods: Forty four nonpremedicated patients undergoing conventional cardiac surgery were allocated to the study. Anaesthetic induction was performed with fentanyl (30 g/kg, IV) (Group 1; n = 22), or fentanyl (20 g/kg; IV) and midazolam (0.1 mg/kg, IV) (Group 2; n = 22). Anaesthesia was maintained with fentanyl (0.1 _g kg-1 min-1, IV) and isoflurane (0.8%) within 100% oxygen in both groups. In the second group additional dose of midazolam (0.1 mg kg-1, IV) was given just before starting to rewarm the patient. Rectal temperature was monitored continuously and noted at lowest point, at highest point and every five minutes. Sweating was noted, starting with rewarming until the end of the rewarming period, scored from 0 to 3 (0 = no sweat, 1 = a little sweat on the forehead, 2 = sweat on forehead and in the face, 3 = widespread sweat in face, neck, and head). On the postoperative first day patients were tested for awareness. Groups were compared for both awareness and sweating, and any possible correlation between sweating and awareness was investigated. Results: Awareness was observed in 12 patients in Group 1, and two patients in Group 2, and this difference between groups was statistically significant. The rate of sweating was lower in Group 1 than Group 2 (63.55% and 81.82%, respectively), although the degree of sweating was higher in Group 2 (2.28 vs. 2, respectively). These differences were not statistically significant. There was no correlation between sweating and awareness. Conclusions: Our data suggest that addition of midazolam to fentanyl anaesthesia attenuates the awareness but not the rate and the degree of sweating.

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