Karamehmet YILDIZ, Aliye ESMAOĞLU, Kudret DOĞRU, Adem BOYACI, Elvan TERCAN

Total intravenöz anestezide BİS monitörizasyonu eşliğinde alfentanil ve remifentanil karşılaştırması

Bu çalışmada, TİVA 'de propofol-alfentanil ve propofol-remifentanil kombinasyonlarını, intraoperatif hemodinamik stabilite, BİS değerleri ve postanestezik uyanma özellikleri yönünden karşılaştırmayı amaçladık. Laparoskopik kolesistektomi planlanan, ASA I-II grubu, 50 hasta rasgele iki gruba ayrıldı. Birinci gruba (n=25) propofol-alfentanil ve II. gruba (n=25) propofol-remifentanil kombinasyonlarıyla TİVA uygulandı. Anestezi indüksiyonu, 2 mg/kg propofol ile birlikte, çalışma grubuna uygun olarak, 10 $mu$g/kg alfentanil veya toplam 1.5 $mu$g/kg (1+0.5 $mu$g/kg) remifentanil ile sağlandı. Anestezi idamesi, I. grup hastalarda 1 $mu$g/kg/dk alfentanil, II. grup hastalarda 0.25 $mu$g/kg/dk remifentanil ve her iki grup hastalarda 9 mg/kg/saat propofol infüzyonu ile sağlandı. Ameliyat süresince, hastaların hemodinamik verileri, SpO2 ve BİS değerleri ölçülerek kaydedildi. Erken post-anestezik dönemde Aldrete skorları ve geç postanestezik dönemde "Delayed Memory Recall Test" hata puanları ile ilaçlara bağlı yan etkiler kaydedildi. Remifentanil grubunda hemodinamik veriler, başlangıç değerlerine ve alfentanil grubuna göre daha düşüktü. Remifentanil grubundaki hastaların BİS değerleri, ekstübasyon dönemi ve sonrasında, alfentanil grubundaki hastalardan daha yüksekti. Uyanma odasında analjezik ihtiyacı olan hastaların sayısı, remifenlanil grubunda, alfentanil grubundan daha fazla idi. Erken postanestezik dönemde remifentanil grubundaki hastaların Aldrete skorları, alfentanil grubundaki hastalardan daha yüksekti. Geç postanestezik dönemlerde "Delayed Memory Recall Test" hata puanları, remifentanil grubunda, alfentanil grubundan anlamlı olarak daha düşüktü. Sonuç olarak; hem erken hem de geç postoperatif dönemde uyanma hızı ve kalitesi yönünden remifentanilin, özellikle günübirlik vakalar ya da erken taburcu olması beklenen hastalarda uygulanacak TİVA'de, alfentanile iyi bir alternatif olduğunu söyleyebiliriz. Bunun yanısıra, postoperatif dönemde analjezik ihtiyacının daha erken ortaya çıkması, remifentanil için dezavantaj olabilir. Hem intraoperatif dönemde anestezi kalitesinin değerlendirilmesi, hem de postoperatif dönemde uyanma hızı ve kalitesine olumlu katkıları nedeniyle TİVA 'de, BİS mönitarizasyonunun yararlı olduğu söylenebilir.

A copmparison of alfentanil and remifentanil accompanying with BIS monitorization for total intravenous anaesthesia

In this study it was aimed to compare the effects of propofol-alfentanil and propofol-remifentanil combination in TIVA on intraoperative haemodynamic stability, BIS values, and postoperative recovery characteristics. Fifty patients, ASA I or II class and who were scheduled for laparoscopic cholesistectomy were randomly divided into two groups. First group (n=25) propofol-alfentanil and the second group (n=25) were received propofol-remifentanil combination for TIVA respectively. The induction of anaesthesia was performed with propofol 2 mg/kg doses for each group and then the Group I were received 10 mg/kg alfentanil, Group II were received a total dose of 1.5 mg/kg (1+0.5 mg/kg) remifentanil respectively. Group I were received alfentanil 1 mg/kg min and Group II were received remifentanil 0.25 mg/kg min respectively and each group also received propofol 9 mg/kg/hr for the maintenance of anaesthesia. During the operation, haemodynamic data, SpO2 and BIS values were measured and recorded. Aldrete Scores in early post-anaesthetic periods and the error points of "Delayed Memory Recall Test" in late postanaesthetic periods and side effects of the drugs were recorded. Hemodynamic data of remifentanil group were lower than the baseline data and the alfentanil group. During and after the extubation period, BIS values of the remifentanil group were higher than the alfentanil group. The number of patients who received analgesic in remifentanil group were higher than in alfentanil group in postanesthesia care unit. During the early postanaesthetic period, Aldrete Scores of patients in remifentanil group were higher than in alfentanil group. The error points "Delayed Memory Recall Test" in the late postanaesthetic periods in remifentanil group were significantly lower than the alfentanil group. As a conclusion, we can say that remifentanil is a good alternative to alfentanil, in both early and late post-anaesthetic periods, regarding to recovery rate and quality, especially in TIVA for those patients who were expected to be early discharged and day-case operations. Besides that the early analgesic needs in the postoperative period may be disadvantage for remifentanil we think that BIS is useful application for the TIVA because of positive contributions to both evaluation of anaesthesia quality and recovery rate in intraoperative period and quality in postoperative period.

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