Cihangir BİÇER, Gülen GÜLER, Aliye ESMAOĞLU, Kudret DOĞRU, Fatih UĞUR, Adem BOYACI

TUR ameliyatlarında düşük doz intratekal bupivakain+fentanil ile aynı volümdeki bupivakainin etkilerinin karşılaştırlması

Çalışmamızda transuretral rezeksiyon planlanan olgularda, 7.5 mg (1.5 mL) intratekal % 0.5'lik hiperbarik bupivakain+25 $mu$g (0.5 mL) fentanil ile 10 (2 mL) mg intratekal hiperbarik bupivakainin etkilerini karşılaştırmayı amaçladık. Transuretral rezeksiyon planlanan 40 olgu, her grupta 20 olgu olacak şekilde rasgele iki gruba ayrıldı. Grup I olgulara 7.5 mg hiperbarik bupivakain+25 $mu$g fentanil, Grup II olgulara 10 mg hiperbarik bupivakain spinal aralıktan verildi. Girişim boyunca ve postoperatif; sistolik arter basıncı (SAB), diyastolik arter basıncı (DAB), kalp atım hızı (KAH) periferik oksijen saturasyonu (SpO2), motor ve duysal blok seviyeleri ile analjezi kalitesi kaydedildi. Hemodinamik parametreler ve SpO2 değerleri bakımından gruplar arasında istatistiksel yönden fark olmamasına rağmen Grup I'de iki olguda SpO2 değeri başlangıç değerinin % 5 altına düştü. Grup Il'de ise dört olguda bradikardi gözlendi. Duysal blok süresi Grup I'de anlamlı olarak uzarken, motor blok derecesi Grup Il'de daha yüksekti. İlk 24 saat içinde analjezik ihtiyacı olan olgu sayısı Grup I'de Grup ll'ye göre anlamlı olarak azalmıştı (p

Comparison of low dose bupivacaine+fentanyl with bupivacaine in some volume for spinal anaesthesia in transurethral resection

The aim of the present study was to compare the clinical effects of 25 $mu$g (0.5 mL) fentanyl combined with 1.5 mL % 0.5 hyperbaric bupivacaine and 2 mL % 0.5 hyperbaric bupivacaine, in patients undergoing transurethral resection. Fourty patients, scheduled for transurethral resection of the prostate or bladder tumors were randomly assigned into two groups. Spinal anaesthesia was performed with 7.5 mg hyperbaric bupivacaine+25 $mu$g fentanyl in Group I (n=20), 10 mg hyperbaric bupivacaine in Group II (n=20). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate, peripheral oxygen saturation (SpO2), duration and the degree of motor and sensorial blocks and analgesic efficacy were recorded perioperatively. Although there were no significant differences between two groups regarding hemodynamic parameters, we observed bradicardia in four patients in Group II. Comparison of pre and post blockade values of SpO2 showed 5 % decrease in two patients in Group I. While the duration of the sensorial block was longer in Group I, intensity of motor block was higher in Group II (p

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1. Carpenter RL: Hyperbaric lidocaine spinal anaeshtesia: do we need an alternative? Anesth Analg 1995; 81:1125-8.
2. Ben-David B, Levin H, Solomon E, Admoni H, Vaida S: Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 1996; 83:716-9.
3. Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z: Intrathecal fentanyl with small-dose dilute bupivacain: better aneshtesia without prolonging recovery. Anesth Analg 1997; 85:560-4.
4. McCrae AF, Wildsmith JAW: Prevention and treatment of hypotension during central neural block. Br J Anaesth 1993; 70:672-6.
5. Meyer J, Enk D, Penner M: Unilateral spinal aneshtesia using low-flow injection through a 29-gauge Quincke needle. Anesth Analg 1996; 82: 1188-91.
6. Pitkanen M, Haapaniemi L, Tuominen M, Rosenberg PH: Influence of age on spinal anesthesia with isobaric 0.5 % bupivakaine. Br J Anaesth 1984; 56:279-84.
7. Liu SS, Ware PD, Allen WH, Neal JM, Pollock EJ: Dose-Response Characteristics of spinal bupivacaine in volunteers. Anesthesiology 1996; 85:729-36.
8. Rout CC, Rocke DA, Levin J, Gouws E, Reedy D: A revolution of the role of crystalloid preload in the prevention of hypotansion associated with spinal anesthesia for elective caesarean section. Anesthesiology 1993; 79:262-9.
9. Coe AJ, Revanas B: Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia 1990; 45:241-3.
10. Galinski FD, Rue M, Moral V, Castells C, Puig MM: Spinal anesthesia with bupivacaine and fentanyl in geriatric patients. Anesth Analg 1996; 83:537-41.
11. Kuusniemi KS, Pihlajamaki KK, Pitkanen MT, Helenius HY, Kirvela OA: The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000; 91:1452-6.
12. Etches R, Sandler A, Daley M: Respiratory depression and spinal opioids. Can J Anaesth 1989; 36:165-85.
13. Varassi G, Celleno D, Capogna G, et al: Ventilatory effects of subarachnoid fentanyl in the elderly. Anaeshtesia 1992; 47:558-62.
14. Liu S, Chiu A, Carpenter R, et al: Fentanyl prolongs lidocaine spinal aneshtesia without prolonging recovery. Anesth Analg 1995; 80:730-4.
15. Sessler DI: Temperature monitoring. In:Miller RD, ed. Anesthesia. New York: Churchill Livingstone 1994; p.1363-83.
16. Kranke P, Eberhart LH, Roewer N, Tramer MR: Pharmacological treatment of postoperative shivering: A quantitative Systematic review of randomized controlled trials. Anesth Analg 2002; 94:453-60.
17. Kurz A, Sessler ID, Schroeder M, Kurz M: Thermoregulatory response thresholds during spinal aneshtesia. Anesth Analg 1993; 77:721-6.
18. Frank SM, El-Rahmany KH, Cattaneo GC, Barnes AR: Predictors of hypothermia during spinal aneshtesia. Anesthesiology 2000; 92:1330-4.
19. Wheelahan MJ, Leslie K, Silbert SB: Epidural fentanyl reduces the shivering threshold during epidural lidocaine aneshtesia. Anesth Analg 1998; 87:587-90.