Remifentanil ile Kas Gevşeticisiz Entübasyon Uygulanan Çocuklarda Total İntravenöz Anestezi ile İnhaler Anestezisinin Karşılaştırılması

Year 2024, Volume: 9 Issue: 3, 323 - 329, 04.10.2024

Recep Gökçe , Sedat Hakimoğlu

https://doi.org/10.61399/ikcusbfd.1278806

Abstract

Amaç: Çocuklarda tonsillektomi ve/veya adenoidektomi için remifentanil ile kas gevşeticisiz entübasyonun yanı sıra total intravenöz anestezi ile inhaler anestezinin etkileri karşılaştırılmıştır.

Gereç ve Yöntem: Aralık 2014-Haziran 2015 tarihleri arasında tonsillektomi ve/veya adenoidektomi operasyonu geçirecek 80 hasta üzerinde gerçekleştirilmiştir. Hastalar randomize edilerek iki gruba ayrılmıştır. Total intravenöz aneztezi grubuna, 2,5 mg/kg propofol ve 2 mcg/kg remifentanil 90 saniye içinde indüksiyon olarak uygulanmıştır. Bu grupta, anestezi idamesi için 3 mg/kg/saat propofol ve 0,5 mcg/kg/dk remifentanil kullanılmıştır. Sevofluran grubuna ise %8 sevofluran ve 2 mcg/kg remifentanil 90 saniye içinde indüksiyon olarak uygulanmıştır. Bu grupta, anestezi idamesi için %2,5 sevofluran, %50 azot protoksit ve %50 oksijen 6lt/dk'dan kullanılmıştır.

Bulgular: Kalp tepe atımı ve sistolik arter basıncı Grup 2'de anlamlı olarak yüksek bulunmuştur. Diyastolik arter basıncı ise Grup T'de entübasyon sonrası 1 ve 2. dakikalarda, postoperatif 10. dakikada ise Grup I'de yüksek bulunmuştur. Ortalama arter basıncı ise entübasyon sonrası 2. dakikada Grup T'de yüksek görülmüştür. Ayrıca, Wong-Baker ağrı skalası ve ajitasyon skoru Grup I'de anlamlı olarak yüksek bulunmuştur. Spontan solunuma başlama ve extübasyon zamanı ise Grup I'de anlamlı olarak kısaydı. Yan etki açısından ise gruplar arasında fark görülmemiştir.

Sonuç: Grup Total intravenöz aneztezi'nın çocuklarda daha iyi bir tercih olacağı düşünülmüştür çünkü bu yöntem postoperatif ağrı, ajitasyon ve derlenme açısından daha az etkiye sahip olmuştur.

Keywords

Çocuk, İntravenöz Anestezi, Sevofluran, Derlenme, Entübasyon

Comparison of Total Intravenous Anesthesia with Inhaler Anesthesia in Children Intubated with Remifentanil without Muscle Relaxant

Abstract

Objective: The effects of remifentanil and muscle relaxant-free intubation as well as total intravenous anesthesia and inhaled anesthesia for tonsillectomy and/or adenoidectomy in children were compared.

Materials and Methods: The study was conducted on 80 patients who were to undergo tonsillectomy and/or adenoidectomy between December 2014 and June 2015. Patients were randomized and divided into two groups. In the total intravenous anaesthesia group, 2.5 mg/kg propofol and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 3 mg/kg/h propofol and 0.5 mcg/kg/min remifentanil were used for maintenance of anesthesia. In the sevoflurane group, 8% sevoflurane and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 2.5% sevoflurane, 50% nitrogen protoxide and 50% oxygen were used at 6 l/min for maintenance of anesthesia.

Results: Peak heart rate and systolic arterial pressure were significantly higher in Group I. Diastolic arterial pressure was significantly higher in Group T at 1 and 2 minutes after intubation and in Group 2 at 10 minutes postoperatively. Mean arterial pressure was higher in Group T at 2 minutes after intubation. In addition, Wong-Baker pain scale and agitation score were significantly higher in Group I. Spontaneous respiration and extubation time were significantly shorter in Group I. There was no difference between the groups in terms of side effects.

Conclusion: Group total intravenous anaesthesia was thought to be a better choice in children because it had less impact on postoperative pain, agitation and recovery.

Keywords

Pediatric, intravenous anesthesia, sevoflurane, recovery, intubation. parents.

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