TONSİLLEKTOMİ/ADENOTONSİLLEKTOMİ CERRAHİSİNDE KETAMİNİN PREEMPTİF ANALJEZİK ÖZELLİKLERİ

Year 2004, Volume: 5 Issue: 3, 15 - 20, 01.12.2004

Osman Nuri Aydın Bakiye Uğur Sanem Özgün Hülya Eyigör Özgen Copcu

Abstract

Amaç:Tonsillektomi/adenotonsillektomi operasyonlarında cerrahinin çeşitli zamanlarında uygulananketaminin preemptif analjezik özelliklerini araştırmaktır.Yöntem:Tıp Fakültesi Etik Kurulu ve olguların/ailelerinin yazılı onamları sonrası, çalışma prospektif,randomize, çift kör olarak gerçekleştirildi. Yaşları 5-15 arası, 90 çocuk 3 gruba ayrıldı. Preemptif grupta (Grup P,n=30) tosillektomi pozisyonununda, ketamin 0,5mg/kg intravenöz (İV) 2mL serum fizyolojik (%0.9 NaCl=SF)içinde uygulandı. Kanama kontrolüne kadar 6 g/kg/dak. ketamin infüzyonuna devam edildi ve kanamakontrolünde 2 mL SF uygulandı. Ketamine grubunda (Grup K, n=30), tonsillektomi pozisyonu başlangıcında İV2 mLSF verildi. Sonrasında 10 mL/saat SF infüzyonuna devam edildi ve kanama kontrolünde 0,8 mg/kg ketamin2 mL SF içinde İV verildi. Kontrol grubunda (Grup C, n=30) tonsillektomi pozisyonu, cerrahi boyunca vekanama kontrolünde İV SF uygulandı. Postoperatif periyotta sözel ağrı skoru (VPS)>3 olduğunda, ilk 6 saatte1mg/kg İV tramadol, sonrasında 6 mg/kg oral parasetamol ile ağrı sağaltımı yapıldı. Kardiorespiratuar sistembulguları, anesteziden uyanma ve taburcu olma parametreleri tramadol ve parasetamole ihtiyaçı olan olgu sayısı,parasetamol doz sayısı ve komplikasyonlar kaydedildi.Bulgular: Anesteziden uyanma ve taburcu olma parametreleri ile kardiyorespiratuar sistem bulguları gruplararasında benzerdi. Sözel ağrı skoru preemptif grupta, erken postoperatif dönem ve 4. saatte diğer iki gruptan dahadüşükken, 6. saatte kontrol grubunda diğer iki gruptan yüksekti (P<0,05). Parasetamol ve tramadol ihtiyacı olanolgu sayısı ve total parasetamol dozu preemptif grupta diğer iki gruptan daha azdı.Sonuç:Cerrahi insizyon başlamadan önce kullanıldığında, ketaminin tonsillektomi/ adenotonsillektomioperasyonu sonrası preemptif analjezik etkili olduğu ve postoperatif analjezik ihtiyacını azalttığı kanısına varıldı

Keywords

Ketamin, tonsillektomi, preemptif analjezi, postoperatif analjezi ihtiyacı

Preemptive Analgesic Properties of Ketamine on Tonsillectomy Surgery

Abstract

Objectives: The aim was to evaluate the preemptive analgesic effects of ketamine was used in different stages of surgery. Method: All of the patients/parents were informed and The Ethical Committee of the Medical Faculty approved the study. Ninety patients (ages, 5-15) divided into three groups. The pre-emptive group (Group P, n=30) received intravenous (IV) ketamine 0,5mg/kg in 2mL saline at tonsillectomy position, followed by a continuous infusion of ketamine 6g/kg/min, and 2 mL saline was administered during homeostasis. In the ketamine group (Group K, n=30), 2 mL saline was given at tonsillectomy position, and saline infusion (10 mL/h) continued until homeostasis, and 0,8 mg/kg examine was given during homeostasis in 2 mLsaline. In the control group (Group C, n=30) saline was given at all stages of study. When VPS is greater than 3; tramadol 1 mg/kg IV administered in the first 6 hours postoperatively, and after paracetamol orally, 40mg/kg was given. Cardiorespiratory system data, recovery from anaesthesia and discharging parameters, tramadol and paracetamol requirement, total dose of paracetamol, and complications were recorded. Results: Recovery from anesthesia and discharging parameters were similar between the groups. In the preemptive group, VPS scores were lower than the other two groups at the early postoperative period, and at 4th, hours. The VPS scores were higher in the control group than the other two groups at 6th hour (P< 0,05). Tramadol and paracetamol requirement, total dose of paracetamol were fewer than the other groups in the preemptive group. Total complication number was similar in all groups. Conclusion: Ketamine decreases postoperative analgesic requirement and has preemptive analgesic effect when used before surgery in tonsillectomy/adenotonsillectomy surgery.

Keywords

Ketamine, tonsillectomy, preemptive analgesia, postop. analgesic requirement

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