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ABDOMİNAL CERRAHİDE REMİFENTANİL VE ALFENTANİL İNFÜZYONLARININ KARŞILAŞTIRILMASI

Year 2005, Volume: 6 Issue: 1, 5 - 8, 01.04.2005

Abstract

Amaç:Bu çalışmada, abdominal cerrahi uygulanan hastalarda inhalasyon anestezisine eklenen remifentanil vealfentanil infüzyonlarının etkinliği ve güvenirliği karşılaştırıldı.Yöntem ve bulgular:ASA I-II, 22-65 yaşları arasında 40 hasta rastgele iki gruba ayrılarak çalışmaya alındı.İndüksiyona, remifentanil grubunda (Grup R, n=20) 1 g/kg bolus ve 0.5 g/kg/dk remifentanil infüzyon dozu,alfentanil grubunda (Grup A, n=20) 25 g/kg bolus ve 1 g/kg/dk alfentanil infüzyon dozu ile başlandı ve her ikigruba bilinç kaybı sağlanıncaya kadar 10 mg/10 sn hızda propofol verildi. İdame %0.5 end tidal izofluran, %66N O/O ile sağlandı. Entübasyondan 5 dakika sonra ilaç infüzyon dozları %50 azaltıldı. Remifentanil operasyonbitiminde, alfentanil ise 15 dakika önce sonlandırıldı. Cerrahiye otonomik ve somatik yanıt, bolus ve infüzyonartışları ile kontrol edildi. Derlenme; spontan solunum, yeterli solunum, sözel emre yanıt zamanları ve Aldreteskorlaması ile değerlendirildi.Cerrahiye hemodinamik yanıt, ilaç bolus ve infüzyon artışları Grup A'da, hipotansiyon ve bradikardi, Grup R'dedaha fazla bulundu. Yeterli solunum, ekstübasyon ve sözel emre yanıt verme zamanları Grup R'de daha kısa,Aldrete skorları ise benzer bulundu.Sonuç:Bu çalışmada kullanılan infüzyon dozlarında remifentanil, intraoperatif hemodinamik yanıtı daha iyikontrol ederken, hızlı derlenme özelliği ile de alfentanilden daha etkin ve güvenli bulundu

References

  • 1. Andrews CJH, Sinclair M, Prys-Roberts, et al. Ventilatory effects during and after continuous infusion of fentanyl or alfentanil. Br JAnaesth 1983;55:211-6.
  • 2. Monk TG, Mueller M, White PF. Treatment of stress responses during balanced anesthesia. Comparative effects of isoflurane, alfentanil, and trimethaphane. Anesthesiology 1992;76:39-45.
  • 3. Fragen RJ. Total intravenous anesthesia. In: Fragen RJ (ed). Drug infusions in anesthesiology, 2 ed. Philadelphia: Lippincott-Raven Publishers, 1996;149- 171.
  • 4. Bailey PL, Egan TD, Stanley H. Intravenous opioid anesthetics. In: Miller RO (ed). Anesthesia. New York: Churchill Livingstone, 2000; 273-376.
  • 5. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil.AnesthAnalg 1999;89:7-14.
  • 6. Egan TD, Lemmens HJM, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers.Anesthesiology 1993;79:881-92.
  • 7. Glass PSA, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra short acting opioid: remifentanil. (GI87084B).AnesthAnalg 1993;77:1031-40.
  • 8. Alderete JA. The post-anesthesia recovery score revisited. J ClinAnesth 1995;7:9.
  • 9. Schüttler J, Albrecht S, Breivik H, et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia 1997;52:307- 17.
  • 10. Cartwright DP, Kvalsvik O, Cassuto J, et al. A randomized, blind comparison of remifentanil and alfentanil during anesthesia for outpatient surgery. AnesthAnalg 1997;85:1014-9.
  • 11. Elliot P, O'Hare R, Bill KM, et al. Severe cardiovascular depression with remifentanil. Anesth Analg 2000;91:58-61.
  • 12. Mallick A, Elliot S, Egan TD, et al. Remifentanil is too potent to be given by bolus. Br J Anaesth 2004;93:305- 306.
  • 13. Philip BK, Scuderi PE, Chung F, et al. Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. Anesth Analg 1997;84:515-21.
  • 14. Sebel PS, Hoke JF, Westmoreland C, et al. Histamine concentrations and hemodynamic responses after remifentanil.AnesthAnalg 1995;80:990-3. 15. Kapila A, Lang E, Glass P, et al. MAC reduction of isoflurane by remifentanil. Anesthesiology 1994;81(3A):A378.
  • 16. Glass PSA, Hardman HD, Kamiyama Y, et al. Pharmacodynamic comparison of G187084B (GI) a novel ultra-short acting opioid and alfentanil {abstract}.AnesthAnalg 1992;74:S113.

A Comparison of Remifentanil and Alfentanil Infusions in Abdominal Surgery

Year 2005, Volume: 6 Issue: 1, 5 - 8, 01.04.2005

Abstract

Objective: We studied the efficacy and safety of remifentanil and alfentanil infusions in combination with inhalational anesthesia during abdominal surgery. Material and methods: Forty patients, ASA I-II, aged between 22-65 years were randomly allocated into two groups. Anesthesia was induced with remifentanil 1 g/kg bolus, followed by 0.5 g/kg/min infusion in the remifentanil group (Group R, n=20), alfentanil 25 g/kg bolus and 1 g/kg/min infusion in the alfentanil group (Group A, n=20) and propofol was given at a rate of 10 mg/10 sec until loss of consciousness. Lungs were ventilated with 0.5% end-tidal isoflurane and 66% N2O/O2. Infusion rates were reduced by 50% 5 minutes after intubation. Remifentanil was discontinued at the end of operation and alfentanil 15 minutes before. Autonomic and somatic responses to surgery were controlled with bolus and infusion rate increases. Recovery was assessed with the time for spontaneous and adequate respiration, response to verbal command and Aldrete scores. Results: Hemodynamic response to surgery, drug boluses and increases in infusion rates were found to be higher in Group A, while incidences of hypotension and bradycardia were higher in Group R. In Group R, adequate respiration, extubation and response to verbal command were shorter and Aldrete scores were similar. Conclusion: Remifentanil, when administered at the same doses with this study, controlled intraoperative hemodynamic response better in comparison with alfentanil and was found to be more effective and safe because of its rapid recovery properties.

References

  • 1. Andrews CJH, Sinclair M, Prys-Roberts, et al. Ventilatory effects during and after continuous infusion of fentanyl or alfentanil. Br JAnaesth 1983;55:211-6.
  • 2. Monk TG, Mueller M, White PF. Treatment of stress responses during balanced anesthesia. Comparative effects of isoflurane, alfentanil, and trimethaphane. Anesthesiology 1992;76:39-45.
  • 3. Fragen RJ. Total intravenous anesthesia. In: Fragen RJ (ed). Drug infusions in anesthesiology, 2 ed. Philadelphia: Lippincott-Raven Publishers, 1996;149- 171.
  • 4. Bailey PL, Egan TD, Stanley H. Intravenous opioid anesthetics. In: Miller RO (ed). Anesthesia. New York: Churchill Livingstone, 2000; 273-376.
  • 5. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil.AnesthAnalg 1999;89:7-14.
  • 6. Egan TD, Lemmens HJM, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers.Anesthesiology 1993;79:881-92.
  • 7. Glass PSA, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra short acting opioid: remifentanil. (GI87084B).AnesthAnalg 1993;77:1031-40.
  • 8. Alderete JA. The post-anesthesia recovery score revisited. J ClinAnesth 1995;7:9.
  • 9. Schüttler J, Albrecht S, Breivik H, et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia 1997;52:307- 17.
  • 10. Cartwright DP, Kvalsvik O, Cassuto J, et al. A randomized, blind comparison of remifentanil and alfentanil during anesthesia for outpatient surgery. AnesthAnalg 1997;85:1014-9.
  • 11. Elliot P, O'Hare R, Bill KM, et al. Severe cardiovascular depression with remifentanil. Anesth Analg 2000;91:58-61.
  • 12. Mallick A, Elliot S, Egan TD, et al. Remifentanil is too potent to be given by bolus. Br J Anaesth 2004;93:305- 306.
  • 13. Philip BK, Scuderi PE, Chung F, et al. Remifentanil compared with alfentanil for ambulatory surgery using total intravenous anesthesia. Anesth Analg 1997;84:515-21.
  • 14. Sebel PS, Hoke JF, Westmoreland C, et al. Histamine concentrations and hemodynamic responses after remifentanil.AnesthAnalg 1995;80:990-3. 15. Kapila A, Lang E, Glass P, et al. MAC reduction of isoflurane by remifentanil. Anesthesiology 1994;81(3A):A378.
  • 16. Glass PSA, Hardman HD, Kamiyama Y, et al. Pharmacodynamic comparison of G187084B (GI) a novel ultra-short acting opioid and alfentanil {abstract}.AnesthAnalg 1992;74:S113.
There are 15 citations in total.

Details

Other ID JA27VC35EA
Journal Section Research Article
Authors

Gonca Tuncel This is me

Serpil Şavlı This is me

Gülçin Özalp This is me

Sanem Turgut This is me

Nihal Kadıoğulları This is me

Publication Date April 1, 2005
Published in Issue Year 2005 Volume: 6 Issue: 1

Cite

EndNote Tuncel G, Şavlı S, Özalp G, Turgut S, Kadıoğulları N (April 1, 2005) A Comparison of Remifentanil and Alfentanil Infusions in Abdominal Surgery. Meandros Medical And Dental Journal 6 1 5–8.