Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması

Abstract

Amaç:  Sevofluran çocuklarda anestezi indüksiyonu ve idamesinde en sık tercih edilen volatil anestezik ajandır. Çalışmamızda genel anestezinin analjezik komponentini N₂O veya kaudal blok ile sağlayarak ve anestezi süresince bisepektral indeks (BIS) monitörizasyonu ile anestezi derinliğini sabit tutarak; bu iki uygulama şeklinin minimal alveolar konsantrasyon (MAK) ve hemodinami üzerindeki etkilerini gözlemsel olarak karşılaştırmayı amaçladık.

Gereç ve Yöntemler: Genel anestezi altında günübirlik operasyon geçirecek 40 çocuk hastaya; %40 O2/hava (grup K) veya %40 O2/N2O (grup N) karışımı içinde %8 sevofluran kullanılarak inhalasyon indüksiyonu uygulandı. Gurup K’daki çocuklara yan yatar pozisyonda,  22 G kaudal iğneyle 0.7 mL/kg,  % 0.2  bupivakain solüsyonu kullanılarak kaudal blok uygulandı. Operasyon süresince her iki grubun hemodinamik parametreleri, BIS ve MAK değerleri takip edilerek kaydedildi.

Bulgular: Her iki grubun hemodinamik parametreleri benzer bulunmuştur. Sevofluranın, N2O katkısı olmaksızın kaudal blok yapılan grupta istatiksel yönden anlamlı olmamakla birlikte daha düşük MAK değerlerinde sürdürülebildiği tespit edilmiştir.

Sonuç: İntraoperatif ve postoperatif analjezi sağlamanın yanı sıra çevre kirliliğini azaltması yönünden de bir avantaj sağladığı için kaudal bloğun, anestezi sırasında uygun koşullarda N₂O’e göre daha öncelikle tercih edilmesi gerektiği düşüncesindeyiz.

Keywords

• Sevofluran anestezisi,nitröz oksit,kaudal blok

Observational comparison of sevoflurane and nitrous oxide or caudal block in pediatric patients

Abstract

Aim: Sevoflurane is the most preferred volatile anesthetic agent for the induction and maintenance of anesthesia in children. In our study, the analgesic component of general anesthesia was provided by N₂O or caudal block and during anesthesia, the depth of the anesthesia was kept constant by means of the monitoring of bispectral index (BIS). We aimed to make an observational comparison the effects of these two methods on minimal alveolar concentration (MAC) and hemodynamics.

Material and Methods: Forty pediatric patients scheduled to undergo on day case based surgery under general anesthesia were included in the study. Inhalation induction using 8% sevoflurane in a mixture of 40% O2/Air (group K) or 40% O2/N2O (group N) were used in all children.  Then, patients in Group K received caudal block in lateral decubitus position with 0.7 mL/kg, 0.2% bupivacaine solution using 22 G caudal needle. Hemodynamic parameters, BIS and MAC values were recorded during the operation in all patients.

Results: Hemodynamic parameters were similar in both groups. It was determined that sevoflurane was not statistically significant in the caudal block group without the contribution of N2O, but could be maintained in lower MAC values.

Conclusion: We recommend use of caudal block since it ensures adequately satisfactory intraoperative and postoperative analgesia without any harm to atmosphere in comparison to N₂O during general anesthesia in the presence of no medical contraindications.

Keywords

• sevoflurane anesthesia,nitrous oxide,caudal block

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