TY - JOUR T1 - A comparison of the effects of urapidil and remifentanil on hemodynamics and extubation quality in intracranial surgery AU - Biricik, Ebru AU - Kaya, Fatih AU - Ilgınel, Murat Türkeün AU - Laflı Tunay, Demet AU - Karacaer, Feride AU - Cerit, Burak AU - Güneş, Yasemin PY - 2024 DA - December Y2 - 2024 DO - 10.36516/jocass.1544053 JF - Journal of Cukurova Anesthesia and Surgical Sciences JO - J Cukurova Anesth Surg PB - Merthan TUNAY WT - DergiPark SN - 2667-498X SP - 223 EP - 228 VL - 7 IS - 4 LA - en AB - Giriş: Serebral perfüzyon basıncını azaltmak ve kanama riskini en aza indirmek için uyanma sırasında stabil hemodinamiği korumak oldukça önemlidir. Urapidil ve remifentanilin ekstübasyon kalitesi ve ekstübasyon sırasında hemodinami üzerindeki etkilerini karşılaştırmayı amaçladık.Materyal ve Metod: 18-65 yaş aralığında, ASA 1-3 dahil 90 hasta çalışmaya dahil edildi. Anestezi tüm gruplarda remifentanil 0,125-0,25 µg/kg/dk ve sevofluran %1-2 ile sürdürüldü. Grup I' de remifentanil infüzyonu ameliyatın son 15 dakikasında 0,02-0,03 µg/kg/dk' ya düşürüldü. Grup II' de remifentanil infüzyonu ameliyatın bitiminden 15 dakika önce durduruldu. 5 dakika sonra, urapidil bolus dozu (12,5 mg) verildi ve urapidil infüzyonu (3,2-4,8 μg/kg/dak) başlatıldı. Grup III'te, remifentanil infüzyonu ameliyatın bitiminden 15 dakika önce durduruldu ve urapidil infüzyonu (3,2-4,8 μg/kg/dak) başlatıldı. Hemodinamik veriler, entropi değerleri ve Glasgow Koma Skalası, son 15. dakikada ve ekstübasyondan sonraki 5. dakikaya kadar kaydedildi.Bulgular: Ekstübasyondan önce ve sonra SAP (sistolik arter basıncı), MAP (ortalama arter basıncı) ve DAP (diyastolik arter basıncı) ortalama değerleri arasında istatistiksel olarak anlamlı farklar gözlendi (p KW - urapidil KW - remifentanil KW - hemodynamics KW - intracranial surgery CR - 1.Gesztesi Z, Mootz BL, White PF. The Use of a Remifentanil Infusion for Hemodynamic Control During Intracranial Surgery. Anesth Analg. 1999;89:1282-7. https://doi.org/10.1213/00000539-199911000-00038 CR - 2.Warner DS, Hindman BJ, Todd MM et al. Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniectomy. Anesth Analg. 1996;83:348-53. https://doi.org/10.1213/00000539-199608000-00025 CR - 3.Luthra A, Prabhakar H, Rath GP. Alleviating stress response to tracheal extubation in neurosurgical patients: a comparative study of two infusion doses of dexmedetomidine. J Neurosci Rural Pract. 2017;8:49-56. https://doi.org/10.4103/jnrp.jnrp_91_17 CR - 4.Zhou Y, Liu L, Fan F et al. Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome. J Hypertens. 2021;39:1982-90. https://doi.org/10.1097/HJH.0000000000002872 CR - 5. Louizos AA, Hadzilia SJ, Davilis DI et al. Administration of esmolol in microlaryngeal surgery for blunting the hemodynamic response during laryngoscopy and tracheal intubation in cigarette smokers. Ann Otol Rhinol Laryngol. 2007;116:107-11. https://doi.org/10.1177/000348940711600205 CR - 6.Min JH, Chai HS, Kim YH et al. Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol. 2010;76:188-92. CR - 7.Ghodraty MR, Hasani V, Bagheri-Aghdam A et al. Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial. J Clin Anesth. 2016;33:514-20. https://doi.org/10.1016/j.jclinane.2015.09.001 CR - 8.Kim MH, Lee KY, Bae SJ et al. Intraoperative dexmedetomidine attenuates stress responses in patients undergoing major spine surgery. Minerva Anestesiol. 2018;85:468-77. https://doi.org/10.23736/S0375-9393.18.12992-0 CR - 9.Egan TD. Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000. Curr Opin Anaesthesiol. 13:449-455, 2000 https://doi.org/10.1097/00001503-200008000-00009 CR - 10.Liu YH, Hu XB, Yang XM et al. Comparing remifentanil and sufentanil in stress reduction during neurosurgery: a randomised controlled trial. Int J Clin Pharm. 2020;42:1326-34. https://doi.org/10.1007/s11096-020-01094-1 CR - 11.Guy J, Hindman BJ, Baker KZ et al. Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions. Anesthesiology. 1997;86:514-24. https://doi.org/10.1097/00000542-199703000-00002 CR - 12.Balakrishnan G, Raudzens P, Samra SK et al. A Comparison of Remifentanil and Fentanyl in Patients Undergoing Surgery for Intracranial Mass Lesions. Anest Analg. 2000;91:163-9. https://doi.org/10.1213/00000539-200007000-00030 CR - 13.Nho JS, Lee SY, Kang JM et al. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation. Br J Anaesth. 2009;103:817-21. https://doi.org/10.1093/bja/aep307 CR - 14.Aouad MT, Al-Alami AA, Nasr VG et al. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia Anesth Analg. 2009;108:1157-60. https://doi.org/10.1213/ane.0b013e31819b03d8 CR - 15.Xing Y, Lin N, Han R et al. Sevoflurane versus Propofol combined with Remifentanil anesthesia Impact on postoperative Neurologic function in supratentorial Gliomas (SPRING): protocol for a randomized controlled trial. BMC Anesthesiol. 2020;20:117. https://doi.org/10.1186/s12871-020-01035-5 CR - 16.Cote DJ, Burke WT, Castlen JP et al. Safety of remifentanil in transsphenoidal surgery: A single-center analysis of 540 patients. J Clin Neurosci. 2017;38:96-9. https://doi.org/10.1016/j.jocn.2016.12.011 CR - 17.Coles JP, Leary TS, Monteiro JN et al. Propofol Anesthesia for Craniotomy. A Double-Blind Comparison of Remifentanil, Alfentanil, and Fentanyl. J Neurosurg Anesthesiol. 2000;12:15-20. https://doi.org/10.1097/00008506-200001000-00004 CR - 18.Gunduz M, Gunes Y, Ozbek H et al. Comparison of dexmedetomidine or remifentanil infusion combined with sevoflurane anesthesia in craniotomy: hemodynamic variables and recovery. Neurosurgery Quarterly. 2009;19:116-9. https://doi.org/10.1097/WNQ.0b013e3181a45b0d CR - 19.Langtry HD, Mammen GJ, Sorkin EM. Urapidil. Drugs. 1989;38:900-40. https://doi.org/10.2165/00003495-198938060-00005 CR - 20.Alijotas-Reıg J, Bove-Farre I, de Cabo-Frances F et al. Effectiveness and Safety of Prehospital Urapidil for Hypertensive Emergencies. Am J Emerg Med. 2001;19:130-3. https://doi.org/10.1053/ajem.2001.20008 CR - 21.Van Aken H, Puchstein C, Anger C et al. The influence of urapidil, a new antihypertensive agent, on cerebral perfusion pressure in dogs with and without intracranial hypertension. Intensive Care Med. 1983;9:123-6. https://doi.org/10.1007/BF01772578 CR - 22.Scafuro M, Cafaggi G, Petrella F et al. Urapidil: hypotension induced in neuroanesthesia. Minerva Anestesiol. 1992;58:141-4. CR - 23.Steib A, Freys G, Curzola U et al. Effects of urapidil on the cardiovascular response to intratracheal intubation. Annales Francaises D'anesthesie et de Reanimation. 1991;10:113-6. https://doi.org/10.1016/S0750-7658(05)80451-4 CR - 24.Quéré J, Ozier Y, Bringier J et al. Does urapidil attenuate the blood pressure response to tracheal intubation for general anaesthesia? Drugs (Basel). 1990;40:80-1. https://doi.org/10.2165/00003495-199000404-00025 CR - 25.Hernández-Palazón J, Tortosa Serrano JA, García-Palenciano C et al. Cardiovascular response to tracheal intubation in patients with intracranial tumor. Comparative study between urapidil and lidocaine. Rev Esp Anestesiol Reanim. 2000;47:146-50. CR - 26.Ye T, Luo A, Ren H et al. Preliminary report on cardiovascular responses to urapidil during intubation and extubation. Chin Med Sci J. 1993;8:240-2. CR - 27.Tauzin-Fin P, Sesay M, Gosse P et al. Effects of perioperative alpha1 block on haemodynamic control during laparoscopic surgery for phaeochromocytoma. Br J Anesth. 2004;92:512-7. https://doi.org/10.1093/bja/aeh083 UR - https://doi.org/10.36516/jocass.1544053 L1 - https://dergipark.org.tr/tr/download/article-file/4192834 ER -