Fentanil ve Remifentanil’in perkütan nefrolitotomi vakalarında inraoperatif hemodinami ve postoperatif derlenmeye etkileri

Yıl 2021, Cilt: 13 Sayı: 3, 93 - 100, 29.12.2021

Yasemen Höbek Aydın , Dilek Öztürk Kazancı

https://doi.org/10.54233/endouroloji.1016389

Öz

Amaç: Perkütan nefrolitotomi (PCNL) uygulanan hastalarda fentanil veya remifentanilin intraoperatif hemodinamik etkileri ve postoperatif derlenme üzerine etkilerini karşılaştırmak.
Gereç ve Yöntemler: Çalışmamız randomize, ve prospektif olarak yapıldı. Çalışmaya Amerikan Anestezist Derneği (ASA) I-II ile PCNL uygulanan 40 hasta dahil edildi. Uygulanan anestezi tekniği aynı olup remifentanil-fentanil ilaç kullanımına göre tüm hastalar 2 gruba ayrıldı. Her iki grupta anestezi indüksiyonu bolus dozda propofol 2mg/kg ile idame sevofluran (MAC 2) ile sağlandı. Kas gevşemesi 0,6 mg/kg rokuronyum ile elde edildi. Grup 1’e anestezi indüksiyonu sırasında tek doz halinde 1 μgr/kg remifentanil, Grup 2’ye anestezi indüksiyonu sırasında tek doz olarak fentanil 2µg/kg verildi. Hemodinamik stabiliteyi sağlamak amaçlı Grup 1’de remifentanil infüzyon şeklinde (0.05 μg/kg/dk.), grup 2’de ise 45 dk. da bir fentanil 0,5 μg/kg iv puşe verildi. İntraoperatif hemodinamik parametreler ve iyileşme verileri kaydedildi. Aldrete Skoru, Ramsay Sedasyon Skalasında 15, 60, 360. dakikalardaki değerler ameliyat sonrası kaydedildi. Ağrı değerlendirmesi için görsel analog skala (VAS0-10) kullanıldı.
Bulgular: İntraoperatif hemodinamik ölçümler Grup 1’de daha stabildi. Nitro-gliserin ihtiyacı Grup 2’de anlamlı olarak arttı (p <0,05). Aldrete skorları, Ramsay sedasyon ölçekleri ve VAS gruplar arasında anlamlı farklılık göstermedi. Derlenme Grup 1’de Grup 2’den anlamlı olarak erkendi (p<0,05).
Sonuç: PCNL sırasında fentanile kıyasla Remifentanil ile stabil hemodinamik durum ve daha güvenli iyileşme sağlanabilir.

Anahtar Kelimeler

Fentanil, perkütan nefrolitotomi, remifentanil, görsel analog skor.

Effects of Fentanyl and Remifentanil on intraoperative hemodynamics and postoperative recovery in percutaneous nephrolithotomy cases

Öz

Objective: To compare the effects of fentanyl or remifentanil on intraoperative hemodynamic effects and postoperative recovery in patients undergoing percutaneous nephrolithotomy (PCNL).
Material and Methods: Randomized and prospective study was conducted. Forty patients who underwent PCNL with the American Society of Anaesthesiologists (ASA) I-II enrolled into the study. All patients were divided into 2 groups according to administered anaesthesiology technique and drugs, which are remifentanil and fentanyl. Induction of anesthesia was same in both groups. Induction of anesthesia was obtained with a bolus dose of propofol (1-2 mg/kg), maintenance was achieved with sevoflurane (MAC2). Muscle relaxation was achieved with rocuronium. Group 1 was consisted of patients who were administered remifentanil and they received 1 μgr/kg of remifentanil as a single dose during the induction of anaesthesia Group 2 was received fentanyl 2 μg/kg as a single dose during the induction of anaesthesia. Group 1 received remifentanil 0.05 μgr/kg per minute as an infusion throughout the procedure for providing intraoperative hemodynamic stability, in group 2 fentanyl was given at a dose of 0.5 μg/kg iv bolus every 45 minutes. Intraoperative hemodynamic parameters and recovery data were recorded. Aldrete score, Ramsay sedation scale 15, 60, 360 minutes were noted after surgery. Visual analogue scale (VAS0-10) was used for pain evaluation.
Results: Intraoperative hemodynamic measurements were more stable in Group 1. The need for nitro-glycerine was significantly increased in Group 2 (p<0.05). The Aldrete scores, Ramsay sedation scales and VAS did not differ significantly between the groups. Immediate recovery was significiantly earlier in Group 1 than Group 2 (p<0.05).
Conclusion: Stable hemodynamic status and safer recovery can be provided with remifentanil compared to fentanyl during PCNL.

Anahtar Kelimeler

fentanyl, percutaneous nephrolithotomy, remifentanil, visual analog score

Kaynakça

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