A comparison of the effects of urapidil and remifentanil on hemodynamics and extubation quality in intracranial surgery

Abstract

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<0,05). Grup I'de, başlangıçtaki SAP, MAP ve DAP ortalama değerleri, ekstübasyondan sonraki 1-3 ve 5. dakikalardaki ortalama değerlerden düşüktü. Grup II-III'te, başlangıçtaki SAP, MAP ve DAP, ekstübasyondan 1-3-5 dakika sonraki değerlerden daha yüksekti. Sonuç: Hem intrakranial cerrahinin sonunda urapidil uygulamasının infüzyonu hem de bolus+infüzyonu, ekstübasyona bağlı hemodinamik reaksiyonları etkili bir şekilde önlemekte ve kalp hızını etkilemeden kan basıncını kontrol etmektedir. Ayrıca, gruplar arasında ekstübasyon kalitesi ve ekstübasyon süresi de benzer bulunmuştur.

Keywords

• urapidil
• remifentanil
• hemodynamics
• intracranial surgery

Kaynakça

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