Entübasyona Hemodinamik Yanıtı Önlemede Remifentanil, Fentanil, Esmolol, Lidokain, ve Amiodaronun Etkilerinin Karşılaştırılması

Yıl 2020, Cilt: 15 Sayı: 3, 22 - 29, 16.10.2020

Özlem Öner , Emel Yıldız

https://doi.org/10.17517/ksutfd.673702

Öz

Amaç: Laringoskopi ve endotrakeal entübasyona bağlı sempatoadrenerjik aktivitenin artışına bağlı olarak hipertansiyon, taşikardi yanıtı görülebilir. Bu yanıt özellikle intrakraniyal ve kardiyovasküler hastalığı olan hastalarda yaşamı tehdit eden komplikasyonlara neden olabilmektedir. Biz bu çalışmada çalışmada, remifentanil, amiodaron, fentanil, esmolol ve lidokain’in trakeal entübasyonda hemodinamik yanıt üzerindeki göreceli etkinliğini karşılaştırdık. Gereç ve Yöntemler: Bu çalışmaya elektif cerrahi geçirecek 20–60 ASA I-II, 90 hasta dahil edildi. Hastalar kapalı zarf tekniği ile altı gruba ayrıldı. Entübasyona yanıtı engellemek için Birinci grup kontrol grubu (G1) hariç, ikinci gruba (G2) fentanil, üçüncü gruba (G3) remifentanil, dördüncü gruba (G4) esmolol, beşinci guruba (G5) amiodaron, altıncı gruba (G6) ise lidokain entübasyon öncesi ek olarak uygulandı. Tüm hastalara aynı anestezi tekniği uygulandı. Sistolik kan basıncı (SKB), diastolik kan basıncı (DKB) ve kalp atım hızı (KAH) için belirlenen zamanlarda ölçümler yapılarak kaydedildi. Bulgular: Gruplar arasında demografik veriler açısından fark bulunmadı (p>0.05). Remifentanil grubundaki SKB stabilitesi esmolol ve fentanil gruplarına göre daha fazlaydı. Remifentanil grubundaki DKB’daki düşüş diğer gruplara göre daha fazlaydı. KAH’daki düşüş remifentanil grubunda 1. 3. ve 5. dakikalarda daha fazla idi. Sonuç: Bizim çalışmamıza gore, entübasyona hemodinamik yanıtı önlemede remifentanilin 0.5 mikrogram/kg infüzyon dozunda diğer ilaç gruplarına en etkin ilaç olabileceğini söyliyebiliriz.

Anahtar Kelimeler

Endotrakeal entübasyon, Hemodinamik yanıt, Hipertansiyon, Taşikardi

Comparison of The Effects of Remifentanil, Fentanyl, Esmolol, Lidocaine, and Amiodarone in Preventing Hemodynamic Response to Intubation

Öz

Objective: Hypertension and tachycardia response may occur due to increased sympathoadrenergic activity due to laryngoscopy and tracheal intubation. This response may result in life-threatening complications, especially in patients with intracranial and cardiovascular disease. In this study, we compared the relative efficacy of remifentanil, amiodarone, fentanyl, esmolol and lidocaine on hemodynamic response in tracheal intubation. Material and Methods: In this study, 90 patients with ASA I-II physical status and between the ages of 20 and 60 were included. The patients were divided into six groups with closed envelope technique. In order to prevent the intubation response, except for the first group control group (G1), fentanyl to the second group (G2), remifentanil to the third group (G3), esmolol to the fourth group (G4), amiodarone to the fifth group (G5), and sixth group (G6) lidocaine before the intubation to the additionally applied.All patients received the same anesthetic technique. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) measurements were done at specified times and recorded. Results: There was no difference between the groups in terms of demographic data (p> 0.05).SBP stability in remifentanil group was higher than esmolol and fentanyl groups. The decrease in DBP in the remifentanil group was higher than in the other groups. The decrease in HR was higher in the remifentanil group at the 1st, 3rd and 5th minutes. Conclusion: According to our study, we can say that remifentanil may be the most effective drug for other drug groups at 0.5 microgram / kg infusion dose to prevent hemodynamic response to intubation

Anahtar Kelimeler

Endotracheal intubation, Hemodynamic response, Hypertension, Tachycardia

Kaynakça

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