Comparison of The Effects of Remifentanil and Fentanyl Combined with Desflurane on Intraoperative Hemodynamic Parameters and Postoperative Recovery Period in Anesthesia for Day Case Surgery

Yıl 2020, Cilt: 6 Sayı: 1, 115 - 122, 30.04.2020

Murat Doğan , Ezgi Güngördü

https://doi.org/10.19127/mbsjohs.686947

Öz

Objective: We aimed to compare the effects of two different opioids, fentanyl and remifentanil with short-acting inhalation agent, desflurane on intraoperative hemodynamics and recovery quality in the postoperative period in anesthesia for day case surgery.
Methods: A prospective randomized case control study was carried out at Anesthesia and Reanimation Clinics of The Istanbul Education and Research Hospital with the approval of the local ethics committee between 2001-2002. The study population (n=100) who has arthroscopic knee surgery was composed of patients between the ages of 18-65 classified as ASAI-II. The cases were randomized and divided into two groups. After giving fentanyl to patients in the first group and remifentanil infusion to patients in the second group, induction has administered by propofol and mivacurium was given as a muscle relaxant in both groups. After endotracheal intubation, systemic blood pressure, heart rate and peripheral oxygen saturation (SpO2) values were recorded every five minutes. When the surgery was completed, eye opening, following commands, saying her name, saying her birthday, sitting without help and getting the correct answer to the DSS test was recorded for both groups. Visual Pain Scale (VAS) and Modified Aldrete Score were evaluated and recorded at 0, 15, 30, and 60 minutes. Patients were observed and recorded in terms of side effects such as increased secretion, bradycardia, nausea, vomiting, dizziness, headache, and tremors in both groups.
Results : In terms of demographic features there was no statistically significant difference between the two groups. Generally; systemic blood pressures were significantly higher in the fentanyl group. Heart rate was significantly higher in fentanyl group during intubation and intraoperative periods . There was no statistically significant difference between groups in terms of Sp02 . Time until spontaneous breathing, extubation, eye opening, following commands, saying the name, DSST and unassisted sitting were significantly longer in the fentanyl group . The mean values of VAS scores at the 15th and 30th minutes were significantly higher in the remifentanil group . Similarly, the mean Aldrete recovery scale score scores at 15th and 30th minutes were significantly higher in the remifentanil group . When postoperative pathological findings were evaluated, the frequency of bradycardia was significantly higher in the remifentanil group, there was no difference in terms of other side effects.
Conclusion: According to the our study results; we concluded that it is a better alternative to use remifentanil together with desflurane which is preferred short-acting inhalation agent in ambulatory anesthesia; in terms of hemodynamic stability during the intubation, peroperative and extubation periods and rapid postoperative recovery.

Anahtar Kelimeler

Remifentanil, Fentanyl, Day Case Surgery, Recovery, VAS, Aldrete

Proje Numarası

yok

Kaynakça

• Albertin A, Casati A, Deni F, Danelli G, Comotti R, Grifoni F, Fanelli G: Clinical comparison of either small doses of fentanyl or remifentanyl for bulunting cardiovascular changes induced by tracheal intubation. MınervaAnestesiologica, 66(10): 691-696, 2001.
• American Hospital Association; The Migration of Care to Non-hospital Settings: Have Regulatory Structures Kept Pace with Changes in Care Delivery?; July 2006. (Accessed on June 08, 2014).
• Barbier D, N'Dele D, Bennis M, Thevenin-Lemoine C. Et al, Day surgery for anterior cruciate ligament reconstruction in children: a prospective study on feasibility and satisfaction. J Child Orthop. 2019 Feb 1;13(1):100-106.
• Cafiero T, Mastronardi P, Burrelli R, Santoro R: The effects of remifentanil on hemodinamic response to intubation. A comparative study with fentanil. MinervaAnestesiol 2000 Nov; 66(11): 793-7.
• Choi JW, Joo JD, Kim DW, et al; Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control. J Korean Med Sci. 2016 Sep;31(9):1485-90.
• Clayman MA, Seagle BM. Office surgery safety: the myths and truths behind the Florida moratoria--six years of Florida data. Plast Reconstr Surg 2006; 118:777.
• Coldiron B, Shreve E, Balkrishnan R. Patient injuries from surgical procedures performed in medical offices: three years of Florida data. Dermatol Surg 2004; 30:1435.
• Cook DR Stiller Rl. İn vitro metabolism of mivacurium chioride, Anaesth. Analg. 1989 ;68 :452-456
• Dershwitz M, RandelGl, Rosovv CE, Fragen RJ, et al: Initial clinical experience with remifentanyl, a new opioid metabolized by esterases. Anesth. Analg. 81:619, 1995
• Doris T, Frances C. Postoperative pain control in ambulatory surgery. Surg Clinics of North America. 1999 April; 79(2): 401
• Doyle PW, Coles JP, Leary TM, Brazier P, Gupta AK: A comparison of remifentanil and fentanil in patients undergoing carotid endarterectomy. Eur J Anaesthesiol 2001 Jan; 18(1): 13-9
• Doze V.A., Shafer A., White P.F: Propofol-nitrous oxide versus thiopental-isoflurane-nitrous oxide for general anesthesia. Anesthesiology 69; 63-71, 1998
• Dy EA, Lovely LK, Graziano GP, Samra SK, Welch KB: Remifentanil and fentanil based anesthesia of somatosensory evoked potentiais. Anesthesia and Analgesia, 92(6): 1510-5, 2001
• Gelb AW, Morriss WW, Johnson W, et al. World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia. Anesth Analg 2018; 126:2047.
• Glass PSA: Pharmacology of remifentanil. European Journal of Anaesthesiology 12 :73, 1995
• Grundmann U, Siiomon M, Bach F, Becker S, Bauer M, Larsen B, Kleinschmidt S: Recovery profile and side effects of remifentanil-based anaesthesia with desfluran or propofol for laporoscopic cholesystectomy. Açta Anaesthesiol Scand 2001 Mar; 45(3): 320-6
• Haytural C, Aydınlı B, Demir B, et al. Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to UndergoERCP. Biomed Res Int. 2015;2015:465465.
• Hüppe T, Kneller N, Raddatz A.Upper Age Limit in Outpatient Anesthesia: Opportunities and Risks. Anasthesiol Intensivmed Notfallmed Schmerzther. 2018 May;53(5):380-386. Joo HS. Sevoflurane versus propofol for anesthetic induction:a meta- analysis. Anesth Analg-2000 Jul;91(1);213-9 Lang B, Zhang L, Li F, Lin Y, Zhang W, Yang C. Comparison of the efficacy and safety of remifentanil versus different pharmacological approaches on prevention of etomidate-induced myoclonus: a meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2019 May 9;13:1593-1607.
• Lapetina EM, Armstrong EM. Preventing errors in the outpatient setting: a tale of three states. Health Aff 2002; 21:26.
• Measurement of pain.Katz J, Melzack R Surg Clin North Am. 1999 Apr; 79(2):231-52.
• The post-anesthesia recovery score revisited. Aldrete JA J Clin Anesth. 1995 Feb; 7(1):89-91.
• Monsef Kasmaee V, Zia Zibari SM), Aghajani Nargesi M. Remifentanil versus Propofol/Fentanyl Combination in Procedural Sedation for Dislocated Shoulder Reduction; a Clinical Trial. Arch Acad Emerg Med. 2019 Jan 25;7(1).
• Mulas M, Sances D, Sabbia E, Pala G, Ruiu P: Remifentanil vs fentanyl in ultrashort gynaecological day surgery. Br. J. Anaesth 80: 12, 1998
• Peacock JE: Ambulatory anesthesia experience with remifentanil. Anesth Analg-1999 Oct;89 . 22-7
• Shapiro FE, Punwani N, Rosenberg NM, et al. Office-based anesthesia: safety and outcomes. Anesth Analg 2014; 119:276.
• Twersky RS, Jamerson B, Wamer DS, Fieisher LA, Hogue S: Hemodynamics and emergenceptofile of remifentanil versus fentanil prospectively compared in a large population of surgical patients, J ClinAnesth 2001 Sep; 13(6): 407-16
• Viby-Mogensen J. Jargensen B. Reversal of intense mivacurium block with human plasma cholinesterase in patients with atypical PCHE. Anaesth. 1995 ; 82 : 1295-1298
• Vila H Jr, Soto R, Cantor AB, Mackey D. Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers. Arch Surg 2003; 138:991.
• White PF, Tang J, Wender RH, et al. Desflurane versus sevoflurane for maintenance of outpatient anesthesia: the effect on early versus late recovery and perioperative coughing. Anesth Analg 2009; 109:387.
• Wilhelm W, Schlaich N, Harrer J, Kleinschmidt S, Müller M, Larsen R: Recovery and neurological examination after remifentanil-desfluran or fentanyl-desfluran anaesthesia for carotid artery surgery. Br. J. Anesthesia86 (1): 44-9, 2001