Araştırma Makalesi
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Ketamin ve tramadolün postoperatif kateter kaynaklı mesane rahatsızlığı üzerine etkilerinin karşılaştırılması

Yıl 2019, , 529 - 534, 01.12.2019
https://doi.org/10.21601/ortadogutipdergisi.553672

Öz

Amaç: Kateter kaynaklı mesane rahatsızlığı (KKMR) post anestezik hastalarda yaygın görülen bir durumdur. Bu çalışmanın amacı tramadolün ve ketaminin KKMR bulgusunun azaltılmasındaki etkinliklerinin karşılaştırılmasıdır.
Gereç ve Yöntem: Çalışmamız Üroloji ameliyathanesinde genel anestezi altında peruktan nefrolitotomi ameliyatı olan 90 hasta ile yapılmıştır. Hastalara intraoperatif foley sonda takıldı. Uyandırma işleminden 20 dk önce grup K hastaya ketamin (250 ugr/kg) grup T hastaya tramadol (1,5 mg/kg) ve grup S hastaya plasebo (%0,9 sf) ilaç IV uygulandı.

Hastaların post op 5., 10., 15., 30. dk'da VAS değeri, hemodinamik parametreleri kaydedildi. VAS’ı 3 ve üzeri olan üç gruptaki hastalara, acil analjezi için meperidin 0.5-1 mg/kg IV meperidin verildi. KKMR nin seviyesi ve bulantı bağımsız bir gözlemci tarafından 0., 1., 4., 6. saatlerde ayrıca değerlendirildi. 3. derece bulantı - kusması olan hastalara anti-emetik olarak, 4mg iv ondansetron verildi.
Bulgular: Ekstübasyondan 20 dakika önce verilen, ketamin ve tramadolün, VAS değerlerini azalttığı, KKMR skorlarını düşürdüğü, ek analjezik gereksiniminin tramadol grubunda daha az olduğu sonuçlarına ulaşıldı.
Sonuç: Biz genel anestezi altında elektif perkütan nefrolitotomi operasyonu uygulanan hastalarda, tramadolün, postoperatif KKMR şiddeti ve insidansını azaltmada güvenli ve etkili bir yöntem olabileceği kanısındayız.

Kaynakça

  • Agarwal A, Gupta D, Kumar M, Dhiraaj S, Tandon M, Singh PK. Ketamine for treatment of catheter related bladderdiscomfort: a prospective, randomized, placebo controlled and doubleblind study Br J Anaest 2006; 96: 587-9.
  • Yamanishi T, Chapple CR, Chess-Williams R. Which muscarinicreceptor is important in the bladder? World J Urol 2001; 19: 299-306.
  • Tso MM, Blatchford KL, Callado LF, McLaughlin DP, Stamford JA. Stereoselective effects of ketamine on dopamine, seroronin andnoradrenaline release and uptake in rat brain slices. Neurochem Int 2004; 44: 1-7.
  • Shiue CY, Vallabhahosula S, Wolf AP, et al. Carbon-11 labelledketamine-synthesis, distribution in mice and PET studies in baboons.Nucl Med Biol 1997; 24: 145-50.
  • Hustveit O, Maurset A, Oye I. Interaction of the chiral forms ofketamine with opioid, phencyclidine, sigma and muscarinic receptors. Pharmacol Toxicol 1995; 77: 355-9.
  • Kohr R, Durieux ME. Ketamine: teaching an old drug new tricks.Anesth Analg 1998; 87: 1186-93.
  • Wilson LE, Hatch DJ, Rehdsr K. Mechanism of the relaxantaction on isolated porcine tracheal muscles. Br J Anaesth 1993; 71: 544-50.
  • Hirota K, Lambert DG. Ketamine: Its mechanism(s) of action andunusual clinical uses. Br J Anaesth, Editorial 1996; 77: 441-4.
  • Furuhashi-Yonaha A, Lida H, Asano T, Takeda T, Dohi S. Shortand long-term efficacy of oral ketamine in eight chronic-pain patients. Can J Anaesth 2002; 49: 886-7.
  • Rafa RB, Friderichs E. Profile of tramadol and tramadol analog. In: Bountra C, Munglani R, Schmidt K. Editors. Pain-Current Understanding, Emerging Therapies and Novel Approaches to Drug Discovery. New York: Marcel Dekker 2003: 731-742.
  • Shiraishi M, Minami K, Uezono Y, Yanagihara N, Shigematsu A. Inhibition by tramadol of muscarinic receptor-induced responses incultured adrenal medullary cells and in Xenopus laevis oocytesexpressing cloned M1 receptors. J Pharmacol Exp Ther 2001; 299: 255-60.
  • Shiga Y, Minami K, Shiraishi M, et al. The inhibitory effects oftramadol on muscarinic receptor-induced responses in Xenopusoocytes expressing cloned M3 receptors. Anesth Analg 2002; 95: 1269-73.
  • De Groat WC. Anatomy and physiology of the lower urinary tract. Urol Clin North Am 1993; 20: 383-401.
  • Andersson KE. Advances in the pharmacological control of thebladder. Exp Physiol 1999; 84: 195-213.
  • Andersson KE. Pharmacology of lower urinary tract smooth musclesand penile erectile tissues. Pharmacol Rev 1993; 45: 253.
  • Agarwal A, Raza M, Singhal V, et al. Evaluation of efficacy oftolterodine for prevention of catheter related bladder discomfort: aprospective, randomized, placebo controlled double blind study. Anesth Analg 2005; 101: 1065-7.
  • Park JM, Houck CS, Sethna NF, et al. Ketorolac suppressespost- operative bladder spasms after paediatric ureteralreimplantation. Anesth Analg 2000; 91: 11-5.
  • Pehrson R, Stenman E, Andersson KE. Effects of tramadol on ratdetrusor overactivity induced by experimental cerebral infarction. EurUrol 2003; 44: 495-9.
  • Agarwal A, Yadav G, Gupta D, Singh PK, Singh U. Evaluation of intra-operative tramadol for prevention of catheterrelatedbladder discomfort: a prospective, randomized, double-blindstudy. British Journal of Anaesthesia 2008; 101: 506-10.
  • Durieux ME. Inhibition by ketamine of muscarinic acetylcholinereceptor function. Anesth Analg 1995; 81: 57-62.
  • Gupta D, Agarwal A, Dhiraaj S. Ketamine for treatment ofcatheter-related bladder discomfort. Br J Anaesth 2005; 95: 720.

The comparison of the effects of ketamine and tramadol on postoperative catheter-related bladder discomfort

Yıl 2019, , 529 - 534, 01.12.2019
https://doi.org/10.21601/ortadogutipdergisi.553672

Öz

Objective: CRBD is a condition that occurs commonly in postanesthetic patients who undergo intraoperative urinary catheterization. The aim of this study is to investigate and compare the effects of ketamine and tramadol on severity and incidence of CRBD. The patients that underwent elective percutaneous nephrolithotomy operations under general anesthesia were monitorized perioperatively.
Material and Method: After induction of anaesthesia Foley urinary catheters were introduced.

20 minutes before extubation placebo (0.9% NaCl), 250 µg/kg ketamine IV and 1.5 mg/kg tramadol IV were administered to the patients in the group S, K and T, respectively. VAS (Visual Analogue Scale), arterial blood pressure, heart rate, saturation of arterial oxygen are assessed and recorded at 5, 10, 15 and 30 minutes postoperatively. Severity of CRBD and incidence of nausea are assessed and recorded by an observer who was blind to the study at 0, 1, 4 and 6 hours postoperatively. If VAS 3, 0.5-1 mg/kg meperidine IV were administered to the patients as an urgent analgesia. Patients with 3rd degree nausea and vomiting were given anti-emetic and 4 mg iv ondansetron.
Results: In conclusion we have found that ketamine and tramadol which were given 20 minutes before extubation reduced the VAS and CRBD scores, and analgesic need in tramadol group was lesser than the other two groups.
Conclusion: We think that in patients who undergo elective percutaneous nefroliotomy under general anesthesia tramadol is a safe and effective method which reduces severity and incidence of postoperative CRBD.

Kaynakça

  • Agarwal A, Gupta D, Kumar M, Dhiraaj S, Tandon M, Singh PK. Ketamine for treatment of catheter related bladderdiscomfort: a prospective, randomized, placebo controlled and doubleblind study Br J Anaest 2006; 96: 587-9.
  • Yamanishi T, Chapple CR, Chess-Williams R. Which muscarinicreceptor is important in the bladder? World J Urol 2001; 19: 299-306.
  • Tso MM, Blatchford KL, Callado LF, McLaughlin DP, Stamford JA. Stereoselective effects of ketamine on dopamine, seroronin andnoradrenaline release and uptake in rat brain slices. Neurochem Int 2004; 44: 1-7.
  • Shiue CY, Vallabhahosula S, Wolf AP, et al. Carbon-11 labelledketamine-synthesis, distribution in mice and PET studies in baboons.Nucl Med Biol 1997; 24: 145-50.
  • Hustveit O, Maurset A, Oye I. Interaction of the chiral forms ofketamine with opioid, phencyclidine, sigma and muscarinic receptors. Pharmacol Toxicol 1995; 77: 355-9.
  • Kohr R, Durieux ME. Ketamine: teaching an old drug new tricks.Anesth Analg 1998; 87: 1186-93.
  • Wilson LE, Hatch DJ, Rehdsr K. Mechanism of the relaxantaction on isolated porcine tracheal muscles. Br J Anaesth 1993; 71: 544-50.
  • Hirota K, Lambert DG. Ketamine: Its mechanism(s) of action andunusual clinical uses. Br J Anaesth, Editorial 1996; 77: 441-4.
  • Furuhashi-Yonaha A, Lida H, Asano T, Takeda T, Dohi S. Shortand long-term efficacy of oral ketamine in eight chronic-pain patients. Can J Anaesth 2002; 49: 886-7.
  • Rafa RB, Friderichs E. Profile of tramadol and tramadol analog. In: Bountra C, Munglani R, Schmidt K. Editors. Pain-Current Understanding, Emerging Therapies and Novel Approaches to Drug Discovery. New York: Marcel Dekker 2003: 731-742.
  • Shiraishi M, Minami K, Uezono Y, Yanagihara N, Shigematsu A. Inhibition by tramadol of muscarinic receptor-induced responses incultured adrenal medullary cells and in Xenopus laevis oocytesexpressing cloned M1 receptors. J Pharmacol Exp Ther 2001; 299: 255-60.
  • Shiga Y, Minami K, Shiraishi M, et al. The inhibitory effects oftramadol on muscarinic receptor-induced responses in Xenopusoocytes expressing cloned M3 receptors. Anesth Analg 2002; 95: 1269-73.
  • De Groat WC. Anatomy and physiology of the lower urinary tract. Urol Clin North Am 1993; 20: 383-401.
  • Andersson KE. Advances in the pharmacological control of thebladder. Exp Physiol 1999; 84: 195-213.
  • Andersson KE. Pharmacology of lower urinary tract smooth musclesand penile erectile tissues. Pharmacol Rev 1993; 45: 253.
  • Agarwal A, Raza M, Singhal V, et al. Evaluation of efficacy oftolterodine for prevention of catheter related bladder discomfort: aprospective, randomized, placebo controlled double blind study. Anesth Analg 2005; 101: 1065-7.
  • Park JM, Houck CS, Sethna NF, et al. Ketorolac suppressespost- operative bladder spasms after paediatric ureteralreimplantation. Anesth Analg 2000; 91: 11-5.
  • Pehrson R, Stenman E, Andersson KE. Effects of tramadol on ratdetrusor overactivity induced by experimental cerebral infarction. EurUrol 2003; 44: 495-9.
  • Agarwal A, Yadav G, Gupta D, Singh PK, Singh U. Evaluation of intra-operative tramadol for prevention of catheterrelatedbladder discomfort: a prospective, randomized, double-blindstudy. British Journal of Anaesthesia 2008; 101: 506-10.
  • Durieux ME. Inhibition by ketamine of muscarinic acetylcholinereceptor function. Anesth Analg 1995; 81: 57-62.
  • Gupta D, Agarwal A, Dhiraaj S. Ketamine for treatment ofcatheter-related bladder discomfort. Br J Anaesth 2005; 95: 720.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

İlker Solmaz Bu kişi benim 0000-0002-1959-8159

Ayşegül Ceylan 0000-0003-2816-2629

Mehmet Burak Eşkin 0000-0001-6781-9334

Ahmet Coşar 0000-0002-7549-2463

Yayımlanma Tarihi 1 Aralık 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

Vancouver Solmaz İ, Ceylan A, Eşkin MB, Coşar A. Ketamin ve tramadolün postoperatif kateter kaynaklı mesane rahatsızlığı üzerine etkilerinin karşılaştırılması. otd. 2019;11(4):529-34.

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