Pediatrik Ambulatuar Cerrahi Hastaların Sünnet Operasyonlarında Remifentanil-Propofole karşı Fentanil Propofol

Öz

Sünnet dünya genelinde en sık uygulanan cerrahi işlemdir. Fentanil, remifentanil ve propofol pediatri pratiğinde bu amaç için en yaygın kullanılan ilaçlardır. Bu çalışmada sünnet yapılan çocuk hastalarda fentanil veya remifentatil uygulamasının etkinliğini ve güvenirliliğinin karşılaştırılması amaçlandı. Sünnet cerrahisi uygulanan ASA I-II, 120 erkek çocuk (American Society of Anesthesiologists), retrospektif olarak çalışmaya alındı. Hastalara propofol 2-3 mg kg -1 sonrasında Grup F’ye fentanil 0,5-1 μg kg-1 (n=60), Grup R’ye remifentanil 0.5-1 μg kg-1 (n=60) kullanılarak indüksiyon yapıldı. Anestezi idamesinde sevofluran 4 L dk -1 %50 hava ve oksijen %3-4 kullanıldı. Peroperatif ve derlenme ünitesinde hemodinamik verileri ve komplikasyon kayıtları alındıktan sonra hastalar 6 saat boyunca çocuk cerrahi servisinde takip edildi. Sünnet cerrahisi uygulanan 0-2 yaş, 120 erkek çocuk hastanın gruplar arasında yaş, vücut ağırlığı, boy, ASA fiziksel durumu ve operasyon süreleri arasında istatistiksel olarak fark yoktu. Remifentanil-propofol alan Grup R hastalar, Grup F alanlara göre uyanma süresi istatistiksel olarak önemli oranda kısaydı. Grup F’de kusma en sık görülen komplikasyon iken, Grup R’de ise bradikardiydi. Gruplar komplikasyon gelişimi sıklığı bakımından karşılaştırıldığında bradikardi, bronkospazm, solunum depresyonu ve alerjik reaksiyon sıklığı açısından gruplar arasında fark gözlenmedi. Sonuç olarak sünnet cerrahisi uygulanan pediatrik hastaları değerlendirdiğimiz bu çalışmada; remifentanil-propofol kullanımının bu yaş grubunda önermekle birlikte olası yan etkiler açısından hastaların yakından izlenmesinin gerekliliğini de vurgulamayı amaçladık.

Anahtar Kelimeler

• Pediatric,circumcision,remifentanil

Remifentanil-Propofol versus Fentanyl-Propofol for Circumcision Operations in Pediatric Ambulatory Surgical Patients

Öz

Circumcision is the most frequent surgical procedure performed worldwide. The present study aimed to compare the efficacy and safety of fentanyl vs. remifentanil in pediatric patients undergoing circumcision procedure. A total of 120 boys, who were ASA (American Society of Anesthesiologists) I-II and underwent circumcision procedure, were retrospectively evaluated. Induction for anesthesia was provided using propofol that using 0,5-1 μg kg-1 (n=60) in Group F and using remifentanil 0,5-1 μg kg-1 (n=60) in Group R. After monitoring the patients and recording hemodynamic parameters and complications the findings every 30 minutes in peroperative and the recovery room, the patients were then followed for 6 hours. A total of 120 boys at the age of 0-2 years old who were underwent circumcision procedure, were retrospectively evaluated. The groups were comparable in terms of age, body weight, height, ASA physical status and duration of surgery that was not statistically significant.Recovery time from anesthesia was statistically significantly shorter in the remifentanil-propofol (Group R) as compared to the fentanyl-propofol (Group F). While vomiting was the most common complication in Group F, bradycardia was the most common complication in Group R. Comparison of the frequencies of complications between the groups revealed no difference in terms of bradycardia, bronchospasm, respiratory depression and allergic reaction. In conclusion, based on the results of the present study, we recommend using remifentanil-propofol in this pediatric age group but also underline the necessity of close monitoring of these patients for the potential side effects.

Anahtar Kelimeler

• Pediatric,circumcision,remifentanil

Kaynakça

1. 1. Al-Shamsi MM, Al-Zamili AH. The frequency of circumcision in infants and children in Diwaniah. Karbala J Med. 2008;2: 323-30.
2. 2. Collins CE, Everett LL. Challenges in pediatric ambulatory anesthesia: kids are different. Anesthesiol Clin 2010;28: 315-28.
3. 3. von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD,et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010;376: 773–83.
4. 4. Moses S, Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks .Sex Transm Infec 1998;74: 368-73.
5. 5. Ozkan A, Okur M, Kaya M, Kaya E, Kucuk A, Erbas M, et al. Sedoanalgesia in pediatric daily surgery. Int J Clin Exp Med. 2013;6: 576-82.
6. 6. Choong K, Al Faleh K, Doucette J, Gray S, Rich B, Verhey L, et al. Remifentanil for endotracheal intubation in neonates: a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed 2010;95: 80-84.
7. 7. Davis PJ, Cladis FP. The use of ultra-short-acting opioids in pediatric anesthesia. Clin Pharmacokinet 2005;44: 787-96.
8. 8. Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anesthesia. Drugs 2005;65: 1793-823.

9. 9. Cravero JP, Blike GT. Review of pediatric sedation. Anesth Analg 2004;99: 1355-64.
10. 10. Altaş C, Küçükosman G, Yurtlu BS, Okyay RD, Aydın BG, Pişkin Ö, et al. Anesthesia methods used by anesthetic specialists for circumcision cases. National survey study for Turkey. Saudi Med J. 2017;38: 75-81.
11. 11. Wang W, Huang P, Gao W, Cao F, Yi M, Chen L, et al. Efficacy and Acceptability of Different Auxiliary Drugs in Pediatric Sevoflurane Anesthesia: A Network Meta-analysis of Mixed Treatment Comparisons. Sci Rep. 2016;6: 36553.
12. 12. Amorim MA, Govêia CS, Magalhães E, Ladeira LC, Moreira LG, Miranda DB. Effect of dexmedetomidine in children undergoing general anesthesia with sevoflurane: a meta-analysis. Braz J Anesthesiol. 2017;67: 193-198.
13. 13. Schaefer MS, Kranke P, Weibel S, Kreysing R, Ochel J, Kienbaum P. Total intravenous anesthesia vs single pharmacological prophylaxis to prevent postoperative vomiting in children: A systematic review and meta-analysis. Paediatr Anaesth. 2017;27: 1202-1209.
14. 14. Wolf AR, Potter F. Propofol infusion in children: when does an anesthetic tool become an intensive care liability? Pediatr Anesth 2004;14: 435–438.
15. 15. Vasile B, Rasulo F, Candiani, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 2003; 29: 1417–1425. 16. Rama-Maceiras P, Ferreira TA, Molins N, Sanduende Y, Bautista AP, Rey T. Less postoperative nausea and vomiting after propofol-remifentanil versus propofol-fentanyl anesthesia during plastic surgery. Acta Anaesthesiol Scand 2005;49: 305–11.
16. 17. Hirsh I, Lerner A, Shnaider I, Reuveni A, Pacht A, Segol O, et al. Remifentanil versus fentanyl for esophagogastroduodenoscopy in children. J Pediatr Gastroenterol Nutr. 2010;51: 618-21.
17. 18. Eltzschig HK, Schroeder TH, Eissler BJ, Felbinger TW, Vonthein R, Ehlers R, et al. The effect of remifentanil or fentanyl on postoperative vomiting and pain in children undergoing strabismus surgery. Anesth Analg 2002; 94: 1173-7.
18. 19. Ewalenko P, Janny S, Dejonckheere M, Andry G, Wyns C. Antiemetic effect of subhypnotic doses of propofol after thyroidectomy. Br J Anaesth 1996;77: 463-7.
19. 20. Dewachter P, Mouton-Faivre C, Emala CW, Beloucif S. Case scenario: bronchospasm during anesthetic induction. Anesthesiology. 2011;114: 1200-10.
20. 21. Drake-Brockman TF, Ramgolam A, Zhang G, Hall GL, von Ungern-Sternberg BS. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial. Lancet. 2017;18: 701-708.