Publication: Değişik dozlarda alfentanil ve remifentanilin kas gevşeticisiz endotrakeal entübasyon koşullarına etkileri
Abstract
Amaç: Çalışmamızda, propofol indüksiyonundan sonra, 2 MAC sevofluran ve % 70 azot protoksit ile birlikte uygulanan alfentanil (10 µg kg-1, 15 µg kg-1) ve remifentanilin (1 µg kg-1, 1,5 µg kg-1) entübasyon koşullarına etkileri karşılaştırılmıştır. Gereç ve Yöntem: Elektif operasyon geçirecek 20-60 yaş arası 75 hasta randomize olarak 5 gruba ayrıldı (n=15). 1.5-2 mg kg-1 iv propofol enjeksiyonu sonrasında hastalar yüz maskesi ile 2 MAC sevofluran, % 70 N2O oksijen içinde havalandırılmaya başlandı. Grup K'ye 1,5 mg kg-1 süksinilkolin (kontrol grubu); grup A10'a 10 µg kg-1, grup A15'e 15 µg kg-1 alfentanil; grup R1'e 1 µg kg-1 ve grup R1,5'a 1,5 µgkg-1 remifentanil i.v. uygulandı. İndüksiyondan 90 sn. sonra entübasyon işlemi gerçekleştirildi. Maske ile sağlanan ventilasyonun kolaylığı, entübasyon sırasında çenenin kas tonusu, vokal kord pozisyonu, Cormack-Lehane sınıflandırması, hastanın entübasyona ve tüpün balonunun şişirilmesine yanıtı değerlendirildi. Bulgular: A10 grubunda Cormack-Lehane sınıflandırması diğer gruplardan belirgin yüksek ve vokal kordlar hareketli olarak saptandı (p<0.05). Endotrakeal entübasyon işlemine ve tüpün balonunun şişirilmesine öksürük yanıtı skoru grup A10'da grup K, R1 ve R1,5, grup A15'te grup K ve R1,5'a göre belirgin yüksek bulundu (p <0.01). Tüm gruplardaki entübasyon sonrası ortalama arter basıncı değerleri kontrol değerlere göre belirgin düşüktü (p<0.05); kalp atım hızlarıysa, R1 ve R1.5 gruplarında kontrol grubuna göre belirgin düşüktü (p<0.01). Sonuç: Propofol indüksiyonundan sonra 2 MAC sevofluran ve % 70 azot protoksit ile birlikte uygulanan remifentanil, kas gevşeticisiz gerçekleştirilen endotrakeal entübasyona öksürük yanıtını baskılayarak, hemodinamik yanıtı azaltmaktadır.
Aim: In this study, we compared the effects of alfentanil (10 µg kg-1, 15 µg kg-1) and remifentanil (1 µg kg-1, 1,5 µg kg-1) on intubating conditions after propofol induction while breathing 2 MAC sevoflurane and % 70 N2O. Materials and Methods: Seventy fifth patients, aged 20-60 years, scheduled for elective surgery were randomly assigned to 5 groups (n=15). Anesthesia was induced with 1.5-2 mg kg-1 propofol. Patients were ventilated with 2 MAC sevoflurane, % 70 N2O in oxygen via face mask. Groups C, A10, A15, R1, R1.5 received 1,5 mg kg-1 succinylcholine, 10 µg kg-1 alfentanil, 15 µg kg-1 alfentanil, 1 µg kg-1 remifentanil and 1.5 µg kg-1 remifentanil respectively. Endotracheal intubation was performed at 90th seconds following. Ease of ventilation, jaw relaxation, position of vocal cords, Cormack-Lehane classification, and patients' response to intubation and inflation of endotracheal tube cuff were assessed. Results: In group A10, Cormack-Lehane classification was significantly higher and vocal cords were mobile compared to other groups (p< 0.05). Patients' cough response to intubation and inflation of endotracheal tube cuff were significantly higher in group A10 compared to groups C, R1 and R1.5 and in group A15 compared to groups C and R1.5 (p < 0.01). In all opioid groups, mean arterial pressures after intubation were significantly lower compared to control (p< 0.05). In groups R1 and R1.5 heart rates were significantly lower compared to control (p< 0.01). Conclusions: After propofol induction, remifentanil with 2 MAC sevoflurane and % 70 nitrous oxide decreases cough as well as hemodynamic responses to intubation done without neuromuscular blockade.
Aim: In this study, we compared the effects of alfentanil (10 µg kg-1, 15 µg kg-1) and remifentanil (1 µg kg-1, 1,5 µg kg-1) on intubating conditions after propofol induction while breathing 2 MAC sevoflurane and % 70 N2O. Materials and Methods: Seventy fifth patients, aged 20-60 years, scheduled for elective surgery were randomly assigned to 5 groups (n=15). Anesthesia was induced with 1.5-2 mg kg-1 propofol. Patients were ventilated with 2 MAC sevoflurane, % 70 N2O in oxygen via face mask. Groups C, A10, A15, R1, R1.5 received 1,5 mg kg-1 succinylcholine, 10 µg kg-1 alfentanil, 15 µg kg-1 alfentanil, 1 µg kg-1 remifentanil and 1.5 µg kg-1 remifentanil respectively. Endotracheal intubation was performed at 90th seconds following. Ease of ventilation, jaw relaxation, position of vocal cords, Cormack-Lehane classification, and patients' response to intubation and inflation of endotracheal tube cuff were assessed. Results: In group A10, Cormack-Lehane classification was significantly higher and vocal cords were mobile compared to other groups (p< 0.05). Patients' cough response to intubation and inflation of endotracheal tube cuff were significantly higher in group A10 compared to groups C, R1 and R1.5 and in group A15 compared to groups C and R1.5 (p < 0.01). In all opioid groups, mean arterial pressures after intubation were significantly lower compared to control (p< 0.05). In groups R1 and R1.5 heart rates were significantly lower compared to control (p< 0.01). Conclusions: After propofol induction, remifentanil with 2 MAC sevoflurane and % 70 nitrous oxide decreases cough as well as hemodynamic responses to intubation done without neuromuscular blockade.