Publication: Oral cerrahide hasta kontrollü sedasyon: midazolam ve midazolam + remifentanil kombinasyonunun karşılaştırılması
Abstract
Bu çalışmanın amacı, gömülü üçüncü molar diş çekimi operasyonlarında midazolam – remifentanil kombinasyonunu hasta kontrollü sedasyonda kullanarak, hastanın memnuniyet seviyesini, kooperasyonunu ve klinik etkilerini değerlendirmektir. Bu prospektif klinik çalışmaya, gömülü mandibular üçüncü molar diş çekimi operasyonu geçirmek üzere kırk hasta (ASA I-II) dahil edilmiştir. Her hastaya 0,03 mg/ kg intravenöz midazolam bolus dozu anestezist tarafından uygulanmıştır. Hasta kontrollü sedasyon cihazı ile midazolam grubundaki (MG) hastalara 0,5 mg/ ml midazolam tatbik edilmiştir. Midazolam-remifentanil (MRG) grubundaki hastalara 0,5 mg/ ml midazolam – 12,5 mg/ ml remifentanil kombinasyonu aynı şekilde uygulanmıştır.Hasta kontrollü cihazın kilitli kalma süresi 5 dakika olarak ayarlanmıştır. Vital bulgular ve oksijen satürasyonu kaydedilmiş, hastanın ve hekimin memnuniyet seviyeleri ve amnezi derecesi değerlendirilmiştir. Sedasyon süresince gruplar arasında sistolik ve diastolik kan basıncı bakımından istatistiksel olarak anlamlı fark tespit edilmemiştir (p>0,05). MRG grubunda 30.dakikada kalp atım sayısı MG grubuna göre anlamlı derecede daha düşük bulunmuştur (p < 0,05). MRG grubunda bulunan 10 hastada ise desaturasyon tespit edilmiştir ve 30.dakikada SpO2, MG grubuna göre anlamlı derecede daha düşük olduğu bulunmuştur. MG grubunda hekimin çalışma memnuniyeti, hastaların %45’i ile mükemmel olarak değerlendirilirken %55’i ile iyi olarak değerlendirilmiştir; MRG grubunda ise çalışma memnuniyeti, hataların %55’i ile mükemmel olarak değerlendirilirken, %35’i ile iyi, %5’i ile orta ve geri kalan %5’i ile çok kötü olarak değerlendirilmiştir. Operasyondan hemen sonra MG grubundaki hastaların %95’i işlemin memnuniyet derecelerini mükemmel olarak değerlendirirken %5’i iyi olarak değerlendirilmiştir. Bu oranın 24 saat sonra değişmediği gözlenmiştir. Operasyondan hemen sonra MRG grubundaki hastaların %90’ının memnuniyet derecelerini mükemmel, %5’inin iyi ve geriye kalan %5’inin orta olarak değerlendirilmiştir. 24 saat sonra hastaların memnuniyet oranında değişim olduğu tespit edilmiştir. %75’i memnuniyet derecesini mükemmel olarak belirlerken, %15’i iyi, %10’u ise kötü olarak belirlemiştir. Oksijen saturasyonunun görülen kısa süreli düşüşlerine rağmen, hasta kontrollü midazolam – remifentanil uygulaması herhangi bir ciddi yan etki olmaksızın tatmin edici bir sedasyon düzeyi ve iyi bir amnezi derecesi sağlayan, güvenilir bir kombinasyon olduğu görüşündeyiz.
The aim of this study was to evaluate the level of patient satisfaction and cooperation and the clinical efficiency of midazolam-remifentanil combination for patient-controlled sedation in impacted third molar surgery. Forty (ASA I-II) patients scheduled to undergo surgical extractions of impacted mandibular third molars were included in this prospective clinical study. A bolus dose of 0,03 mg/ kg intravenous midazolam was initially administered to each patient by an anesthesiologist. In the midazolam group (MG), 2 ml of 0,5 mg/ ml midazolam were administered by the PCS device. In the midazolam-remifentanil combination group (MRG), 2 ml of 0,5 mg/ ml midazolam and 12,5 µg/ ml remifentanil were given in the same manner. The lockout period PCS device was 5 min. Vital signs and oxygen saturation were recorded. Levels of patient and surgeon satisfaction and the degree of amnesia were also assessed. No statistically significant differences showed for systolic and diastolic blood pressures during sedation (p > 0,05) between the groups. The heart rate in the 30th min in the MRG group was significantly lower than in the MG group (p < 0,05). In the MRG group, 10 patients had desaturation for a short period, and in the 30th minute, SpO2 was significantly lower than in the MG group (p < 0,05). Surgeon satisfaction in the MG group was rated excellent 45% and good 55% of the time; in the MRG group, satisfaction was excellent 55%, good 35%, satisfactory 5%, and unacceptable 5% of the time. Immediately after surgery, 95% of the patients in MG group groups ranked their satisfaction as excellent and 5% as good. Patient satisfaction was evaluated again 24 h after the operation and was found to be unchanged in the MG group. Immediately after surgery, 90% of the patients in MRG group groups ranked their satisfaction as excellent, 5% as good and 5% as average . 24 hour after the operation in the MRG group, 75% of the patients reported their satisfaction as excellent, 15% as good, and 10% as poor. Although low levels of oxygen saturation were seen over short periods, the patient-controlled midazolam-remifentanil application appears to be a safe and reliable combination that provides a good level of amnesia and satisfactory level of sedation without any serious side effects.
The aim of this study was to evaluate the level of patient satisfaction and cooperation and the clinical efficiency of midazolam-remifentanil combination for patient-controlled sedation in impacted third molar surgery. Forty (ASA I-II) patients scheduled to undergo surgical extractions of impacted mandibular third molars were included in this prospective clinical study. A bolus dose of 0,03 mg/ kg intravenous midazolam was initially administered to each patient by an anesthesiologist. In the midazolam group (MG), 2 ml of 0,5 mg/ ml midazolam were administered by the PCS device. In the midazolam-remifentanil combination group (MRG), 2 ml of 0,5 mg/ ml midazolam and 12,5 µg/ ml remifentanil were given in the same manner. The lockout period PCS device was 5 min. Vital signs and oxygen saturation were recorded. Levels of patient and surgeon satisfaction and the degree of amnesia were also assessed. No statistically significant differences showed for systolic and diastolic blood pressures during sedation (p > 0,05) between the groups. The heart rate in the 30th min in the MRG group was significantly lower than in the MG group (p < 0,05). In the MRG group, 10 patients had desaturation for a short period, and in the 30th minute, SpO2 was significantly lower than in the MG group (p < 0,05). Surgeon satisfaction in the MG group was rated excellent 45% and good 55% of the time; in the MRG group, satisfaction was excellent 55%, good 35%, satisfactory 5%, and unacceptable 5% of the time. Immediately after surgery, 95% of the patients in MG group groups ranked their satisfaction as excellent and 5% as good. Patient satisfaction was evaluated again 24 h after the operation and was found to be unchanged in the MG group. Immediately after surgery, 90% of the patients in MRG group groups ranked their satisfaction as excellent, 5% as good and 5% as average . 24 hour after the operation in the MRG group, 75% of the patients reported their satisfaction as excellent, 15% as good, and 10% as poor. Although low levels of oxygen saturation were seen over short periods, the patient-controlled midazolam-remifentanil application appears to be a safe and reliable combination that provides a good level of amnesia and satisfactory level of sedation without any serious side effects.