Publication: Propofol-Alfentanil ve Propofol-Ketamin ile uygulanan total intravenöz anestezinin günübirlik cerrahide derlenme üzerine etkilerinin karşılaştırılması
Abstract
Bu çalışmanın amacı; transvajinal oosit toplanacak hastalarda propofol-alfentanil ve propofol-ketamin ile uygulanan total intravenöz anestezinin derlenme, taburculuk kriterleri, postoperatif analjezik gereksinimi ve girişimin sonuçları üzerine etkilerini karşılaştırmaktır. ASA I-II sınıfında, 20-45 yaş arası 60 hasta randomize olarak iki gruba ayrıldı (n=30). Premedikasyon için 30 dk önce 0.03 mg/ kg midazolam iv uygulandı. Tüm hastalarda kalp atım hızı (KAH), noninvazif ortalama arteryel kan basıncı (OAB), periferik oksijen satürasyonu (SpO2), tidal sonu karbondioksit basıncı (ETCO2) indüksiyon öncesi ve işlem sonuna kadar her 5 dakikada bir kaydedildi. İndüksiyonda 1. gruba propofol 1,5 mg/ kg ve alfentanil 10 μg/ kg iv, 2. gruba propofol 1,5 mg/ kg ve ketamin 0.75 mg/ kg iv uygulandıktan sonra hastalara 4 numara laringeal maske takılarak ETCO2 basıncı 30-35 mmHg arasında tutulacak şekilde %50 oksijen içinde hava ile asiste ventilasyon uygulandı. Total propofol dozu, işlem sonlandığında sözlü uyarana yanıt ve oryantasyon zamanı, analjezik gereksinimi kaydedildi. VAS>3 şiddetinde ağrısı olan hastalara meperidin 1 mg/ kg iv uygulandı. Servise alınma ve taburculuk süreleri, oosit sayısı, fertilizasyon ve gebelik oranları kaydedildi. Her iki grupta 5, 10. ve 15. dk OAB ve KAH değerleri preoperatif değerlerine göre anlamlı düşük saptandı (p<0.001). Alfentanil grubundaki azalma ketamin grubuna göre belirgin fazla bulundu (p<0.01). İki grup arasında total propofol dozu, ilk analjezik gereksinim zamanı ve 24. saat VAS skoru açısından anlamlı farklılık izlenmedi (p>0.05). Analjezik gereksinimi ketamin grubunda (% 40) alfentanil grubundan (%26,6) yüksek bulundu (p>0.05). Ketamin grubunda uyanma (p<0,01), servise alınma (p<0,005) ve taburculuk (p<0,05) süreleri alfentanil grubuna göre anlamlı olarak uzun bulundu. Ketamin grubunda postoperatif 1.saatte baş dönmesi sıklığı alfentanil grubundan belirgin yüksek bulundu (p<0.001). İki grup arasında toplanan 35 oosit sayısı, embriyo sayısı, gebelik durumu ve cerrah memnuniyeti açısından farklılık saptanmadı (p>0.05). Transvajinal oosit toplanması girişimlerinde, ketaminin propofol ile birlikte kullanılması sırasında peroperatif hemodinamik stabilite sağlamasına karşın servise alınma ve taburculuk sürelerinde uzamaya neden olmasından dolayı bu girişimlerde propofol alfentanil kombinasyonunun tercih edilebileceği kanısına varılmıştır. 36
The aim of this study was to compare the effects of propofol-alfentanil and propofol-ketamine combinations on hemodynamic parameters, recovery, side effects, discharge time, analgesic requirement and the outcome of procedure in outpatients undergoing transvaginal oocyte retrieval. Sixty patients with ASA I-II, aged between 20-45 years, undergoing invitro fertilization were randomly divided into two groups. 0.03 mg/ kg midazolam iv was administered for premedication. In all the patients heart rate, mean arteria pressure, oxygen saturation, end-tidal carbondioxide pressure were recorded before the induction and with 5 minute intervals peroperatively. Patients received propofol 1,5 mg/ kg and alfentanil 10 μg/ kg iv in group 1 (n=20) or propofol 1,5 mg/ kg and ketamine 0.75 mg/ kg iv in group 2 (n=20) for induction. After insertion of laryngeal mask airway, all patients had assisted ventilation with 50% oxygen and 50% air to maintain ETCO2 between 30-35 mmHg. Total dose of propofol, response time to verbal command, orientation time, analgesic requirement were recorded. 1mg/ kg meperidin iv was administered to patients with VAS>3. Mean arterial pressure and heart rate of all patients at 5.,10. and 15. minutes were significantly lower than preoperative values (p<0.001). The decrease in alfentanil group was significantly more than in ketamine group (p<0.01). There was no significant difference between two groups for total propofol dose, first analgesic requirement time and 24.th hour VAS score (p>0.05). Analgesic requirement in ketamine group (40%) was higher than alfentanil group (%26,6). In ketamine group orientation time (p<0.01), transferation from PACU (p<0.005) and discharge time (p<0.05) were significantly longer than those of alfentanil group.There was no significant difference between the groups according to oosit number, fertilization and pregnancy rate, and gratitude of the surgeon (p>0.05). At postoperative first hour, the incidence of 37 dizziness, nausea and vomiting in ketamine group was significantly higher than alfentanil group (p<0.001). We concluded that although propofol-ketamine anesthesia for transvaginal oocyte retrieva provides hemodinamic stability, propofol-alfentanil anesthesia should be preferred as side effects of propofol-ketamine such as dizziness and nausea-vomiting causes a delay in discharge time of outpatients.
The aim of this study was to compare the effects of propofol-alfentanil and propofol-ketamine combinations on hemodynamic parameters, recovery, side effects, discharge time, analgesic requirement and the outcome of procedure in outpatients undergoing transvaginal oocyte retrieval. Sixty patients with ASA I-II, aged between 20-45 years, undergoing invitro fertilization were randomly divided into two groups. 0.03 mg/ kg midazolam iv was administered for premedication. In all the patients heart rate, mean arteria pressure, oxygen saturation, end-tidal carbondioxide pressure were recorded before the induction and with 5 minute intervals peroperatively. Patients received propofol 1,5 mg/ kg and alfentanil 10 μg/ kg iv in group 1 (n=20) or propofol 1,5 mg/ kg and ketamine 0.75 mg/ kg iv in group 2 (n=20) for induction. After insertion of laryngeal mask airway, all patients had assisted ventilation with 50% oxygen and 50% air to maintain ETCO2 between 30-35 mmHg. Total dose of propofol, response time to verbal command, orientation time, analgesic requirement were recorded. 1mg/ kg meperidin iv was administered to patients with VAS>3. Mean arterial pressure and heart rate of all patients at 5.,10. and 15. minutes were significantly lower than preoperative values (p<0.001). The decrease in alfentanil group was significantly more than in ketamine group (p<0.01). There was no significant difference between two groups for total propofol dose, first analgesic requirement time and 24.th hour VAS score (p>0.05). Analgesic requirement in ketamine group (40%) was higher than alfentanil group (%26,6). In ketamine group orientation time (p<0.01), transferation from PACU (p<0.005) and discharge time (p<0.05) were significantly longer than those of alfentanil group.There was no significant difference between the groups according to oosit number, fertilization and pregnancy rate, and gratitude of the surgeon (p>0.05). At postoperative first hour, the incidence of 37 dizziness, nausea and vomiting in ketamine group was significantly higher than alfentanil group (p<0.001). We concluded that although propofol-ketamine anesthesia for transvaginal oocyte retrieva provides hemodinamic stability, propofol-alfentanil anesthesia should be preferred as side effects of propofol-ketamine such as dizziness and nausea-vomiting causes a delay in discharge time of outpatients.