GKD Anest Yoð Bak Dern Derg. 2021; 27(2): 147-154 | DOI: 10.5222/GKDAD.2021.42650

Pediyatrik Kalp Cerrahisi Anestezisinde Remifentanil ve Fentanilin Ýntraoperatif Hemodinamik Etkilerinin Karþýlaþtýrýlmasý

Osman Uzundere¹, Fikret Salik¹, Cem Kývýlcým Kaçar¹, Aylin Erkul¹, Mustafa Býçak¹, Onur Doyurgan², Fatih Özdemir^3
1T.C. Saðlýk Bilimleri Üniversitesi Diyarbakýr Gazi Yaþargil Eðitim Ve Araþtýrma Hastanesi, Diyarbakýr, Türkiye
²T.C. Saðlýk Bilimleri Üniversitesi Diyarbakýr Gazi Yaþargil Eðitim Ve Araþtýrma Hastanesi Pediatrik Kardiak Cerrahi Bölümü, Diyarbakýr, Türkiye
³T.C. Saðlýk Bilimleri Üniversitesi Ümraniye Eðitim ve Araþtýrma Hastanesi Pediatrik Kardiak Cerrahi Bölümü, Ýstanbul, Türkiye

Amaç: Bu prospektif gözlemsel çalýþmanýn amacý, pediyatrik kalp cerrahisinde intraoperatif analjezik olarak kullanýlan remifentanil ve fentanilin hemodinamik etkilerini karþýlaþtýrmaktý.
Yöntem: Hastalar intraoperatif analjezi amacýyla sürekli intravenöz remifentanil infüzyonu uygulananlar (Grup R) ve aralýklý intravenöz fentanil uygulananlar (Grup F) üzere iki gruba ayrýldý. Gruplar hemodinamik özellikler ve intraoperatif komplikasyonlar açýsýndan karþýlaþtýrýldý.
Bulgular: Çalýþmaya dahil edilen hastalarda en sýk görülen doðumsal kalp patolojisi ventriküler septal defektlerdi (% 32). Ýntraoperatif komplikasyonlar 21 hastada (%40) meydana geldi ve en sýk görülen komplikasyon ventriküler fibrilasyondu (6 hasta, %11,5). Her iki gruptaki hastalar intraoperatif hemodinamik göstergeler açýsýndan karþýlaþtýrýldýðýnda, Grup R’deki hastalarýn sternotomi sonrasý ortalama arteriyel basýnç deðerleri Grup F’deki hastalara göre anlamlý olarak düþüktü (p=0,034). Diðer hemodinamik göstergeler açýsýndan iki grup arasýnda istatistiksel olarak anlamlý bir fark bulunamadý. Ýki grup intraoperatif komplikasyonlar açýsýndan karþýlaþtýrýldýðýnda, Grup F’de komplikasyon geliþen hasta sayýsý daha yüksek olmasýna raðmen fark istatistiksel olarak anlamlý deðildi (p=0,1).
Sonuç: Bu çalýþma sonucunda pediyatrik kalp cerrahisi geçiren hastalarda intraoperatif hemodinamik stabilitenin saðlanmasýnda remifentanilin fentanil kadar etkili olduðu saptanmýþtýr.

Anahtar Kelimeler: Fentanil, kardiyovasküler anestezi, konjenital kalp hastalýklarý, opioid analjezikler, remifentanil

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Comparison of the Intraoperative Hemodynamic Effects of Remifentanil and Fentanyl in Pediatric Cardiac Surgery Anesthesia

Osman Uzundere¹, Fikret Salik¹, Cem Kývýlcým Kaçar¹, Aylin Erkul¹, Mustafa Býçak¹, Onur Doyurgan², Fatih Özdemir^3
1TR HSU Diyarbakýr Gazi Yaþargil TRH, Department Of Anesthesiology And Reanimation, Diyarbakýr, Turkey
²TR HSU Diyarbakýr Gazi Yaþargil TRH, 2Department of Pediatric Cardiac Surgery, Diyarbakýr, Turkey
³TR HSU Ümraniye TRH, Department of Pediatric Cardiac Surgery, Istanbul, Turkey

Objective: The aim of this prospective observational study was to compare the hemodynamic effects of remifentanil and fentanyl, which are used as intraoperative analgesics in pediatric cardiac surgery.
Methods: Patients were divided into two groups as those who received continuous intravenous remifentanil infusion (Group R) or intermittent intravenous fentanyl for intraoperative analgesia (Group F). These groups were compared in terms of hemodynamic characteristics and intraoperative complications.
Results: The most common congenital cardiac pathology observed in the patients included in the study was ventricular septal defects (32%). Intraoperative complications occurred in 21 (40%) patients, and ventricular fibrillation was the most common complication (n=6; 11.5%). When the patients in both groups were compared in terms of intraoperative hemodynamic indicators, the mean arterial pressure values of the patients in Group R after sternotomy were significantly lower than those of the patients in Group F (p=0.034). No statistically significant difference was found between the two groups in terms of other hemodynamic indicators. When the two groups were compared in terms of intraoperative complications, the difference was not statistically significant although the number of patients with complications was higher in Group F (p=0.1).
Conclusion: As a result of this study, it was found that remifentanil was as effective as fentanyl in maintaining intraoperative hemodynamic stability in patients undergoing pediatric cardiac surgery.

Keywords: Cardiovascular anesthesia, congenital heart disease, fentanyl, opioid analgesics, remifentanil

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