GKD Anest Yoð Bak Dern Derg. 2013; 19(2): 86-91 | DOI: 10.5222/GKDAD.2013.086

Remifentanilin Klinik Etkileri Bakýmýndan Nitröz Okside Üstünlüðü Var mýdýr?

Elzem Þen, Ayþe Mýzrak, Sýtký Göksu
Gaziantep Üniversitesi Týp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalý, Gaziantep

AMAÇ: Nitröz oksit ve remifentanilin hemodinami, B12 vitamini, derlenme süresi, yan etkiler, hasta ve cerrah memnuniyeti üzerine olan etkilerini karþýlaþtýrmayý amaçladýk.
YÖNTEMLER: ASA I-II risk grubunda abdominal histerektomi planlanan, premedike edilmemiþ olan 75 olgu rastgele 3 gruba ayrýldý; azot protoksit (Grup N), remifentanil (Grup R) ve kontrol (Grup K). Anestezi indüksiyonunda her 3 gruba da 2 mg kg-1 propofol, 0,6 mg kg-1 rokuronyum verildi. Remifentanil grubuna 0,5 μg kg-1 remifentanil yüklemesini takiben 0,2 μg kg-1 dk-1 infüzyona baþlandý. Endotrakeal entübasyonun ardýndan, % 2 sevofluran ile birlikte % 50 O2/N2O (Grup N) veya hava (Grup R, K) içeren 4 L dk-1 taze gaz verilmeye baþlandý. Hemodinamik parametreler, B12 vitamini, yan etkiler, hasta ve cerrah memnuniyeti ve derlenme süreleri kaydedildi.
BULGULAR: Sýfýrýncý, 10., 15., 30. dk.’larda intraoperatif kalp atým hýzý (KAH), remifentanil grubunda kontrol grubuna göre istatistiksel olarak anlamlý düþük bulunmuþtur (p<0.05). Ýntraoperatif 5., 30. dk. ve postoperatif 0. dk’da KAH deðerleri Grup N’de Grup R’deki deðerlere göre istatistiksel olarak anlamlý þekilde yüksekti (p<0.05). Ýntraoperatif 45. dk.’daki ortalama arteriyel kan basýncý (OAB) deðeri istatistiksel olarak Grup N’de Grup R’dekinden daha yüksekti (p=0,02). Aldrete Derlenme Skorunun 9 olma süresi Grup N’de Grup R’ye göre istatistiksel olarak anlamlý yüksekti (p=0,009). Ýntraoperatif cerrah memnuniyeti sýrasýyla Grup R>Grup N>Grup K idi (p<,0,05). Grup N’de bulantý-kusmasý olan hastalarýn yüzdeleri Grup R’dekinden istatistiksel olarak anlamlý yüksek bulunmuþtur (p=0,001).
SONUÇ: Remifentanil ile daha hýzlý derlenme ve daha az PBK saðlanmýþ olmakla birlikte, hem remifentanil ve hem de N2O ile benzer þekilde stabil bir hemodinamik etki ve konforlu bir genel anestezi saðlanmýþtýr.

Anahtar Kelimeler: nitröz oksit, remifentanil, hemodinamik etkiler, B12 vitamini

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Is Remifentanil Superior to Nitrous Oxide Regarding the Clinical Effects?

Elzem Þen, Ayþe Mýzrak, Sýtký Göksu
Gaziantep University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep

OBJECTIVE: We aimed to compare the effects of N2O and remifentanil on hemodynamic parameters, B12 vitamin values, recovery times, side effects, patient and surgeon satisfactions.
METHODS: Seventy-five ASA I-II women scheduled for abdominal hysterectomy were randomly divided into three groups as nitrous oxide (Group N), remifentanil (Group R) and control (Group K) groups. In each group, the patients were given 2 mg kg-1 propofol, 0.6 mg kg-1 rocuronium during induction of anesthesia. In the remifentanil group following 0.5 μg kg-1 bolus remifentanil, 0.2 μg kg-1 dk-1 infusion was started. Following endotracheal intubation, fresh gas 4 L dk-1 containing 50 % O2/N2O (in Group N) or medical air (in Group R, K) in with 2 % sevoflurane was given. Hemodynamic parameters, B12 vitamin, side effects, patient and surgeon satisfactions and recovery times were recorded.
RESULTS: In the remifentanil group, intraoperative heart rate (HR) values were found statistically significantly lower than those of the control group at 0., 10., 15., 30. minutes (p<0.05). In Group N, HR values were statistically significant higher than Group R at intraoperative 5., 30., minutes and postoperative 0. minute (p<0.05). In group N, the intraoperative mean arterial pressure (MAP) at 45. minute was statistically higher than group R (p=0.02). Aldrete Recovery Score to be 9 in Group N was statistically significantlt longer than Group R (p=0.009). Surgeon satisfaction levels in groups were in decreasing order as Group R > Group N > Group K (p<0.05). In Group N, nausea and vomiting were statistically significantly higher than Group R (p=0.001).
CONCLUSION: Although remifentanil provided more rapid recovery with less frequent postoperative nausea, and when compared with nitrous oxide, both of them provided a stable hemodynamic effect and a satisfactory general anesthesia.

Keywords: nitrous oxide, remifentanil, hemodynamic effects, B12 vitamin

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