Azot Protoksitsiz Düşük Akımlı Desfluran Anestezisinde Remifentanil Ve Fentanil İnfüzyonlarının Hemodinamik Değişiklikler Ve Derlenme Koşulları Açısından Karşılaştırılması
Abstract
Azot protoksitsiz düşük akımlı desfluran anestezisinde remifentanil ve fentanil infüzyonlarının hemodinamik değişiklikler ve derlenme koşulları açısından karşılaştırılması
Cihan Şahin1, Dilek Yazıcıoğlu2
1TOBB ETÜ Hastanesi, Anestezi Ve Reanimasyon Ana Bilim Dalı, Ankara
2Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Anestezi Ve Reanimasyon Ana Bilim Dalı, Ankara
AMAÇ: Azot protoksitsiz düşük akımlı desfluran anestezisinde remifentanil ve fentanil infüzyonlarının hemodinamik değişiklikler ve derlenme koşulları açısından karşılaştırılmasıdır.
YÖNTEM: Elektif kulak cerrahisi geçirecek ve Amerikan Anestezistler Derneği I-II fizyolojik sınıfta 40 yetişkin hasta rastgele Remifentanil (Grup R; n=20) ve Fentanil (Grup F; n=20) gruplarına ayrıldı. Kalp hızı, sistolik, diastolik ve ortalama arter basınçları, periferik oksijen saturasyonu, Bispektral indeks değeri, soluk sonu karbondioksit ve desfluran konsantrasyonları, inspiratuvar oksijen ve karbondioksit monitorize edildi, değerler 5 dk arayla kaydedildi. Grup R’de 1 µg kg-1 yükleme ardından 0,25-1µg kg-1 dk-1 remifentanil infüzyonu başlandı; Grup F’de, fentanil 2 μg kg -1 bolus ardından, 3 μg kg-1 saat -1 infüzyon başlandı, infüzyon her 30 dakika sonunda 0,5 μg kg-1saat-1 azaltıldı ve operasyonun son 10-15 dakikasında sonlandırıldı. Operasyon sonunda ekstübasyon, spontan göz açma zamanı, Aldrete derlenme skoru ≥9 olma süreleri ile istenmeyen olaylar ve tedavileri kaydedildi.
BULGULAR: Gruplar hasta özellikleri bakımından benzerdi. Gruplar arasında diastolik arter basınçları 70 ve 80. dakika ölçümlerinde (Grup R’de daha düşük p=0,0174 ve p=0,0346); ortalama arter basınçları 80 ve 85. dakika ölçümlerinde (Grup R’de daha düşük p=0,04 ve p= 0,03) ve kalp hızında birden fazla ölçüm zamanında fark bulundu. Fentanil uygulanan grupta derlenmenin daha erken olduğu belirlendi; derlenme süresi Grup R: 9,9 ± 2,9 dk, Grup F: 8,4 ±0,9 dk (p= 0,0411).
SONUÇ: Azot protoksitsiz düşük akımlı desfluran anestezisinde remifentanil veya fentanil infüzyonu hemodinamik değişkenler bakımından benzer etkilere sahiptir; her iki ajan bu amaçla güvenle kullanılabilir; azaltılan dozlarda infüzyon şeklinde uygulanan fentanil daha kısa derlenme süresi sağlamakla remifentanilden üstün bulunmuştur.
Anahtar Kelimeler: desflurane, düşük akım anestezi, fentanyl, nitröz oksitsiz, remifentanil
References
- 1- Upadya M, Saneesh PJ. Low-flow anaesthesia – underused mode towards sustainable anaesthesia. Indian J Anaesth 2018;62(3):166–172.
- 2- Forman S, Ishızawa Y. Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity. In: Gropper M, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N, Leslie K, editors. Miller's Anesthesia. Elsevier, 2019;509-539.
- 3- Baum J.A. Technical requirements for anaesthesia management with reduced fresh gas flow. In: Baum JA (ed). Low Flow Anaesthesia. The theory and practise of low flow, minimal flow and closed system anaesthesia. Oxford: Butterworth Heinemann, 2001; 111-173.
- 4- Bilgi M, Goksu S, Mizrak A, et al. Comparison of the effects of low-flow and high flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests. Eur J Anaesthesiol 2011;28(4):279–283
- 5- Edmonds A, Stambaugh H, Pettey S, Daratha KB. Evidence-Based Project: Cost Savings and Reduction in Environmental Release With Low-Flow Anesthesia. AANA J 2021;89(1):27-33.
- 6- Arslan M, Gisi G, Öksüz G, et al. Are high fresh gas flow rates necessary during the wash-in periodin low-flow anesthesia? Kaohsiung J Med Sci 2020;36:834–840.
- 7- Öterkuş M, Dönmez İ, Nadir AH, Rencüzoğulları İ, Karabağ Y, Binnetoğlu K. The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery. Saudi Med J 2021; 42(3):264-269
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- 11- Mallik T, Aneja S, Tope R, Muralidhar V. A randomized prospective study of desflurane versus isoflurane in minimal flow anesthesia using “equilibration time” as the change-over point to minimal flow. J Anaesthesiol Clin Pharmacol 2012;28:470-475.
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- 13- Venkatachalapathy R, Cherian A, Panneerselvam S. Changes in Gas Composition during Low Flow Anaesthesia without Nitrous Oxide. J Clin Diagn Res 2017;11(7):29–33.
- 14- Watcha M.F., White P.F. Economics of anesthetic practise. Anesth 1997;86(5):1170-1196.
- 15- Choi JW, Joo JD, Kim DW, et al. Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control. J Korean Med Sci 2016;31(9):1485-1490. 16- Ceylan A, Kırdemir P, Kabalak A, Aksu C, Baydar M, Goğuş N. Düşük akım desfluran ve sevofluran anestezisinde karboksihemoglobin, hemodinami ve uyanma kriterlerinin karşılaştırılması. Gülhane Tıp Dergisi 2004;46:291–297.
- 17- Barçın S, Sahan L, Ornek D ve ark. The effects of nitrous oxide on controlled hypotension during low flow anesthesia Bras Anesth 2013;63(2):170-177
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- 19- Echevarria G, Elgueta F, Fierro C, et al. Nitrous oxide reduces postoperative opioid-induced hyperalgesia after remifentanil–propofol anaesthesia in humans. BJA 2011; 107:959-965.
- 20- Stricker PA, Kraemer FW, Ganesh A. Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent. J Clin Anesth 2009;21:124-126.
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- 22- Negargar S, Peirovifar A, Mahmoodpoor A, et al. Hemodynamic parameters of low-flow isoflurane and low-flow sevoflurane anesthesia during controlled ventilation with laryngeal mask airway. Anesth Pain Med 2014;4;(5):e20326.
- 23- Khetarpal R, Attri JP, Banerjee A, Verma R. Advantages of 1-1-12 Wash in Scheme during Induction with Low Flow Anesthesia with and without Nitrous Oxide. Anesth Essays Res 2018;12(2):371–376.
Remifentanil and fentanil infusions in nitrous oxide-free low flow-desfluran anesthesia: A randomized comparison of hemodynamic effects and recovery conditions
Abstract
Remifentanil and fentanil infusions in nitrous oxide-free low flow-desfluran anesthesia: A randomized comparison of hemodynamic effects and recovery conditions
Cihan Şahin1, Dilek Yazıcıoğlu2
1TOBB ETU Medical Faculty Hospital, Department of Anaesthesia and Intensive Care, Ankara, Turkey
2Dıskapı Yıldırım Beyazıt Training and Research Hospital, Department of Anaesthesia and Intensive Care, Ankara, Turkey
OBJECTIVE: Remifentanil and fentanyl infusions were compared in terms of hemodynamic parameters and recovery characteristics in nitrous oxide-free low-flow desflurane anesthesia.
METHODS: Forty adults in American Society of Anesthesiologists I-II physical class, undergoing elective ear surgery were randomly divided into the Remifentanil (Group R; n=20) and Fentanyl (Group F n=20) groups. Heart rate systolic, diastolic, mean arterial pressures, peripheral oxygen saturation, Bispectral index value, end-tidal carbon dioxide and desflurane concentrations, inspiratory oxygen and carbon dioxide were monitored, values were recorded every 5 minutes. In Group R, after 1 µg kg-1 loading, 0.25-1 µg kg-1 min-1 remifentanil infusion was started; In Group F, after a 2 μg kg -1 bolus of fentanyl, followed by a 3 μg kg-1 h-1 infusion was started, the infusion was decreased by 0.5 μg kg-1h-1 after every 30 minutes and ended in the last 10-15 minutes of operation. End of the surgery, time to extubation, spontaneous eye-opening, Aldrete score ≥9, adverse events, and treatments were recorded.
RESULTS: Groups were similar with respect to patient characteristics. Groups were different in diastolic arterial pressure measurements at the 70th and 80th minutes (p=0.0174, p=0.0346); in mean arterial pressure measurements at the 80th and 85th minutes (p=0.04, p= 0.03), and in hearth rate measurements in more than one measurement interval. Time to Aldrete ≥9 was shorter with fentanyl infusion; Group R: 9.9 ± 2.9 min, Group F: 8.4 ±0.9 min (p= 0.0411).
CONCLUSION: In nitrous oxide-free low-flow desflurane anesthesia, remifentanil and fentanyl infusion had similar effects in terms of hemodynamic variables. Both agents can be used safely in this context.
Keywords: desflurane, fentanyl, low flow anesthesia, nitrous oxide-free, remifentanil
References
- 1- Upadya M, Saneesh PJ. Low-flow anaesthesia – underused mode towards sustainable anaesthesia. Indian J Anaesth 2018;62(3):166–172.
- 2- Forman S, Ishızawa Y. Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity. In: Gropper M, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N, Leslie K, editors. Miller's Anesthesia. Elsevier, 2019;509-539.
- 3- Baum J.A. Technical requirements for anaesthesia management with reduced fresh gas flow. In: Baum JA (ed). Low Flow Anaesthesia. The theory and practise of low flow, minimal flow and closed system anaesthesia. Oxford: Butterworth Heinemann, 2001; 111-173.
- 4- Bilgi M, Goksu S, Mizrak A, et al. Comparison of the effects of low-flow and high flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests. Eur J Anaesthesiol 2011;28(4):279–283
- 5- Edmonds A, Stambaugh H, Pettey S, Daratha KB. Evidence-Based Project: Cost Savings and Reduction in Environmental Release With Low-Flow Anesthesia. AANA J 2021;89(1):27-33.
- 6- Arslan M, Gisi G, Öksüz G, et al. Are high fresh gas flow rates necessary during the wash-in periodin low-flow anesthesia? Kaohsiung J Med Sci 2020;36:834–840.
- 7- Öterkuş M, Dönmez İ, Nadir AH, Rencüzoğulları İ, Karabağ Y, Binnetoğlu K. The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery. Saudi Med J 2021; 42(3):264-269
- 8- Glenski T, Levine L. The implementation of low-flow anesthesia at a tertiary pediatric center: A quality improvement initiative. Paediatr Anesth 2020;30(10):1139-1145.
- 9- Aronson JK. Meyler's Side Effects of Drugs. Elsevier Science 2016:355-369.
- 10- Hargasser SH, Mielke LL, Entholzner EK et al. Experiences with the new inhalational agents in low-flow anaesthesia and closed-circuit technique. Appl Cardiopulm Pathophysiol 1995;5(2):47–57.
- 11- Mallik T, Aneja S, Tope R, Muralidhar V. A randomized prospective study of desflurane versus isoflurane in minimal flow anesthesia using “equilibration time” as the change-over point to minimal flow. J Anaesthesiol Clin Pharmacol 2012;28:470-475.
- 12- Toal P, Chiplonkar S, Pancha P. A randomised prospective comparison of equilibration point and changing gas composition during low flow anaesthesia with sevoflurane vs desflurane. Indian J Anaesth 2019;63(10):814–819.
- 13- Venkatachalapathy R, Cherian A, Panneerselvam S. Changes in Gas Composition during Low Flow Anaesthesia without Nitrous Oxide. J Clin Diagn Res 2017;11(7):29–33.
- 14- Watcha M.F., White P.F. Economics of anesthetic practise. Anesth 1997;86(5):1170-1196.
- 15- Choi JW, Joo JD, Kim DW, et al. Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control. J Korean Med Sci 2016;31(9):1485-1490. 16- Ceylan A, Kırdemir P, Kabalak A, Aksu C, Baydar M, Goğuş N. Düşük akım desfluran ve sevofluran anestezisinde karboksihemoglobin, hemodinami ve uyanma kriterlerinin karşılaştırılması. Gülhane Tıp Dergisi 2004;46:291–297.
- 17- Barçın S, Sahan L, Ornek D ve ark. The effects of nitrous oxide on controlled hypotension during low flow anesthesia Bras Anesth 2013;63(2):170-177
- 18- Muslu B, Muslu S, Zengin D, Özgök A, Erdemli Ö. Remifentanil nörolept anestezide fentanile alternatif olabilir mi? Yeni Tıp Dergisi 2008;25:25-30
- 19- Echevarria G, Elgueta F, Fierro C, et al. Nitrous oxide reduces postoperative opioid-induced hyperalgesia after remifentanil–propofol anaesthesia in humans. BJA 2011; 107:959-965.
- 20- Stricker PA, Kraemer FW, Ganesh A. Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent. J Clin Anesth 2009;21:124-126.
- 21- Tomatır E. Düşük akımlı anestezide hasta güvenliği boyutu: Düşük Akımlı Anestezi- Düşük akımlı, minimal akımlı ve kapalı sistemle anestezide kuram ve uygulama. Tomatır E (ed) Nobel Tıp Kitabevleri, İstanbul 2002;191-219
- 22- Negargar S, Peirovifar A, Mahmoodpoor A, et al. Hemodynamic parameters of low-flow isoflurane and low-flow sevoflurane anesthesia during controlled ventilation with laryngeal mask airway. Anesth Pain Med 2014;4;(5):e20326.
- 23- Khetarpal R, Attri JP, Banerjee A, Verma R. Advantages of 1-1-12 Wash in Scheme during Induction with Low Flow Anesthesia with and without Nitrous Oxide. Anesth Essays Res 2018;12(2):371–376.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 28, 2023 |
| Submission Date | September 2, 2022 |
| Acceptance Date | December 19, 2022 |
| Published in Issue | Year 2023 Volume: 5 Issue: 2 |
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