Fonksiyonel endoskopik sinüs cerrahisi olgularında nikardipin ve remifentanil kombinasyonunun cerrahi görme alanı ve hemodinamik parametreler üzerineetkileri
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada Fonksiyonel Endoskopik Sinüs Cerrahisi Olgularında kanamayı azaltmak ve endoskopik görüş alanını iyileştirmek amacıyla uygulanan kontrollü hipotansiyon (KH) için kullanılan Nikardipin/Remifentanil kombinasyonunun cerrahi görüş alanı, hemodinamik veriler, postoperatif bulantı kusma ve ağrı üzerine etkilerini araştırdık. Materyal ve Metot: Çalışmamıza 18-65 yaş arası 73 hasta dahil edildi. Hastalar randomize olarak iki gruba ayrıldı. Grup R (Remifentanil) 36 hasta, Grup RN (Remifentanil/Nikardipin kombinasyonu) 37 hastayı kapsamaktadır. Entübasyon işlemini takiben Grup R'de: Remifentanil: 0.05–2.0 ?g/kg/dk, Grup RN'de: Remifentanil 0.025- 1 ?g/kg/dk, Nikardipin: 0.5-3.5 ?g/kg/dk intravenöz (ıv) dozu ile infüzyona başlandı. GrupR ve Grup RN'de hedeflenen ortalama arter basıncı (OAB) 50-65 mmHg olarak belirlendi ve ilaç dozları hedeflenen OAB sağlanana kadar arttırıldı. Sistolik arter basıncı (SAB), diastolik arter basıncı (DAB), OAB, kalp hızı (KAH) değerleri T0; İndüksiyon öncesi olmak üzere her on beş dakikada bir, T8; Ekstübasyon sırasında, T9; anestezi? sonrasi bakim ünı? tesı? (PACU)' nde 10. dk'da kaydedildi. Indüksiyon sonrası ekstübasyona kadar her on beş dakikada bir End-tidal karbondioksit (EtCO2) değerleri kaydedildi. Cerrahi operasyon başladıktan sonra 15 dakikada bir kanama miktarı, aspirasyon ihtiyacı ve cerrahi alan görünürlüğü Boezaart skalası ile değerlendirildi. PACU 'da kalış süresi, bulantı kusma ve Sayısal Derecelendirme Skalası (NRS) ağrı ölçeği ile ağrı değerlendirmesi yapıldı. Bulgular: Grup RN'de PACU kalış süresi Grup R'den anlamlı olarak daha kısa izlendi (p=0,003). NRS ağrı skorlamasında gruplar arasında istatistiksel olarak anlamlı farklılık izlendi ve grup R'de daha yüksekti (p=0,001). Bulantı kusma skorlarında gruplar arasında istatistiksel olarak anlamlı farklılık görüldü ve grup RN'de daha düşüktü (p=0,037). SAB ve OAB grup RN'de anlamlı olarak daha düşük bulundu (p=0,018 ve p=0,023). Tüm zaman periyotları boyunca KAH değerinin her iki grup içinde dağılımında anlamlı farklılık belirlendi ve grup RN'de daha yüksekti (p= ?0,001). Tüm zaman periyotları boyunca Boezaart skorunun her iki grup içinde dağılımında anlamlı farklılık vardı ve grup RN'de daha düşüktü (p= ?0,001). Sonuç: Fonksiyonel endoskopik sinüs cerrahisinde KH uygulaması için Remifentanil/Nikardipin kombinasyonu daha iyi bir cerrahi alan kalitesi sağlar. Bu kombinasyonun bir yandan KH'nun sürdürülmesinde bir yandan da postoperatif ağrı ve bulantı kusma skorları üzerinde daha başarılı oluşu nedeniyle remifentanilin tek başına uygulanmasına göre tercih edilebilir bir seçenektir. Anahtar Kelimeler: kontrollü hipotansiyon, nikardipin/remifentanil kombinasyonu, fonksiyonel endoskopik sinüs cerrahisi
Aim: In this study, we investigated the effects of the Nicardipine/Remifentanil combination used for controlled hypotension (CH) to reduce bleeding and improve the endoscopic field of view on the surgical field of view, hemodynamic data, postoperative nausea, vomiting, and pain in Functional Endoscopic Sinus Surgery Cases. Materials and Methods: Our patients aged between 18 and 65 years were included in our study. Patients were randomly divided into two groups. Group R (Remifentanil) included 36 patients and Group RN (Remifentanil/Nicardipine combination) included 37 patients. Following intubation in Group R: Remifentanil: 0.05-2.0 ?g/kg/min, Group RN: Remifentanil: 0.025-1 ?g/kg/min, Nicardipine: 0.5-3.5 ?g/kg/min intravenous (iv) infusion was started. In Group R and Group RN, the average target mean arterial pressure (MAP) was determined as 50-65 mmHg, and drug doses were increased until the targeted MAP was reached. Systolic arterial pressure (SBP), diastolic arterial pressure (DBP), MAP, and heart rate (HR) values were recorded every fifteen minutes at T0; before induction, T8; during extubation, T9; at 10 minutes in the post-anesthesia care unit (PACU). End-tidal carbon dioxide (EtCO2) values were collected every fifteen minutes after induction until extubation. The amount of bleeding, need for aspiration, and surgical field visibility were evaluated every 15 minutes after the start of the surgical operation using the Boezaart scale. Duration of PACU stay, nausea and vomiting, and pain assessment with the Numerical Rating Scale (NRS) pain scale were performed. Results: PACU length of stay was significantly shorter in group RN than in group R (p=0.003). There was a statistically significant difference between the groups in NRS pain scoring and it was higher in group R (p=0.001). Nausea and vomiting scores showed a statistically significant difference between the groups and were lower in group RN (p=0.037). SAB and OAB were significantly lower in group RN (p=0.018 and p=0.023). There was a significant difference in the distribution of HR within both groups during all periods and it was higher in group RN (p= ?0.001). There was a notable difference in the distribution of Boezaart score in both groups during all periods and it was found to be lower in group RN (p= ?0.001). Conclusion: Remifentanil/Nicardipine combination for application of CH in functional endoscopic sinus surgery provides a better surgical field quality. This combination is preferable to remifentanil alone because it is more successful in maintaining CH on the one hand and postoperative pain scores and nausea as well as vomiting on the other hand. Keywords: Controlled hypotension, nicardipine/remifentanil combination, functional endoscopic sinus surgery.
Aim: In this study, we investigated the effects of the Nicardipine/Remifentanil combination used for controlled hypotension (CH) to reduce bleeding and improve the endoscopic field of view on the surgical field of view, hemodynamic data, postoperative nausea, vomiting, and pain in Functional Endoscopic Sinus Surgery Cases. Materials and Methods: Our patients aged between 18 and 65 years were included in our study. Patients were randomly divided into two groups. Group R (Remifentanil) included 36 patients and Group RN (Remifentanil/Nicardipine combination) included 37 patients. Following intubation in Group R: Remifentanil: 0.05-2.0 ?g/kg/min, Group RN: Remifentanil: 0.025-1 ?g/kg/min, Nicardipine: 0.5-3.5 ?g/kg/min intravenous (iv) infusion was started. In Group R and Group RN, the average target mean arterial pressure (MAP) was determined as 50-65 mmHg, and drug doses were increased until the targeted MAP was reached. Systolic arterial pressure (SBP), diastolic arterial pressure (DBP), MAP, and heart rate (HR) values were recorded every fifteen minutes at T0; before induction, T8; during extubation, T9; at 10 minutes in the post-anesthesia care unit (PACU). End-tidal carbon dioxide (EtCO2) values were collected every fifteen minutes after induction until extubation. The amount of bleeding, need for aspiration, and surgical field visibility were evaluated every 15 minutes after the start of the surgical operation using the Boezaart scale. Duration of PACU stay, nausea and vomiting, and pain assessment with the Numerical Rating Scale (NRS) pain scale were performed. Results: PACU length of stay was significantly shorter in group RN than in group R (p=0.003). There was a statistically significant difference between the groups in NRS pain scoring and it was higher in group R (p=0.001). Nausea and vomiting scores showed a statistically significant difference between the groups and were lower in group RN (p=0.037). SAB and OAB were significantly lower in group RN (p=0.018 and p=0.023). There was a significant difference in the distribution of HR within both groups during all periods and it was higher in group RN (p= ?0.001). There was a notable difference in the distribution of Boezaart score in both groups during all periods and it was found to be lower in group RN (p= ?0.001). Conclusion: Remifentanil/Nicardipine combination for application of CH in functional endoscopic sinus surgery provides a better surgical field quality. This combination is preferable to remifentanil alone because it is more successful in maintaining CH on the one hand and postoperative pain scores and nausea as well as vomiting on the other hand. Keywords: Controlled hypotension, nicardipine/remifentanil combination, functional endoscopic sinus surgery.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
