Pediatrik Ambulatuar Cerrahi Hastaların Sünnet Operasyonlarında Remifentanil-Propofole karşı Fentanil Propofol

Year 2020, Volume: 42 Issue: 1, 1 - 6, 01.01.2020

Sema Şanal Baş

https://doi.org/10.20515/otd.453735

Abstract

Sünnet dünya genelinde en sık
uygulanan cerrahi işlemdir. Fentanil, remifentanil ve propofol pediatri
pratiğinde bu amaç için en yaygın kullanılan ilaçlardır. Bu çalışmada sünnet
yapılan çocuk hastalarda fentanil veya remifentatil uygulamasının etkinliğini
ve güvenirliliğinin karşılaştırılması amaçlandı. Sünnet cerrahisi uygulanan ASA
I-II, 120 erkek çocuk (American Society of Anesthesiologists), retrospektif
olarak çalışmaya alındı. Hastalara propofol 2-3 mg kg -1 sonrasında Grup F’ye
fentanil 0,5-1 μg kg-1 (n=60), Grup R’ye remifentanil 0.5-1 μg kg-1 (n=60)
kullanılarak indüksiyon yapıldı. Anestezi idamesinde sevofluran 4 L dk -1 %50
hava ve oksijen %3-4 kullanıldı. Peroperatif ve derlenme ünitesinde hemodinamik
verileri ve komplikasyon kayıtları alındıktan sonra hastalar 6 saat boyunca
çocuk cerrahi servisinde takip edildi. Sünnet cerrahisi uygulanan 0-2 yaş, 120
erkek çocuk hastanın gruplar arasında yaş, vücut ağırlığı, boy, ASA fiziksel
durumu ve operasyon süreleri arasında istatistiksel olarak fark yoktu.
Remifentanil-propofol alan Grup R hastalar, Grup F alanlara göre uyanma süresi
istatistiksel olarak önemli oranda kısaydı. Grup F’de kusma en sık görülen
komplikasyon iken, Grup R’de ise bradikardiydi. Gruplar komplikasyon gelişimi
sıklığı bakımından karşılaştırıldığında bradikardi, bronkospazm, solunum
depresyonu ve alerjik reaksiyon sıklığı açısından gruplar arasında fark
gözlenmedi. Sonuç olarak sünnet cerrahisi uygulanan pediatrik hastaları
değerlendirdiğimiz bu çalışmada; remifentanil-propofol kullanımının bu yaş
grubunda önermekle birlikte olası yan etkiler açısından hastaların yakından
izlenmesinin gerekliliğini de vurgulamayı amaçladık.

Keywords

Pediatric, circumcision, remifentanil

Remifentanil-Propofol versus Fentanyl-Propofol for Circumcision Operations in Pediatric Ambulatory Surgical Patients

Abstract

Circumcision
is the most frequent surgical procedure performed worldwide. The present study
aimed to compare the efficacy and safety of fentanyl vs. remifentanil in
pediatric patients undergoing circumcision procedure. A total of 120 boys, who
were ASA (American Society of Anesthesiologists) I-II and underwent
circumcision procedure, were retrospectively evaluated. Induction for
anesthesia was provided using propofol that using 0,5-1 μg kg-1 (n=60) in Group
F and using remifentanil 0,5-1 μg kg-1 (n=60) in Group R. After monitoring the
patients and recording hemodynamic parameters and complications the findings
every 30 minutes in peroperative and the recovery room, the patients were then
followed for 6 hours. A total of 120 boys at the age of 0-2 years old who were
underwent circumcision procedure, were retrospectively evaluated. The groups
were comparable in terms of age, body weight, height, ASA physical status and
duration of surgery that was not statistically significant.Recovery time from
anesthesia was statistically significantly shorter in the remifentanil-propofol
(Group R) as compared to the fentanyl-propofol (Group F). While vomiting was
the most common complication in Group F, bradycardia was the most common
complication in Group R. Comparison of the frequencies of complications between
the groups revealed no difference in terms of bradycardia, bronchospasm,
respiratory depression and allergic reaction. In conclusion, based on the
results of the present study, we recommend using remifentanil-propofol in this
pediatric age group but also underline the necessity of close monitoring of
these patients for the potential side effects.

Keywords

Pediatric, circumcision, remifentanil

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