Effects of ketamine or fentanyl addition to propofol on the quality of sedo-analgesia during endoscopic ultrasonography

Yıl 2019, , 167 - 170, 30.06.2019

Hayrettin Daşkaya , Harun Uysal Ferda Yılmaz İnal Asım Esen , Kazım Karaaslan

https://doi.org/10.16899/jcm.578643

Öz

Aim: Endoscopic ultrasonography procedures are usually
performed in prone position with sedation. In this prospective study we
investigated efficacy, patient and endoscopist satisfaction of sedation with
propofol + ketamin or propofol + fentanyl combinations on patients who
underwent diagnostic EUS.

Materials
and methods: 111 patients were included in the study who were
planned for EUS with sedation. All patients received 1 mg/kg Lidocaine and 0.01
mg / kg Atropine. Propofol + ketamine group (Group K) sedated with 1,5mg/kg
propofol, 1 mg/kg ketamine and propofol + fentanyl group (Group F) sedated with
1,5mg/kg propofol, 1mcg/kg fentanyl. In absence of sedation an additional dose
of 0,2 mg/kg Propofol was applied in both groups. During intraoperative period
patients were recorded with Richmond agitation score, heart rate,
systolic-diastolic-mean blood pressure, peripheric oxygen saturation 5 minutes
interval. Total time of the procedure and total amount of propofol consumed
during this period were recorded. Postoperative nausea, vomiting Numeric Rank Score,
for pain visual pain score and aldrete score were recorded. Endoscopist and
patient satisfaction scores were requested between 0-4 and recorded.

Results: Each group has similar demographic data and operation
time. Total amount of propofol usage was lower in group F (p<0.001). Group F
has shorter Post-Anesthesia Care Unit stay (p<0.001). While endoscopist
satisfaction were same, patient satisfaction were significantly different
(p:001). Intraoperative heart rate and blood pressure were significantly
increased in Group K while these values were more stable in Group F. Post-Anesthesia
Care Unit entrance blood pressure and heart rates were higher in group K.
Intraoperative SpO₂ were not
significantly different. 

Conclusıon: Considering that the majority of patients undergoing
endoscopic procedures has comorbid conditions and elderly and statistically
significant differences has in group K and group F; we think that combination
of fentanyl and propofol is more advantageous for the sedation in endoscopic
ultrasonography cases for esophagus, stomach and pancreas-biliary system 

Anahtar Kelimeler

endoscopic ultrasonography, sedo-analgesia, outpatient anesthesia

Endoskopik ultrasonografi yapılan olgularda propofole ketamin veya fentanil ilavesinin sedo-analjezi kalitesi üzerine etkileri

Öz

Amaç:Endoskopik ultrasonografi işlemleri genellikle pron
pozisyonunda ve sedo-analjezi altında yapılmaktadır. Bu prospektif çalışmada
tanısal endoskopik ultrasonografi yapılan hastalarda propofol+ketamin ve
propofol+fentanil kombinasyonları ile yapılan sedo-analjezinin etkinliği, hasta
memnuniyeti ve endoskopist memnuniyeti farklılıklarının incelenmesi
amaçlanmaktadır.

Gereç-yöntem: Sedo-analjezi ile endoskopik ultrasonografi işlemi
planlanmış 111 hasta çalışmaya dâhil edildi. Tüm hastalara 1mg/kg Lidokain ve
0,01 mg/kg Atropin yapıldıktan sonra Propofol+ketamin grubuna (Grup K) 1,5
mg.kg^-1 Propofol, 1 mg.kg^-1 Ketamin, Propofol+fentanil
grubuna (Grup F) da 1,5 mg.kg^-1 Propofol, 1 mcg. kg^-1
Fentanil ile sedo-analjezi sağlandı. Hastaların intraoperatif dönemde Richmond
Ajitasyon Skoru, kalp atım hızı, sistolik-diyastolik-ortalama kan basıncı,
periferik oksijen saturasyonu total işlem süresi ve bu esnada tüketilen toplam
propofol miktarı kaydedildi. Tüm hastalarda Numerik Rank Skoru, vizüel ağrı
skoru ve Aldrete derlenme skoru kaydedildi. İşlem bittikten sonra endoskopistten
ve hastadan memnuniyetini 0-4 arsında puanlandırması istenip kaydedildi.

Bulgular: Her iki grupta demografik veriler ve total operasyon
süreleri benzerdi. Toplamda tüketilen tüketilen Propofol düzeyi grup F’de daha
düşüktü (p<0.001). Grup F’de derlenme ünitesinde kalış süresi daha kısa
gözlendi (p<0.001). Endoskopist memnuniyetinde herhangi bir fark
gözlenmezken, hasta memnuniyetinde anlamlı fark tespit edildi (p:001). Grup K’da
İntraoperatif kalp atım hızı ve tansiyon arteriyalde anlamlı artışlar
gözlenirken, grup F’de bu değerler daha stabil seyr etti. Derlenme ünitesi
giriş kalp atım hızları ve tansiyon değerleri grup K’da daha yüksek gözlendi.

Sonuç: Endoskopik girişim yapılan hastaların büyük
çoğunluğunun ileri yaş ve ek hastalık mevcudiyeti bulunmaktadır. Bu hastalarda
anestezi ile yapılan işlemlerde anestejik ajan seçimi önem arz etmektedir. Bu
açıdan bakıldığında endoskopik girişimlerde sedo-analjezi uygulanmalarında fentanil
propofol kombinasyonunun avantajlı olduğunu düşünmekteyiz.

Anahtar Kelimeler

endoskopik ultrasonografi, sedo-analjezi, ameliyathane dışı anestezi

Kaynakça

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