An Application of Sedation, to The Patients Performed Colonoscopy, Alongwith Ketamine-Propofol Combination in Different Ratios
Öz
Background:We aimed to investigate the effect of ketamine-propofol combination (ketofol) in the different
ratios on the hemodynamic parameters, recovery time, complications, and patient and doctor satisfaction in
the cases underwent endoscopic colonoscopy.
Methods:Atotal of 105 endoscopic colonoscopy patients who aged 18-65 and meet the criteria of American
Society of Anesthesiologists (ASA) I-II were included in this randomized, controlled, double-blind study.
Patients were divided into three separate groups: Group 1 consisted of the patients who administered 25 mg
ketamine + 25 mg propofol, Group 2 included the patients who administered 25 mg ketamine + 50 mg
propofol and Group 3 comprised the patients who administered 25 mg ketamine + 75 mg propofol . Each
patient received intravenous 0,2 ml/kg ketofol. Ramsay sedation scale (RSS) of >4 was expected during the
procedure. In the patients with RSS of 4 or less, we administered an additional doses of ketofol about one four
of initial dose. We recorded the heart rate, mean arterial pressure, arterial oxygen saturation, demographic
data, administered drug dosage, sedation time, time for spontaneous eye opening and Modified Aldrete Scale
(MAS) of >9, complications and patient-doctor satisfaction were recorded.
Results: When comparing heart rate among the groups, the 10th min of heart rate was found higher in the
Group 1 patients than that of others. There was no statistically significant difference in the other
measurement times. While there was no significant difference in the 10, 15, 20 and 30 min of mean arterial
pressure between the groups, the difference was statistically significant in the other measurement times.
When we look at drug dosage, there was no difference in the induction dose between the groups, whereas
total dose was lower in group 3 patients than the others. The time for spontaneous eye opening and MAS >9
after the procedure was found longer in the group 3 patients than the others. There was no statistically
significant difference in the patient satisfaction among groups whereas doctor satisfaction was higher in the
group 3 than group 1 and 2.
Conclusion: The total drug dose decreased as the propofol ratio used in ketofol increased. Hence, the doctor
satisfaction increased. On the other hand, the time for spontaneous eye opening and MAS >9 was increased.
Anahtar Kelimeler
Kaynakça
- 1) Sözen S, Emir S, Alıcı A, Aysu F, Yıldız F, Aziret M, et al. Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü. Ulusal Cerrahi Dergisi 2010;26(1):13-7.
- 2) Lombardi CP, Raffaelli M, De Crea C, Traini E, Oragano L, Sollazzi L, et al. Complications in thyroid surgery. Minerva Chir 2007;62(5):395-408.
- 3) Acun Z, Cihan A, Ulukent S C. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;4(12):997-1001.
- 4) Koutras DA, Matovinovic J, Vought R. The Ecology of Iodine. In: Stanbury JB, Hetzel BS, (eds) Endemic Goiter, Endemic Createnism. John Villey, New York, 1980;185-95.
- 5) Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jørgensen T. Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur J Endocrinol 2000;142(3):224- 30.
- 6) Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: e ff e c t o f c h a n g i n g p r a c t i c e . A r c h S u r g 1999;134(12):1389-93.
- 7) Tezelman S, Borucu I, Senyurek Giles Y, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg 2009;33(3):400-5.
- 8) Marchesi M, Biffoni M, Tartaglia F, Biancari F, Campana FP. Total versus subtotal thyroidectomy in the management of multinodular goiter. Int Surg 1998;83(3):202-4.
- 9) Colak T, Akca T, Kanık A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. S ANZ J Surg 2004;74(11):974-8 .
- 10) Pappalardo G, Guadalaxara A, Frattaroli FM, IIIomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164(7):501-6.
- 11) Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009;52(1):39- 44.
- 12) Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24(11):1335-41.
- 13) Jacobs JK, Aland JW Jr, Ballinger JF. Total thyroidectomy: A review of 213 patients. Ann Surg 1983;197(5):542-9.
- 14) Özbaş S, Koçak S, Aydıntuğ S, Çakmak A, Demirkıran MA. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocrine Journal 2005;52(2):199-205.
- 15) Yabanoğlu H, Aydoğan C, Sahillioğlu E. Evaluation of 213 thyroidectomy cases. Hakkari experience. Ulusal Cerrahi Derg 2011;27(4):212-5.
- 16) Sosa JA, Bowman HM, Tielsch JM. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998;228(3):320-30.
- 17) Filho JG, Kawalski LP. Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 2004;25(4):225-30.
- 18) Bozdağ A. Multinodüler guatr tedavisinde total tiroidektomi deneyimimiz. Fırat Tıp Derg 2014;19(2):88- 90.
- 19) Çıkman Ö, Özkul F, Arık MK, Taş Ş, Çakır C, Karaayvaz M. Endemik bölgede tiroidin benign hastalıklarında total tiroidektomi, 208 hastanın retrospektif analizi. Van Tıp Derg 2013;20(3):125-29.
- 20) Castro MR, Gharib H. Thyroid nodules and cancer. When to wait and watch, when to refer. Postgrad Med 2000;107(1):113-6.
- 21) Bozkurt K, Bektaş SS. The prevalence of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city. Dicle Medical Journal 2010;37(4):363-6.
- 22) Polat Y, Sarıcık B, Berçin S, Koca YS, Polat HT. Tiroidektomi olgularımızın retrospektif analizi. Bozok Tıp Derg 2015;5(3):33-6.
- 23) Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World J Surg 1988;12(4):449-53.
Öz
Amaç: Çalışmamızda, endoskopik kolonoskopi vakalarında farklı oranlarda kullanılan ketofolün
hemodinamik parametreler, derlenme, komplikasyonlar, hasta ve hekim konforu açısından
değerlendirilmesi hedeflenmiştir.
Materyal ve Metod: Randomize, kontrollü, çift kör olarak planlanan çalışmamıza, 18-65 yaş arası,
American Society of Anesthesiologists (ASA) I-II, 105 endoskopik kolonoskopi hasta alındı. Grup I: 25 mg
ketamin + 25 mg propofol; grup II: 25 mg ketamin + 50 mg propofol; grup III: 25 mg ketamin + 75 mg
propofol olarak hastalar üç gruba ayrıldı. Her bir gruba ketofol (ketamin+propofol) karışımından 0,2 ml/kg,
uygulandı. Girişim boyunca Ramsey Sedasyon Skalasının > 4 olması hedeflendi. Sedasyon skalası < 4
olması halinde başlangıç dozunun dörtte biri kadar ek doz yapıldı. Tüm hastaların kalp atım hızı, ortalama
arter basıncı, arteryel oksijen satürasyonu, demografik veriler, kullanılan ilaç dozları, anestezi süresi,
spontan göz açma ve Modifiye Aldrete Skalası > 9 olma zamanı, komplikasyonlar, hasta ve hekim
memnuniyeti kaydedildi.
Bulgular: Gruplar arası kalp atım hızı karşılaştırıldığında 10. dakikadaki kalp atım hızı grup I'de grup II ve
III'den daha yüksekti. Diğer ölçüm zamanlarında ise gruplar arasında istatistiksel olarak anlamlı fark yoktu.
Gruplar arası ortalama arter basıncı karşılaştırıldığında 10, 15, 20 ve 30. dakikalarda gruplar arasında
istatistiksel olarak anlamlı fark yokken diğer ölçüm zamanlarında gruplar arasında istatistiksel olarak
anlamlı fark vardı. Gruplar kullanılan ilaç dozları açısından değerlendirildiğinde ise, gruplar arasında
indüksiyon dozları açısından fark yokken toplam dozlar açısından grup III'deki değerler diğer iki gruptan
daha düşüktü. İşlem sonrası spontan göz açma ve MAS > 9 olma zamanları açısından gruplar
karşılaştırıldığında grup III'deki değerler diğer iki gruptan daha yüksekti. Gruplar arasında hasta
memnuniyeti açısından istatistiksel olarak anlamlı fark yokken; hekim memnuniyeti açısından grup III'deki
değerler diğer iki gruptan daha yüksekti.
Sonuç: Ketofolde kullanılan propofol oranı arttıkça kullanılan toplam ilaç dozu azalmış ve hekim memnuniyeti artmıştır buna karşın spontan göz açma ve MAS > 9 olma süresi uzamıştır.
Anahtar Kelimeler
Kaynakça
- 1) Sözen S, Emir S, Alıcı A, Aysu F, Yıldız F, Aziret M, et al. Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü. Ulusal Cerrahi Dergisi 2010;26(1):13-7.
- 2) Lombardi CP, Raffaelli M, De Crea C, Traini E, Oragano L, Sollazzi L, et al. Complications in thyroid surgery. Minerva Chir 2007;62(5):395-408.
- 3) Acun Z, Cihan A, Ulukent S C. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;4(12):997-1001.
- 4) Koutras DA, Matovinovic J, Vought R. The Ecology of Iodine. In: Stanbury JB, Hetzel BS, (eds) Endemic Goiter, Endemic Createnism. John Villey, New York, 1980;185-95.
- 5) Knudsen N, Perrild H, Christiansen E, Rasmussen S, Dige-Petersen H, Jørgensen T. Thyroid structure and size and two-year follow-up of solitary cold thyroid nodules in an unselected population with borderline iodine deficiency. Eur J Endocrinol 2000;142(3):224- 30.
- 6) Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: e ff e c t o f c h a n g i n g p r a c t i c e . A r c h S u r g 1999;134(12):1389-93.
- 7) Tezelman S, Borucu I, Senyurek Giles Y, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg 2009;33(3):400-5.
- 8) Marchesi M, Biffoni M, Tartaglia F, Biancari F, Campana FP. Total versus subtotal thyroidectomy in the management of multinodular goiter. Int Surg 1998;83(3):202-4.
- 9) Colak T, Akca T, Kanık A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. S ANZ J Surg 2004;74(11):974-8 .
- 10) Pappalardo G, Guadalaxara A, Frattaroli FM, IIIomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164(7):501-6.
- 11) Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009;52(1):39- 44.
- 12) Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24(11):1335-41.
- 13) Jacobs JK, Aland JW Jr, Ballinger JF. Total thyroidectomy: A review of 213 patients. Ann Surg 1983;197(5):542-9.
- 14) Özbaş S, Koçak S, Aydıntuğ S, Çakmak A, Demirkıran MA. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocrine Journal 2005;52(2):199-205.
- 15) Yabanoğlu H, Aydoğan C, Sahillioğlu E. Evaluation of 213 thyroidectomy cases. Hakkari experience. Ulusal Cerrahi Derg 2011;27(4):212-5.
- 16) Sosa JA, Bowman HM, Tielsch JM. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998;228(3):320-30.
- 17) Filho JG, Kawalski LP. Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 2004;25(4):225-30.
- 18) Bozdağ A. Multinodüler guatr tedavisinde total tiroidektomi deneyimimiz. Fırat Tıp Derg 2014;19(2):88- 90.
- 19) Çıkman Ö, Özkul F, Arık MK, Taş Ş, Çakır C, Karaayvaz M. Endemik bölgede tiroidin benign hastalıklarında total tiroidektomi, 208 hastanın retrospektif analizi. Van Tıp Derg 2013;20(3):125-29.
- 20) Castro MR, Gharib H. Thyroid nodules and cancer. When to wait and watch, when to refer. Postgrad Med 2000;107(1):113-6.
- 21) Bozkurt K, Bektaş SS. The prevalence of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city. Dicle Medical Journal 2010;37(4):363-6.
- 22) Polat Y, Sarıcık B, Berçin S, Koca YS, Polat HT. Tiroidektomi olgularımızın retrospektif analizi. Bozok Tıp Derg 2015;5(3):33-6.
- 23) Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World J Surg 1988;12(4):449-53.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2016 |
| Gönderilme Tarihi | 2 Mart 2016 |
| Kabul Tarihi | 18 Mart 2016 |
| Yayımlandığı Sayı | Yıl 2016 Cilt: 13 Sayı: 3 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty