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Entübasyona Hemodinamik Yanıtı Önlemede Remifentanil, Fentanil, Esmolol, Lidokain, ve Amiodaronun Etkilerinin Karşılaştırılması

Yıl 2020, Cilt: 15 Sayı: 3, 22 - 29, 16.10.2020
https://doi.org/10.17517/ksutfd.673702

Öz

Amaç: Laringoskopi ve endotrakeal entübasyona bağlı sempatoadrenerjik aktivitenin artışına bağlı olarak hipertansiyon, taşikardi yanıtı görülebilir. Bu yanıt özellikle intrakraniyal ve kardiyovasküler hastalığı olan hastalarda yaşamı tehdit eden komplikasyonlara neden olabilmektedir. Biz bu çalışmada çalışmada, remifentanil, amiodaron, fentanil, esmolol ve lidokain’in trakeal entübasyonda hemodinamik yanıt üzerindeki göreceli etkinliğini karşılaştırdık. Gereç ve Yöntemler: Bu çalışmaya elektif cerrahi geçirecek 20–60 ASA I-II, 90 hasta dahil edildi. Hastalar kapalı zarf tekniği ile altı gruba ayrıldı. Entübasyona yanıtı engellemek için Birinci grup kontrol grubu (G1) hariç, ikinci gruba (G2) fentanil, üçüncü gruba (G3) remifentanil, dördüncü gruba (G4) esmolol, beşinci guruba (G5) amiodaron, altıncı gruba (G6) ise lidokain entübasyon öncesi ek olarak uygulandı. Tüm hastalara aynı anestezi tekniği uygulandı. Sistolik kan basıncı (SKB), diastolik kan basıncı (DKB) ve kalp atım hızı (KAH) için belirlenen zamanlarda ölçümler yapılarak kaydedildi. Bulgular: Gruplar arasında demografik veriler açısından fark bulunmadı (p>0.05). Remifentanil grubundaki SKB stabilitesi esmolol ve fentanil gruplarına göre daha fazlaydı. Remifentanil grubundaki DKB’daki düşüş diğer gruplara göre daha fazlaydı. KAH’daki düşüş remifentanil grubunda 1. 3. ve 5. dakikalarda daha fazla idi. Sonuç: Bizim çalışmamıza gore, entübasyona hemodinamik yanıtı önlemede remifentanilin 0.5 mikrogram/kg infüzyon dozunda diğer ilaç gruplarına en etkin ilaç olabileceğini söyliyebiliriz.

Kaynakça

  • Kaynaklar: 1-Morgan GE, Mikhail MS.: Nonvolatil Anesthetic Agents. Clinical Anaesthesiology 2 th edition Apletton& Lange, Stamford,1996;137-41.
  • 2-Edwards ND, Alford AM, Dobson PMS. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesthesia 1988; 67: 235-7.
  • 3-Benunof Jonathan L, Saidman Lavvrance C: Anesthesia and perioperative complications 1999 second edition Manegement of the Airway: Complications 1-21.
  • 4-Chraemmer-Jorgensen B, Hertel S, Strom J. Catecholamine response to laryngoscopy and intubation. The influence of three different drug combinations commonly used for induction of anaesthesia. Anaesthesia 1992; 47: 750-6.
  • 5-del Río Vellosillo M, Gallego García J, Soliveres Ripoll J, Abengochea Cotaina A, Barberá Alacreu M. Bolus administration of fentanyl vs continuous perfusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial]. Rev Esp Anestesiol Reanim. 2009 May;56(5):287-91.
  • 6-Mireskandari SM, Abulahrar N, Darabi ME, Rahimi I, Haji-Mohamadi F, Movafegh A. Comparisonof the effect of fentanyl, sufentanil, alfentanil and remifentanilon cardiovascular response to tracheal intubation in children. Iran J Pediatr. 2011 Jun;21(2):173-80.
  • 7-Khan FA, Ullah H. Cochrane Database Syst Rev. 2013 Jul 3;(7):CD004087. doi: 10.1002/14651858.CD004087.pub2.Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation.
  • 8- Myles PS, Hunt JO, Fletcher H, VVatts J, Bain D, Silvers A, Buckland MR. Remifentanil, fentanyl, and cardiac surgery: a double- blinded, randomized, controlled trial of costs and outcomes. Anesth Analg. 2002 Oct;95(4):805-12, table of contents.
  • 9-Marashi SM, Saeedinia SM, Sadeghi M, Movafegh A, Marashi S Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial. Acta Med Iran. 2015 Dec;53(12):733-7.
  • 10-Thomas JE, Joseph SB, David FS, David R, John PK.: Attenuation of Hemodynamic Responses to Rapid Sequence Induction and İntubation in Healthy Patients with a Single Bolus of Esmolol J. Clin. Anesth., vol. 2, July/August 1990;243-252
  • 11-Vestmoreland CL„ Hoke JF, et al. Pharmacokineîics of remifentanil and its majör metabolite in patients undergoing elective inpatient surgery. Anesthesiology 1993;79:893-903
  • 12-Stiller RL, Davis PJ, Mc Gowan FX, et al. İn vitro metabolism of remifentanyl: the effects of pseudocholinesterase deficiency (abstract). Anesthesiology 1995;83:A 381
  • 13-Mekis D, Kamenik M.: A randomised controlled trial comparing remifentanil and fentanyl for induction of anaesthesia in CABG surgery. VVien Klin VVochenschr. 2004 Jul 31; 116(14):484-8.
  • 14-Salihoglu Z, Demiroluk S, Demirkiran, Köse Y Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. Eur J Anaesthesiol. 2002 Feb;19{2):125-8.
  • 15-Steven MH, Martin IG, Everard AD, Claire AH.: VVhich Drug Prevents Tachycardia and Hypertension Associated with Tracheal İntubation: Lidocaine, Fentanyl, or Esmolol? Anesth. Analg. 1991;72:482-6
  • 16-Tuzcu K, Tuzcu EA, Karcioglu M, Davarci I, Coskun M, Ilhan O, Daglıoglu MC, Turhanoglu S.The effects of remifentanil and esmolol on increase in intraocular pressure due to laryngoscopy and tracheal intubation: a double-blind, randomized clinical trial. J Glaucoma. 2015 Jun-Jul;24(5):372-6.
  • 17-Rajbhandari PK. Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation. JNMA J Nepal Med Assoc. 2014 Apr-Jun;52(194):775-9.
  • 18- Efe EM, Bilgin BA, Alanoglu Z, Akbaba M, Denker C.Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft. Braz J Anesthesiol. 2014 Jul-Aug;64(4):247-52. doi: 10.1016/j.bjane.2013.07.003. Epub 2013 Oct 25.
  • 19-Hancı V, Yurtlu S, Karabağ T, Okyay D, Hakimoğlu S, Kayhan G, Büyükuysal Ç, Ayoğlu H, Özkoçak Turan IEffects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study. Braz J Anesthesiol. 2013 May-Jun;63(3):235-44. doi: 10.1016/S0034-7094(13)70223-X.
  • 20- Levitt MA, Dresden GM. The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients. Acad Emerg Med. 2001 Jan;8(1):19-24.
  • 21- Kindler C, Schumacher P, Urvvyler A, Schneider M, Hampl K.: Control of Heart Rate and Blood Pressure Response to İntubation b lidocane and esmolol Anaesthesiology 1994: 81-A 98.
  • 22- Sebel PS, Lovvdon JD. Propofol:A new intravenous anesthetic Anesthesiology;1989:71:260-277.
  • 23- Wang YM, Chung KC, Lu HF, Huang YW, Lin KC, Yang LC, Lin CR.: Lidocaine: the optimai timing of intravenous administration in attenuation of increase of intraocular pressure during tracheal intubation.: Açta Anaesthesiol Sin. 2003 Jun;41(2):71-5g
  • 24-Min JH, Chai HS, Kim YH, Chae YK, Choi SS, Lee A, Choi YS.Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol. 2010 Mar;76(3):188-92.
  • 25-Selvaraj V, Manoharan KR. Prospective randomized study to compare between intravenous dexmedetomidine and esmololfor attenuation of hemodynamic response to endotracheal intubation. Anesth Essays Res. 2016 May-Aug;10(2):343-8. doi: 10.4103/0259-1162.181226.
  • 26-Hussain AM, Sultan ST. Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation. J Coll Physicians Surg Pak. 2005 Aug;15(8):454-7.
  • 27-Gogus N, Akan B, Serger N, Baydar M. Epub 2014 Jun 21. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation. Rev Bras Anestesiol. 2014 Sep-Oct;64(5):314-9. doi: 10.1016/j.bjan.2013.10.010. 28-Olatosi JO, Ehiozie-Osifo A. Efficacy of intravenous esmolol versus lidocaine for attenuation of the pressor response in nigerians. j west afr coll surg. 2016 jan-mar;6(1):47-69.
  • 29-Singh S, Laing EF, Owiredu WK, Singh A. Comparison of esmolol and lidocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in a Ghanaian population. Anesth Essays Res. 2013 Jan-Apr;7(1):83-8. doi: 10.4103/0259-1162.114008.
  • 30-Yokose M, Mihara T, Kuwahara S, Goto T Effect of the McGRATH MAC® Video Laryngoscope on Hemodynamic Response during Tracheal Intubation: A Retrospective Study. PLoS One. 2016 May 12;11(5):e0155566. doi: 10.1371/journal.pone.0155566. eCollection 2016.
  • 31-Hirata N, Miyashita R, Watanabe A, Yamakage M. Low-dose continuous infusion of landiolol can reduce adrenergic response during trachealintubation in elderly patients with cardiovascular disease. J Anesth. 2010 Oct;24(5):786-8. doi: 10.1007/s00540-010-0975-5. Epub 2010 Jul 21.

Comparison of The Effects of Remifentanil, Fentanyl, Esmolol, Lidocaine, and Amiodarone in Preventing Hemodynamic Response to Intubation

Yıl 2020, Cilt: 15 Sayı: 3, 22 - 29, 16.10.2020
https://doi.org/10.17517/ksutfd.673702

Öz

Objective: Hypertension and tachycardia response may occur due to increased sympathoadrenergic activity due to laryngoscopy and tracheal intubation. This response may result in life-threatening complications, especially in patients with intracranial and cardiovascular disease. In this study, we compared the relative efficacy of remifentanil, amiodarone, fentanyl, esmolol and lidocaine on hemodynamic response in tracheal intubation. Material and Methods: In this study, 90 patients with ASA I-II physical status and between the ages of 20 and 60 were included. The patients were divided into six groups with closed envelope technique. In order to prevent the intubation response, except for the first group control group (G1), fentanyl to the second group (G2), remifentanil to the third group (G3), esmolol to the fourth group (G4), amiodarone to the fifth group (G5), and sixth group (G6) lidocaine before the intubation to the additionally applied.All patients received the same anesthetic technique. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) measurements were done at specified times and recorded. Results: There was no difference between the groups in terms of demographic data (p> 0.05).SBP stability in remifentanil group was higher than esmolol and fentanyl groups. The decrease in DBP in the remifentanil group was higher than in the other groups. The decrease in HR was higher in the remifentanil group at the 1st, 3rd and 5th minutes. Conclusion: According to our study, we can say that remifentanil may be the most effective drug for other drug groups at 0.5 microgram / kg infusion dose to prevent hemodynamic response to intubation

Kaynakça

  • Kaynaklar: 1-Morgan GE, Mikhail MS.: Nonvolatil Anesthetic Agents. Clinical Anaesthesiology 2 th edition Apletton& Lange, Stamford,1996;137-41.
  • 2-Edwards ND, Alford AM, Dobson PMS. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesthesia 1988; 67: 235-7.
  • 3-Benunof Jonathan L, Saidman Lavvrance C: Anesthesia and perioperative complications 1999 second edition Manegement of the Airway: Complications 1-21.
  • 4-Chraemmer-Jorgensen B, Hertel S, Strom J. Catecholamine response to laryngoscopy and intubation. The influence of three different drug combinations commonly used for induction of anaesthesia. Anaesthesia 1992; 47: 750-6.
  • 5-del Río Vellosillo M, Gallego García J, Soliveres Ripoll J, Abengochea Cotaina A, Barberá Alacreu M. Bolus administration of fentanyl vs continuous perfusion of remifentanil for control of hemodynamic response to laryngoscopy and orotracheal intubation: a randomized double-blind trial]. Rev Esp Anestesiol Reanim. 2009 May;56(5):287-91.
  • 6-Mireskandari SM, Abulahrar N, Darabi ME, Rahimi I, Haji-Mohamadi F, Movafegh A. Comparisonof the effect of fentanyl, sufentanil, alfentanil and remifentanilon cardiovascular response to tracheal intubation in children. Iran J Pediatr. 2011 Jun;21(2):173-80.
  • 7-Khan FA, Ullah H. Cochrane Database Syst Rev. 2013 Jul 3;(7):CD004087. doi: 10.1002/14651858.CD004087.pub2.Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation.
  • 8- Myles PS, Hunt JO, Fletcher H, VVatts J, Bain D, Silvers A, Buckland MR. Remifentanil, fentanyl, and cardiac surgery: a double- blinded, randomized, controlled trial of costs and outcomes. Anesth Analg. 2002 Oct;95(4):805-12, table of contents.
  • 9-Marashi SM, Saeedinia SM, Sadeghi M, Movafegh A, Marashi S Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial. Acta Med Iran. 2015 Dec;53(12):733-7.
  • 10-Thomas JE, Joseph SB, David FS, David R, John PK.: Attenuation of Hemodynamic Responses to Rapid Sequence Induction and İntubation in Healthy Patients with a Single Bolus of Esmolol J. Clin. Anesth., vol. 2, July/August 1990;243-252
  • 11-Vestmoreland CL„ Hoke JF, et al. Pharmacokineîics of remifentanil and its majör metabolite in patients undergoing elective inpatient surgery. Anesthesiology 1993;79:893-903
  • 12-Stiller RL, Davis PJ, Mc Gowan FX, et al. İn vitro metabolism of remifentanyl: the effects of pseudocholinesterase deficiency (abstract). Anesthesiology 1995;83:A 381
  • 13-Mekis D, Kamenik M.: A randomised controlled trial comparing remifentanil and fentanyl for induction of anaesthesia in CABG surgery. VVien Klin VVochenschr. 2004 Jul 31; 116(14):484-8.
  • 14-Salihoglu Z, Demiroluk S, Demirkiran, Köse Y Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. Eur J Anaesthesiol. 2002 Feb;19{2):125-8.
  • 15-Steven MH, Martin IG, Everard AD, Claire AH.: VVhich Drug Prevents Tachycardia and Hypertension Associated with Tracheal İntubation: Lidocaine, Fentanyl, or Esmolol? Anesth. Analg. 1991;72:482-6
  • 16-Tuzcu K, Tuzcu EA, Karcioglu M, Davarci I, Coskun M, Ilhan O, Daglıoglu MC, Turhanoglu S.The effects of remifentanil and esmolol on increase in intraocular pressure due to laryngoscopy and tracheal intubation: a double-blind, randomized clinical trial. J Glaucoma. 2015 Jun-Jul;24(5):372-6.
  • 17-Rajbhandari PK. Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation. JNMA J Nepal Med Assoc. 2014 Apr-Jun;52(194):775-9.
  • 18- Efe EM, Bilgin BA, Alanoglu Z, Akbaba M, Denker C.Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft. Braz J Anesthesiol. 2014 Jul-Aug;64(4):247-52. doi: 10.1016/j.bjane.2013.07.003. Epub 2013 Oct 25.
  • 19-Hancı V, Yurtlu S, Karabağ T, Okyay D, Hakimoğlu S, Kayhan G, Büyükuysal Ç, Ayoğlu H, Özkoçak Turan IEffects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study. Braz J Anesthesiol. 2013 May-Jun;63(3):235-44. doi: 10.1016/S0034-7094(13)70223-X.
  • 20- Levitt MA, Dresden GM. The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients. Acad Emerg Med. 2001 Jan;8(1):19-24.
  • 21- Kindler C, Schumacher P, Urvvyler A, Schneider M, Hampl K.: Control of Heart Rate and Blood Pressure Response to İntubation b lidocane and esmolol Anaesthesiology 1994: 81-A 98.
  • 22- Sebel PS, Lovvdon JD. Propofol:A new intravenous anesthetic Anesthesiology;1989:71:260-277.
  • 23- Wang YM, Chung KC, Lu HF, Huang YW, Lin KC, Yang LC, Lin CR.: Lidocaine: the optimai timing of intravenous administration in attenuation of increase of intraocular pressure during tracheal intubation.: Açta Anaesthesiol Sin. 2003 Jun;41(2):71-5g
  • 24-Min JH, Chai HS, Kim YH, Chae YK, Choi SS, Lee A, Choi YS.Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol. Minerva Anestesiol. 2010 Mar;76(3):188-92.
  • 25-Selvaraj V, Manoharan KR. Prospective randomized study to compare between intravenous dexmedetomidine and esmololfor attenuation of hemodynamic response to endotracheal intubation. Anesth Essays Res. 2016 May-Aug;10(2):343-8. doi: 10.4103/0259-1162.181226.
  • 26-Hussain AM, Sultan ST. Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation. J Coll Physicians Surg Pak. 2005 Aug;15(8):454-7.
  • 27-Gogus N, Akan B, Serger N, Baydar M. Epub 2014 Jun 21. The comparison of the effects of dexmedetomidine, fentanyl and esmolol on prevention of hemodynamic response to intubation. Rev Bras Anestesiol. 2014 Sep-Oct;64(5):314-9. doi: 10.1016/j.bjan.2013.10.010. 28-Olatosi JO, Ehiozie-Osifo A. Efficacy of intravenous esmolol versus lidocaine for attenuation of the pressor response in nigerians. j west afr coll surg. 2016 jan-mar;6(1):47-69.
  • 29-Singh S, Laing EF, Owiredu WK, Singh A. Comparison of esmolol and lidocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in a Ghanaian population. Anesth Essays Res. 2013 Jan-Apr;7(1):83-8. doi: 10.4103/0259-1162.114008.
  • 30-Yokose M, Mihara T, Kuwahara S, Goto T Effect of the McGRATH MAC® Video Laryngoscope on Hemodynamic Response during Tracheal Intubation: A Retrospective Study. PLoS One. 2016 May 12;11(5):e0155566. doi: 10.1371/journal.pone.0155566. eCollection 2016.
  • 31-Hirata N, Miyashita R, Watanabe A, Yamakage M. Low-dose continuous infusion of landiolol can reduce adrenergic response during trachealintubation in elderly patients with cardiovascular disease. J Anesth. 2010 Oct;24(5):786-8. doi: 10.1007/s00540-010-0975-5. Epub 2010 Jul 21.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Özlem Öner 0000-0001-6171-2114

Emel Yıldız 0000-0003-4493-2099

Yayımlanma Tarihi 16 Ekim 2020
Gönderilme Tarihi 12 Ocak 2020
Kabul Tarihi 14 Mayıs 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 15 Sayı: 3

Kaynak Göster

AMA Öner Ö, Yıldız E. Entübasyona Hemodinamik Yanıtı Önlemede Remifentanil, Fentanil, Esmolol, Lidokain, ve Amiodaronun Etkilerinin Karşılaştırılması. KSÜ Tıp Fak Der. Ekim 2020;15(3):22-29. doi:10.17517/ksutfd.673702