The analgesic and hemodynamic effects of dexmedetomidine and remifentanil during chest tube removal

Amac: Bu calismada remifentanil ve deksmedetomidinin gogus tupu cekilmesi sirasinda agri giderici etkileri incelendi ve bu etkiler sedasyon seviyeleri ile pulmoner ve hemodinamik yanitlar acisindan karsilastirildi. Ca­lis­ma­ pla­ni:­ Calisma prospektif, randomize ve cift kor olarak tasarlandi. Calismaya Şubat 2011 Temmuz 2011 tarihleri arasinda koroner arter baypas greft (KABG) cerrahisi yapilan ardisik 41 hasta (31 erkek, 10 kadin; ort. yas 55.7±10.3 yil; dagilim 27-77 yil) dahil edildi. Tum gogus tupleri ameliyat sonrasi 48. saatte cekildi. Hastalar deksmedetomidin (0.5 mg/kg) (grup D) ve remifentanil (0.5 mg/kg) (grup R) olmak uzere rastgele iki gruba ayrildi. Agri ve sedasyon seviyeleri numerik dereceleme skalasi (NRS) ve Ramsay skorlari ile degerlendirildi. Kan basinclari [sistolik (SAB), diyastolik (DAB) ve ortalama (OAB)], periferik oksijen saturasyonlari (SpO2), solunum hizlari (SH) ve kalp hizlari (KH) ilac perfuzyonu oncesinde, sonrasinda ve tup cekildikten sonra ikiser dakika ara ile kaydedildi. Bul gu lar: Iki gruptaki hastalarin demografik ozellikleri benzerdi. Grup D’de agri skorlari tup cekildikten sonra alti ve 10. dakikalarda kaydedilen olcumlerinde daha dusuktu. Baslangic olcumleri ile karsilastirildiginda, Ramsay skorlari perfuzyon sonrasi tum olcumlerde anlamli olarak farkli bulundu (p<0.05). Sistolik arteriyel kan basinci, OAB ve KH olcumleri grup D’de daha dusuk olup tekrarlayan olcumlerde saptanan farklilik istatistiksel olarak daha anlamli idi. So­nuc:­Gogus tupu cekilmesi sirasinda ve sonrasinda deksmedetomidin, remifentanile kiyasla, daha iyi sedasyon ve analjezinin yani sira, benzer hemodinamik kontrol saglar. Bu etkiler, kardiyak cerrahi sonrasi yogun bakim hastalarinda kardiyak veya solunum depresyonu olmadan guvenle saglanabilir. Anah tar soz cuk ler: Gogus tupu cekilmesi; deksmedetomidin; yogun bakim unitesi. Background:­ This study aims to investigate the effects of remifentanil and dexmedetomidine in alleviating pain during chest tube removal and these effects were compared in terms of sedation levels, pulmonary and hemodynamic responses. Methods: The study was designed as a prospective, randomized, double-blinded study. Between February 2011 and July 2011, 41 consecutive patients (31 males, 10 females; mean age 55.7±10.3 years; range 27 to 77 years) who underwent coronary artery bypass graft (CABG) surgery were enrolled. All chest tubes were removed in postoperative 48th hour. The patients were randomized into two groups as dexmedetomidine (0.5 mg/kg) group (group D) and remifentanil (0.5 mg/kg) group (group R). The pain and sedation levels were assessed by numerical rating scale (NRS) and Ramsay scores. Blood pressures [systolic (SAP), diastolic (DAP) and mean (MAP) pressures], peripheral oxygen saturation (SpO2), respiratory rate (RR) and heart rate (HR) were recorded before and after the agent perfusion and every two minutes after the tube was removed. Results:­The demographic characteristics of the patients in both groups were similar. The pain scores were lower during the measurements which were recorded at six and 10 minutes after chest tube removal in group D. The Ramsay scores were found to be statistically different at all measurements following perfusion, compared to the baseline measurements (p<0.05). Systolic arterial blood pressure, MAP and HR were significantly lower in group D and the difference was more pronounced statistically with repeated measurements. Conclusion:­ Dexmedetomidine provides a comparable hemodynamic control along with better sedation and analgesia during and after chest tube removal than remifentanil. These effects can be provided safely without having cardiac or respiratory depression in post-cardiac surgery intensive care patients.