Çocuk premedikasyonunda oral ve rektal midazolam ve diazepam kullanımlarının karşılaştırılması /
Yazar: GÜLGÜLE ERSOY
Danışman: UZMAN GÜLTEN ARSLAN
Sağlık Bakanlığı / İstanbul Kartal Dr. Lütfi Kırdar Eğitim ve Araştırma Hastanesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2001
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation

Özet:
BU ÇALIŞMADA, PEDİATRİK PREMEDİKASYONDA MİDAZOLAM VE DİAZEPAMIN ORAL-REKTAL UYGULAMASININ SEDASYON SKORU, EBEVEYNDEN AYRILMA SKALASI İNTRAVENÖZ KANÜLASYONA YANIT, DERLENME SÜRESİ, KARDİYOVASKÜLER SİSTEM PARAMETRELERİNE ETKİSİ VE YAN ETKİLERİNİ KARŞILAŞTIRMAYI AÇIKLADIK. 
ETİK KURUL İZNİ ALINDIKTAN SONRA, ASA-1-2 GRUBUNDA, KBB GÖZ VE GENİTORÜRİNER SİSTEM CERRAHİSİ YAPILAN, YAŞLARI 1-10 YIL ARASINDAKİ 100 OLGU ÇALIŞMA KAPSAMINA ALINDI. CERRAHİ GİRİŞİM GÜNÜ DERLENME ODASINA ALINAN OLGULAR, NONİNVAZİV YÖNTEMLE MONİTÖRİZE EDİLEREK KAH VE SPO2 DEĞERLERİ KAYDEDİLDİ. HASTALAR RASTGELE 5 GRUBA AYRILARAK OPERASYONDAN 30 DAKİKA ÖNCE, I. GRUBA (n=20); 0.35 MG/KG ORAL DİAZEPAM, II. GRUBA (n=20); 0.4 MG/KG REKTAL MİDAZOLAM, III. (n=20); 0.5 MG/KG ORAL MİDAZOLAM, IV. GRUBA (n=20); 0.7 MG/KG REKTAL DİAZEPAM, V. GRUBA (n=20); 5 ml VİŞNE SUYU ORAL VERİLDİ.
HASTALARA İLAÇ UYGULAMALARI ANNE VEYA BABASININ YANINDA YAPILDI VE ÇOCUK AMELİYAT ODASINA ALINANA KADAR EBEVYNDEN BİRİSİ ÇOCUĞUN YAANINDA KALDI. TÜM ÇOCUKLARDA PREMEDİKASYON VE SEDASYONUN DEĞERLENDİRİLMESİ, UYGULANAN PREMEDİKASYON YÖNTEMİNİ BİLMEYEN İKİ AYRI ANESTEZİST TARAFINDAN YAPILDI. PREMEDİKASYONDAN SONRA ORTALAMA OLARAK 35.-40. DAKİKALARDA OPERASYON ODASINA ALINIRKEN EBEVEYNDEN AYRILMA 2'Lİ SKALA, İNTRAVENÖZ KANÜLASYONA YANIT 4'LÜ SKALA İLE DEĞERLENDİRİLDİ VE KAYDEDİLDİ.
DAMAR YOLU AÇILABİLEN OLGULARDA İNDÜKSİYON5 MG/KG TİYOPENTAL, 10 MCG/KG ALFENTANİL, 0.1 MG/KG VEKURONYUM, ANESTEZİ İDAMESİ %50 N2O VE %50 O2, %2 SEVOFLURAN İLE SAĞLANDI. VENÖZ GİRİŞİMİN GERÇEKLEŞTİRİLEMEDİĞİ OLGULARDA SEVOFLURAN İNHALASYONU İLE İNDÜKSİYON GERÇEKLEŞTİRİLDİ. PREMEDİKASYON ÖNCESİ, PREMEDİKASYON SONRASI 5., 15., 30. DAKİKALARDA VE EBEVYNDEN AYRILIRKEN KAH, SpO2, SEDASYON SKORU, OPERASYON SONUNDA DERLENME SÜRESİ BELİRLENDİ. ÇALIŞMA SÜRESİNCE PREOPERATİF VE POSTOPERATİF BULANTI-KUSMA, SOLUNUM DEPRESYONU, İLACIN VERİLİŞİNE TEPKİ VE DİĞER KOMPLİKASYONLAR KAYDEDİLİP, İSTATİKSEL OLARAK KARŞILAŞTIRILDI.
ÇALIŞMADA ELDE ETTİĞİMİZ BULGULARA GÖRE; SEDASYON SKORUNUN REKTAL MİDAZOLAM GRUBUNDA DAHA ERKEN BAŞLADIĞI VE DAHA FAZLA DERECEDE OLDUĞU BELİRLENDİ. EBEVEYNDEN AYTRILMA SKALASININ VE İNTRAVENÖZ KANÜLASYONA YANITIN YİNE AYNI GRUPTA DAHA İYİ OLDUĞU VE POSTANESTEZİK DERLENME SÜRESİNİN DE ÇOK KISA OLDUĞU SAPTANDI. KAH YÖNÜNDEN REKTAL GRUPLARIN DAHA STABİLE OLDUĞU GÖZLENİRKEN, SpO2 YÖNÜNDEN GRUPLAR ARASINDA ANLAMLI BİR FARK BULLUNMADI. BULGULARIMIZI LİTERATÜR VERİLERİ İLE KARŞILAŞTIRIP, TABLOLAR VE GRAFİKLER HALİNDE VEREREK TARTIŞTIK.
SONUÇ OLARAK; SEDASYONUN ERKEN VE HIZLI BAŞLAMASI, EBEVYNDEN RAHAT AYRILMA SAĞLANMASI, AYILMA DÖNEMİNDE UZAMA YAPMAMASI, HEMODİNAMİĞİ BOZMAMASI VE POSTOPERATİF BULANTI-KUSMA SIKLIĞINI ARTIRMAMASI ÖZELLİKLERİ NEDENİYLE PEDİATRİK OLGULARDA REKTAL MİDAZOLAM TERCİH EDİLEBİLECEK BİR UYGULAMA OLDUĞU KANISINA VARILMIŞTIR.

Abstract:
IN THIS STUDY, THE SEDATION SCORE OF THE ORAL-RECTAL APPLICATION OF MIDAZOLAM AND DIAZEPAM IN PEDIATRIC PREMEDICATION, THE SCALE OF PARENTAL SEPARATION, RESPONSE TO INTRAVENOUS CANULATION, COMBINATION TIME AND PARTIALS OF THE CARDIOVASCULAR SYSTEM.
AFTER THE ETHICS COMMITTEE PERMISSION was obtained, 100 CASES WITH AGES BETWEEN 1-10 YEARS IN THE ASA-1-2 GROUP, WHO WERE PERFORMED ENT EYE AND GENITORURINARY SYSTEM SURGERY, WERE INCLUDED IN THE STUDY. SURGERY DAY OF SURGERY, THE CASES WHICH WERE TAKEN IN THE COMPILATION ROOM, WERE MONITORED BY NONINVASIVE METHOD AND RECORDED THE CAH AND SPO2 VALUES. DIVIDING PATIENTS INTO 5 RANDOM GROUPS 30 MINUTES BEFORE OPERATION, GROUP I (n = 20); 0.35 MG / KG ORAL DIAZEPAM, II. GRUBA (n = 20); 0.4 MG / KG RECTAL MİDAZOLAM, III. (n = 20); 0.5 MG / KG ORAL MİDAZOLAM, IV. GRUBA (n = 20); 0.7 MG / KG RECTAL DIAZEPAM, GROUP V (n = 20); 5 ml CHERRY JUICE GIVEN ORAL.
DRUG ADMINISTRATIONS TO PATIENTS WERE MADE WITH THE MOM OR FATHER AND ONE OF THE PARENT STAYED WITH THE CHILD UNTIL THE CHILD WAS TAKEN IN THE OPERATING ROOM. EVALUATION OF PREMEDICATION AND SEDATION IN ALL CHILDREN WAS MADE BY TWO SEPARATE ANESTHESISTS WHO DO NOT KNOW THE APPLIED PREMEDICATION METHOD. AS AVERAGE AFTER PREMEDICATION 35.-40. WITHIN THE OPERATION ROOM IN MINUTES, BREAKING FROM THE PARENTS SCALE, RESPONSE TO INTRAVENOUS CANULATION, WAS EVALUATED AND RECORDED WITH THE SCALE OF 4.

INDUCTION WAS PROVIDED WITH 5 MG / KG THIOPENTAL, 10 MCG / KG ALPENTANYL, 0.1 MG / KG VECURONIUM, ANESTHESIA MAINTENANCE WITH 50% N2O AND 50% O2, 2% SEVOFLURAN IN CASES WITH VASCULAR ROAD. INDUCTION WAS PERFORMED BY SEVOFLURAN INHALATION IN CASES WHERE VENOUS INTERVENTION WAS NOT PERFORMED. BEFORE PREMEDICATION, AT 5th, 15th, 30th MINUTES AFTER PREMEDICATION AND WHEN DEPARTING FROM PARENTS, CAH, SpO2, SEDATION SCORE, COMPILATION TIME AT THE END OF OPERATION WAS DETERMINED. DURING THE WORK, PREOPERATIVE AND POSTOPERATIVE VOMITATION, RESPIRATORY DEPRESSION, REACTION TO THE DRUG ADMINISTRATION AND OTHER COMPLICATIONS WERE RECORDED AND COMPARED STATELY.
ACCORDING TO THE FINDINGS WE HAVE OBTAINED IN THE STUDY; THE SEDATION SCORE HAS BEEN DETERMINED THAT THE RECTAL MİDAZOLAM GROUP STARTED EARLY AND BECOMES HIGHER DEGREES. IT WERE DETERMINED THAT THE SCALES OF EXTRACTION FROM PARENTS AND RESPONSE TO INTRAVENOUS CANULATION WERE BETTER IN THE SAME GROUP AND THE POSTANESTHESIC COMPILATION TIME IS TOO SHORT. WHILE RECTAL GROUPS HAVE BEEN MORE STABLE FROM THE CAH, NO SIGNIFICANT DIFFERENCE BETWEEN THE GROUPS IN TERMS OF SPO2. WE HAVE DISCUSSED OUR FINDINGS BY COMPARING WITH LITERATURE DATA AND IN THE FORM OF TABLES AND GRAPHICS.
AS A RESULT; Sedation early and rapid initiation, to provide a comfortable leaving parent, the recovery DURING GROWTH, not to hemodynamics BREAK AND postoperative nausea and vomiting INCREASE be PROPERTIES OF DUE pediatric cases, it is concluded that the AN APPLICATION THAT MAY BE rectal midazolam preferred.