Fast-Track kardiyak anestezide postoperatif sedasyon için Propofol ve Deksmedetomidin HCL' nin karşılaştırılması
The comparison of Dexmedetomidine and propofol for postoperative sedation in fast-track cardiac anaesthesia
Yazar: ZEYNEP PESTİLCİ TÖZ
Danışman: DOÇ. DR. SEZGİN ULUKAYA
Ege Üniversitesi / Tıp Fakültesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation
Dizin: Anestezi = Anesthesia ; Bilinçli sedasyon = Conscious sedation ; Deksmedetomidin = Dexmedetomidin ; Ekstübasyon = Extubation ; Koroner arter bypass = Coronary artery bypass ; Postoperatif dönem = Postoperative period ; Propofol = Propofol

Özet:
Amaç: Bu çalışmada koroner arter baypas greftleme (KABG) geçiren hastalarda deksmedetomidin ile propofolün postoperatif sedasyon ve erken postoperatif özelliklere etkilerinin karşılaştırılması amaçlanmıştır.Yöntem: Prospektif, randomize ve çift kör olarak planlanan çalışmada ASA II/III, 40-75 yaş arası, EF > %40, 42 elektif KABG hastasında çalışıldı. Etomidat, fentanil ve rokuronyum ile anestezi indüksiyonu üzerine idame, 1 mg/kg/sa propofol ve 0.5 µg/kg/sa fentanil, %50 fiO2 içerisine % 3-6 desfluran eklenmesi ile sürdürüldü. Ek analjezi gereksinimi 1 µg/kg fentanil bolusları ile, nöromusküler bloker gereksinimi 0.2-0.3 mg/kg rocuronium bromide ile karşılandı. Sternum kapanma aşamasında hastalar bilgisayar kontrollu randomizasyon şemasına göre iki gruba ayrıldı. Tüm hastalarda fentanil infüzyonu kesildikten sonra bir grupta (Grup P) propofol (n:21) sedasyon dozu olan 0.2-0.7 µg /kg/sa doza azaltılarak devam etti; diğer grupta (Grup D) ise propofol tamamen kesilip yerine 0.2-0.7 µg/kg/saatten deksmedetomidin HCL (n:21) infüzyonuna geçildi. Sternum kapatılması tamamlandığında ise desfluran sonlandırıldı.Hastaların postop ventilasyonları volum kontrollu solunum modeli ile (VT: 6-10 mL/kg, f: 12-20/dk, FiO2: 0.4-0.5, PaCO2 35-45 mmHg) sürdürüldü. Sedasyon düzeyi Ramsey Sedasyon Skoru ? 3; vizüel ağrı skalasına göre ağrı düzeyi ? 4 olacak şekilde sedasyon ilacı ve analjezik gereksinimi planlandı. Ventilatörden ayırma basınç destekli modelle 10 cmH2O'dan azaltma şeklinde yapıldı. Her iki grup hasta belli koşullar sağlandığında ekstübe edildi. Ekstübasyona kadar geçen sürede hastaların her saat başı vital fonksiyonlar, analjezi, sedasyon gereksinimi ve düzeyleri, mekanik ventilasyon özellikleri, toraks drenlerinden drenaj miktarı, olası komplikasyonlar ve hasta memnuniyeti değerlendirildi.BULGULAR: Deksmedetomidin altında KABG sonrası weaning'e geçiş (65 ? 42'ye 104 ? 70 dk) ve ekstübasyon süresi (207 ? 57'ye 249 ? 68 dk) propofole göre daha kısa (p<0.05), ancak yoğun bakımda kalış süresi, total analjezik tüketimi, toraks drenajı, hemodinamik ve gastrointestinal komplikasyonlar benzer bulundu (p>0.05).SONUÇ: Deksmedetomidin, KABG sonrası mekanik ventilatör desteği altındaki hastalarda erken postoperatif dönemde daha hızlı weaning ve ekstübasyon sağlarken diğer genel ölçütleri etkilememektedir.

Abstract:
Objective: The aim of this study is to compare the effects of dexmedetomidine and propofol on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction in patients undergoing coronary artery bypass grefting surgery (CABG) .Methods: Fourty-two patients (aged 40-75 years, ASA II-III, EF > %40) undergoing elective CABG were included in this prospective, double-blind, randomized clinical study. After anaesthesia induction with etomidate, fentanyl and rocuronium; maintenance of anaesthesia was provided by 1 mg/kg/h propofol , 0.5 µg/kg/h fentanyl and desflurane in 50% oxygen in air. Additional analgesia requirements were achieved with 1 µg/kg fentanyl boluses, and neuromusculer blocking agent requirements were achieved with 0.1-0.15 mg/kg rocuronium. Randomisation to either dexmedetomidine group (n=21) or propofol group (n=21), via a random-number table, occurred in the operating room before sternal closure. After termination of fentanyl infusion, propofol was titrated to doses within the range of 0.2-0.7 µg /kg/h (propofol group) or propofol infusion was terminated and dexmedetomidine was started between the range of 0.2-0.7 µg/kg/h (dexmedetomidine group). Desfluran was terminated after sternal closure.Postoperative sedation level was assessed using Ramsey sedation scale and pain was assessed using visual analog scale (VAS). Patients were extubated after adequate clinical conditions were achieved. Postoperative hemodynamic parameters, pain, sedation level, respiratory parameters, thorax drainage and patient satisfaction were assessed until extubation.RESULTS: The times to weaning (65 ? 42 vs 04 ? 70 min.) and extubation (207 ? 57 vs 249 ? 68 min.) were shorter in the dexmedetomidine group compared with the propofol group (p<0.05), but ICU length of stay, analgesic requirement, thorax dranaige, hemodynamic parameters and side effects were found to be similar between groups.CONCLUSIONS: In patients undergoing coronary artery bypass grafting surgery (CABG), dexmedetomidine provides faster weaning and extubation conditions, but has no effect on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction when compared with propofol.THE COMPARISON OF DEXMEDETOMINE AND PROPOFOL FOR POSTOPERATIVE SEDATION IN FAST-TRACK CARDIAC ANAESTHESIAZ. Pestilci Töz, D. Sergin, I. Alper, S. Kocabas, S. Ulukaya, F.Z. AşkarObjective: The aim of this study is to compare the effects of dexmedetomidine and propofol on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction in patients undergoing coronary artery bypass grefting surgery (CABG) .Methods: Fourty-two patients (aged 40-75 years, ASA II-III, EF > %40) undergoing elective CABG were included in this prospective, double-blind, randomized clinical study. After anaesthesia induction with etomidate, fentanyl and rocuronium; maintenance of anaesthesia was provided by 1 mg/kg/h propofol , 0.5 µg/kg/h fentanyl and desflurane in 50% oxygen in air. Additional analgesia requirements were achieved with 1 µg/kg fentanyl boluses, and neuromusculer blocking agent requirements were achieved with 0.1-0.15 mg/kg rocuronium. Randomisation to either dexmedetomidine group (n=21) or propofol group (n=21), via a random-number table, occurred in the operating room before sternal closure. After termination of fentanyl infusion, propofol was titrated to doses within the range of 0.2-0.7 µg /kg/h (propofol group) or propofol infusion was terminated and dexmedetomidine was started between the range of 0.2-0.7 µg/kg/h (dexmedetomidine group). Desfluran was terminated after sternal closure.Postoperative sedation level was assessed using Ramsey sedation scale and pain was assessed using visual analog scale (VAS). Patients were extubated after adequate clinical conditions were achieved. Postoperative hemodynamic parameters, pain, sedation level, respiratory parameters, thorax drainage and patient satisfaction were assessed until extubation.RESULTS: The times to weaning (65 ? 42 vs 04 ? 70 min.) and extubation (207 ? 57 vs 249 ? 68 min.) were shorter in the dexmedetomidine group compared with the propofol group (p<0.05), but ICU length of stay, analgesic requirement, thorax dranaige, hemodynamic parameters and side effects were found to be similar between groups.CONCLUSIONS: In patients undergoing coronary artery bypass grafting surgery (CABG), dexmedetomidine provides faster weaning and extubation conditions, but has no effect on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction when compared with propofol.THE COMPARISON OF DEXMEDETOMINE AND PROPOFOL FOR POSTOPERATIVE SEDATION IN FAST-TRACK CARDIAC ANAESTHESIAZ. Pestilci Töz, D. Sergin, I. Alper, S. Kocabas, S. Ulukaya, F.Z. AşkarObjective: The aim of this study is to compare the effects of dexmedetomidine and propofol on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction in patients undergoing coronary artery bypass grefting surgery (CABG) .Methods: Fourty-two patients (aged 40-75 years, ASA II-III, EF > %40) undergoing elective CABG were included in this prospective, double-blind, randomized clinical study. After anaesthesia induction with etomidate, fentanyl and rocuronium; maintenance of anaesthesia was provided by 1 mg/kg/h propofol , 0.5 µg/kg/h fentanyl and desflurane in 50% oxygen in air. Additional analgesia requirements were achieved with 1 µg/kg fentanyl boluses, and neuromusculer blocking agent requirements were achieved with 0.1-0.15 mg/kg rocuronium. Randomisation to either dexmedetomidine group (n=21) or propofol group (n=21), via a random-number table, occurred in the operating room before sternal closure. After termination of fentanyl infusion, propofol was titrated to doses within the range of 0.2-0.7 µg /kg/h (propofol group) or propofol infusion was terminated and dexmedetomidine was started between the range of 0.2-0.7 µg/kg/h (dexmedetomidine group). Desfluran was terminated after sternal closure.Postoperative sedation level was assessed using Ramsey sedation scale and pain was assessed using visual analog scale (VAS). Patients were extubated after adequate clinical conditions were achieved. Postoperative hemodynamic parameters, pain, sedation level, respiratory parameters, thorax drainage and patient satisfaction were assessed until extubation.RESULTS: The times to weaning (65 ? 42 vs 04 ? 70 min.) and extubation (207 ? 57 vs 249 ? 68 min.) were shorter in the dexmedetomidine group compared with the propofol group (p<0.05), but ICU length of stay, analgesic requirement, thorax dranaige, hemodynamic parameters and side effects were found to be similar between groups.CONCLUSIONS: In patients undergoing coronary artery bypass grafting surgery (CABG), dexmedetomidine provides faster weaning and extubation conditions, but has no effect on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction when compared with propofol.THE COMPARISON OF DEXMEDETOMINE AND PROPOFOL FOR POSTOPERATIVE SEDATION IN FAST-TRACK CARDIAC ANAESTHESIAZ. Pestilci Töz, D. Sergin, I. Alper, S. Kocabas, S. Ulukaya, F.Z. AşkarObjective: The aim of this study is to compare the effects of dexmedetomidine and propofol on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction in patients undergoing coronary artery bypass grefting surgery (CABG) .Methods: Fourty-two patients (aged 40-75 years, ASA II-III, EF > %40) undergoing elective CABG were included in this prospective, double-blind, randomized clinical study. After anaesthesia induction with etomidate, fentanyl and rocuronium; maintenance of anaesthesia was provided by 1 mg/kg/h propofol , 0.5 µg/kg/h fentanyl and desflurane in 50% oxygen in air. Additional analgesia requirements were achieved with 1 µg/kg fentanyl boluses, and neuromusculer blocking agent requirements were achieved with 0.1-0.15 mg/kg rocuronium. Randomisation to either dexmedetomidine group (n=21) or propofol group (n=21), via a random-number table, occurred in the operating room before sternal closure. After termination of fentanyl infusion, propofol was titrated to doses within the range of 0.2-0.7 µg /kg/h (propofol group) or propofol infusion was terminated and dexmedetomidine was started between the range of 0.2-0.7 µg/kg/h (dexmedetomidine group). Desfluran was terminated after sternal closure.Postoperative sedation level was assessed using Ramsey sedation scale and pain was assessed using visual analog scale (VAS). Patients were extubated after adequate clinical conditions were achieved. Postoperative hemodynamic parameters, pain, sedation level, respiratory parameters, thorax drainage and patient satisfaction were assessed until extubation.RESULTS: The times to weaning (65 ? 42 vs 04 ? 70 min.) and extubation (207 ? 57 vs 249 ? 68 min.) were shorter in the dexmedetomidine group compared with the propofol group (p<0.05), but ICU length of stay, analgesic requirement, thorax dranaige, hemodynamic parameters and side effects were found to be similar between groups.CONCLUSIONS: In patients undergoing coronary artery bypass grafting surgery (CABG), dexmedetomidine provides faster weaning and extubation conditions, but has no effect on postoperative sedation, hemodynamic and respiratory parameters and patient satisfaction when compared with propofol.