Supratentoriyal kraniyotomi olgularında total intravenöz anestezi (TİVA) ve desfluran anestezinin hemodinami ve derlenme üzerine etkilerinin araştırılması

Comparison of the effects of total intravenous anesthesias (TIVA) and desflurane anesthesia on hemodynamics and recovery in cases of supratentorial craniatomy

Özet

Çalışmamızda, supratentoriyal kraniyotomi olgularında propofol+remifentanil (TİVA) ve desfluran anestezisinin hemodinami ve derlenme üzerine etkileri karşılaştırılmıştır. Hastane Etik Komite onayı alınarak, ASA l-ll, 15-70 yaş arası intrakraniyal tümör nedeniyle operasyonu planlanan toplam 30 hasta rasgele seçilerek iki gruba ayrıldı. Premedikasyonda Atropin 0.5 mg ve Diazepam 10 mg (i.m.) uygulandı, indüksiyonda her iki gruba da 1u.g/kg remifentanil, 1.5-2 mg/kg propofol, 0.2 mg/kg sisatra-kuryum i.v. verildi. Anestezi idamesinde %50-50 O2-N2O ile 1. gruba % 3-5 desfluran, 2. gruba 75-150 mg/kg/dk propofol ve 0.25 $mu$g/kg/dk remifentanil uygulandı. Peroperatif ve postoperatif SAB, DAB, KAH, SPO2, ETCO2 değerleri takip edildi. Postoperatif dönemde spontan göz açma zamanı, ekstübasyon zamanı, sözlü emirlere uyma zamanı, Aldrete derlenme skoru ve yan etkiler kaydedildi. SAB, DAB ve OAB'leri arasında iki grup arasında fark bulunmadı (p>0.05). Kalp hızı, cerrahi insizyon sonrası, anestezi bitişi ve ekstübasyon dönemlerinde desfluran grubunda anlamlı derecede yüksek bulundu (p

Abstract

In our study, we compared the effects of propofol+remifentanil (TIVA) and desflurane anesthesia on hemodyna¬mics and recovery in cases of supratentorial craniotomy. Thirty patients (age 15-70 years, with an ASA physical status of I or II and scheduled to be operated for intracra-nial tumor) were randomized into two groups. Both groups received intravenous remifentanil 1 $mu$g/kg, propofol 1.5-2 mg/kg and cisatracurium 0.2 mg/kg. In addition to 50-50% O2-N2O used for the maintenance, the first group received 3-5% desflurane and the second group received 75-150 $mu$g/kg/min propofol and 0.15-0.25 $mu$g/kg/min remifentanil. Preper and post-operative assessments were made by recording SBP, DBP, HR, SPO2 and ETCO2 values. Time to spontaneous eye opening, extubation and obey verbal commands were recorded in the post-operative period as well as Aldrete recovery score and side effects. There was no significant difference between the two groups for SBP, DBP and MBP. Heart rate was found significantly higher in the desflurane group at the periods of post-incision, end of anesthesia and extubation. Time to extubate was found significantly shorter in the desflurane group. Aldrete recovery score was significantly higher in the desflurane group at post-extubation 5th and 10th minutes. Both groups had short times to obey verbal commands and spontaneous eye opening, as well as had complete Aldrete recovery score at the 20th minute. We believe that; in long intracranial surgery cases that require early neurological evaluation, propofol + remifentanil (TIVA) and desflurane anesthesia have similar hemodynamic and recovery properties so that both can be used safely.