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

Ozet Amac: Laringoskopi ve endotrakeal entubasyona bagli sempatoadrenerjik aktivitenin artisina bagli olarak hipertansiyon, tasikardi yaniti gorulebilir. Bu yanit ozellikle intrakraniyal ve kardiyovaskuler hastaligi olan hastalarda yasami tehdit eden komplikasyonlara neden olabilmektedir. Biz bu calismada calismada, remifentanil, amiodaron, fentanil, esmolol ve lidokain'in trakeal entubasyonda hemodinamik yanit uzerindeki goreceli etkinligini karsilastirdik. Gerec ve Yontemler: Bu calismaya elektif cerrahi gecirecek 20–60 ASA I-II, 90 hasta dahil edildi. Hastalar kapali zarf teknigi ile alti gruba ayrildi. Entubasyona yaniti engellemek icin Birinci grup kontrol grubu (G1) haric, ikinci gruba (G2) fentanil, ucuncu gruba (G3) remifentanil, dorduncu gruba (G4) esmolol, besinci guruba (G5) amiodaron, altinci gruba (G6) ise lidokain entubasyon oncesi ek olarak uygulandi. Tum hastalara ayni anestezi teknigi uygulandi. Sistolik kan basinci (SKB), diastolik kan basinci (DKB) ve kalp atim hizi (KAH) icin belirlenen zamanlarda olcum¬ler yapilarak kaydedildi. Bulgular: Gruplar arasinda demografik veriler acisindan fark bulunmadi (p>0.05). Remifentanil grubundaki SKB stabilitesi esmolol ve fentanil gruplarina gore daha fazlaydi. Remifentanil grubundaki DKB’daki dusus diger gruplara gore daha fazlaydi. KAH’daki dusus remifentanil grubunda 1. 3. ve 5. dakikalarda daha fazla idi. Sonuc: Bizim calismamiza gore, entubasyona hemodinamik yaniti onlemede remifentanilin 0.5 mikrogram/kg infuzyon dozunda diger ilac gruplarina en etkin ilac olabilecegini soyliyebiliriz. Summary Aim: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 pa¬tients received the same anesthetic technique. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) measure¬ments 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.