Mivakuryum verokuronyumun çocuklarda nöromusküler blok, entübasyon koşulları ve hemodinamik parametreler üzerine etkileri
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Dosyalar
Tarih
2001
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda nondepolarizan kas gevşeticiler olan mivakuryum ve rokuronyumun, çocuklarda sevofluran anestezisi altında nöromusküler bloğa, entübasyon koşullarına ve hemodinamik parametrelere etkilerini değerlendirmeyi amaçladık. Çalışma, adenotonsillektomi operasyonu geçirecek ASA I-H sınıfina giren, 2-12 yaşlar arasındaki 120 olgu üzerinde gerçekleştirilmiştir. Kullanılacak kas gevşetici ajana göre olgular rasgele seçilmiş 60'ar kişilik 2 gruba ayrıldı. Tüm olgulara premedikasyon amacıyla oral 0,015mg/kg atropin ile 0,06 mg/kg midazolam uygulandı. Rutin monitörizasyonu takiben indüksiyon öncesi, indüksiyon sonrası, maksimal blok oluşunca, entübasyon sonrası 1. dakika ve 5. dakikalarda olguların kalp atım hızlan, sistolik ve diyastolik arter basınçtan kaydedildi. Anestezi indüksiyonuna her iki grupta da; %50 02- %50 NîO'den oluşan taze gaz akımına eklenen %5 konsantrasyonda sevofluran ile başlandı. Hastaların pupilleri orta hata gelince sevofluran konsantrasyonu %3'e düşürüldü. Olguların tümüne alfentanil 30 mcg/kg intravenöz uygulandı. İndüksiyonu takiben Grup I'de 0,2 mg/kg mivakuryum, Grup Il'de 0,06 mg/kg rokuronyum 5 sn' de uygulandı. Aynı zamanda TOF-Guard monitörü ile T95, maksimal blok ve süresi, T25, T25-75, T70 parametreleri kaydedildi. Endotrakeal entübasyon kalitesi " Clarke ve Mirakhur değerlendirme skalası ile yapıldı. Rokuronyum yapılan olgulara T25 süresi saptandıktan sonra dekürarizasyon amacıyla 0,04 mg/kg neostigmin ve 0,07 mg/kg atropin i.v yapıldı. Mivakuryum kullanılan olgularda dekürarizasyon uygulanmadı. T95 ve maksimal blok süreleri; Grup I de sırasıyla 137,27±53,76 sn ve 225,83±1 19,28 sn. Grup H'de ise sırasıyla 106,81±54,25 sn ve 181,80 ±89,27 sn bulundu. T95 ve maksimal blok süresi Grup H'de Grup I'e göre istatistiksel olarak anlamlı derecede 65 kısa bulundu (p<0,05). Maksimal blok Grup I'de % 97,83 Grup H'de ise % 99,50 idi. İki grubun maksimal blok düzeyleri arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). T25 ve T70 süreleri; Grup I'de sırasıyla 9,32±4,32 dk ve 18,20±9,62 dk,. Grup H'de ise sırasıyla 28,94±11,14 dk ve 35,12±9,64 dk bulundu. T25 ve T70 süreleri Grup I'de Grup Il'ye göre istatistiksel olarak anlamlı derecede kısa bulundu (p<0,05). T25-75 süresi Grup I'de 6,50±8,05 dk ve Grup Il'de ise 3,72±1,38 dk bulundu. Grup Il'de istatistiksel olarak anlamlı derecede kısa idi (p<0,05). Her iki grupta da kas gevşetici verilmeden hemen önceki hemodinamik değerler ile ölçülen daha sonraki değerler arasında klinik açıdan anlamlı farklılık yoktu. Sonuç olarak her iki kas gevşeticinin çocuklarda yeterli entübasyon koşullarını sağladığı ve hemodinamiğe minimal etkilerinin olduğu, ancak rokuronyumun etki başlama süresinin kısa olması nedeniyle indüksiyonda ve acil durumlarda, mivakuryumun etki süresinin ve derlenme süresinin kısa olması nedeniyle kısa süreli operasyonlarda güvenle kullanılabileceği kanısına varıldı.
In our study aim was to evaulate the effects of nondepolarizing muscle relaxants mivacurium and rocuronium on neuromuscular blockade, intubation conditions and haemodynamic parameters in paediatric patients under sevoflurane anaesthesia. Our study was performed on 120 ASA I-II class patients, ages ranging between 2-12 planned for ellective adenotonsillectomy operations. Patients were randomized into two groups of 60 patients each according to the muscle relaxants planned to be used. All patients received 0.015 mg/kg atropin and 0.5 mg/kg midazolam p.o for premedication. Heart rate, sistolic and diastolic arterial pressures were recorded before induction, after induction, when maximal blockade was occurred and 1 and 5 minutes after intubation. Anaesthesia induction was provided with 50 % O2 + 50 % N2O with 5% sevoflurane. When the patients pupils were in the midline, sevofluran concentration was decreased to 3% and then 30 mcg/kg alfentanyl was applied intravenously. Following induction, patients received either 0.2 mg/kg mivacurium or 0.6 mg/kg rocuronium in 5 seconds. T95, maximal blockade and maximal blockade time, T25, T25-75, T70 parameters were recorded with TOF-Guard monitor at equal times. The quality of endotracheal intubation was evaluated with Clarke and Mirakhur evaluation scale. After the determination of T25 time 0.04 mg/kg neostigmine and 0.07 mg/kg atropin were given to Group II for decurarization. Decurarization was omitted in Group I. The T95 time was 137.27±53.76 sec in Group I and 106.81±54.25 sec in Group EL Maximal blockade time was 225.83±1 19.28 sec in Group I and 181.80 ±89.27 sec in Group E. The T95 time and maximal blockade time were significantly shorter in Group II (p<0.05). Maximal blockade was 97.83 % in Group I and 99.50 % in Group H. No significant difference was found in maximal blockades between the two groups (p>0.05). 67 T25 and T7o times were 9.32±4.32 min and 18.20±9.62 min in Group I and 28.94±11.14 min and 35.12±9.64 min in Group II respectively. T25 and T70 times were significantly shorter in Group I than Group II (p<0.05). T25.75 time was 6.50±8.05 min Group I and 3.72±1.38 min in Group II. T25.75 time was significantly shorter in Group II (p<0.05). Haemodynamic data did not show any clinical differences between the groups. In conclusion, both mivacurium and rocuronium provied adequate intubation conditions and minimal haemodynamic changes. As a result we have concluded that in paediatric patients, having short duration of onset rocuronium is the agent to be preferred in induction and emergency states. Because of its short clinical effects and recovery time, mivacurium is the agent to be prefered in short duration operations.
In our study aim was to evaulate the effects of nondepolarizing muscle relaxants mivacurium and rocuronium on neuromuscular blockade, intubation conditions and haemodynamic parameters in paediatric patients under sevoflurane anaesthesia. Our study was performed on 120 ASA I-II class patients, ages ranging between 2-12 planned for ellective adenotonsillectomy operations. Patients were randomized into two groups of 60 patients each according to the muscle relaxants planned to be used. All patients received 0.015 mg/kg atropin and 0.5 mg/kg midazolam p.o for premedication. Heart rate, sistolic and diastolic arterial pressures were recorded before induction, after induction, when maximal blockade was occurred and 1 and 5 minutes after intubation. Anaesthesia induction was provided with 50 % O2 + 50 % N2O with 5% sevoflurane. When the patients pupils were in the midline, sevofluran concentration was decreased to 3% and then 30 mcg/kg alfentanyl was applied intravenously. Following induction, patients received either 0.2 mg/kg mivacurium or 0.6 mg/kg rocuronium in 5 seconds. T95, maximal blockade and maximal blockade time, T25, T25-75, T70 parameters were recorded with TOF-Guard monitor at equal times. The quality of endotracheal intubation was evaluated with Clarke and Mirakhur evaluation scale. After the determination of T25 time 0.04 mg/kg neostigmine and 0.07 mg/kg atropin were given to Group II for decurarization. Decurarization was omitted in Group I. The T95 time was 137.27±53.76 sec in Group I and 106.81±54.25 sec in Group EL Maximal blockade time was 225.83±1 19.28 sec in Group I and 181.80 ±89.27 sec in Group E. The T95 time and maximal blockade time were significantly shorter in Group II (p<0.05). Maximal blockade was 97.83 % in Group I and 99.50 % in Group H. No significant difference was found in maximal blockades between the two groups (p>0.05). 67 T25 and T7o times were 9.32±4.32 min and 18.20±9.62 min in Group I and 28.94±11.14 min and 35.12±9.64 min in Group II respectively. T25 and T70 times were significantly shorter in Group I than Group II (p<0.05). T25.75 time was 6.50±8.05 min Group I and 3.72±1.38 min in Group II. T25.75 time was significantly shorter in Group II (p<0.05). Haemodynamic data did not show any clinical differences between the groups. In conclusion, both mivacurium and rocuronium provied adequate intubation conditions and minimal haemodynamic changes. As a result we have concluded that in paediatric patients, having short duration of onset rocuronium is the agent to be preferred in induction and emergency states. Because of its short clinical effects and recovery time, mivacurium is the agent to be prefered in short duration operations.
Açıklama
Anahtar Kelimeler
Mivakuryum, Rokuronyum, Nöromusküler blok, Entübasyon koşulları, Hemodinamik parametreler, Hemodynamic parameters, Intubation conditions, Neuromuscular block, Rocuronium
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Apilioğulları, S. (2001). Mivakuryum verokuronyumun çocuklarda nöromusküler blok, entübasyon koşulları ve hemodinamik parametreler üzerine etkileri. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
