Dušan Mekiš (Author), Mirt Kamenik (Author)

Abstract

Izhodišča. Odgovor obtočil na bolečinski dražljaj lahko povzroči nastanek ishemije srčne mišice, še posebej pri bolnikih z ishemično boleznijo srca. V raziskavi smo primerjali vpliv fentanila oziroma remifentanila na obtočila med uvodom v anestezijo, rezom kože in sternotomijo, pri bolnikih z ishemično boleznijo srca, operiranih zaradi premostitvenih zožitev venčnih arterij. Metode. V raziskavo smo vključili 30 bolnikov. Vključili smo bolnike, mlajše od 75 let, po NYHA ocenjene z II-III, z iztisnim deležem levega prekata, večjim od 40%. Za uvod v anestezijo so bolniki dobili infuzijo propofola 6 mg/kg/h in pankuronija 0,1 mg/kg i. v. Bolnike smo naključno razdelili v dve skupini. Remifentanilska skupina je za analgezijo dobila infuzijo remifentanila 0,5 micro g/kg/min, fentanilska skupina pa fentanil v odmerku 5 mikro g/kg i. v. Pet minut po začetku uvoda v anestezijo smo bolnikom vstavili dihalno cevko in jih pričeli umetno predihavati s 50% zmesjo kisika in zraka. Po vstavitvi dihalne cevke smo bolnikom v remifentanilski skupini zmanjšali odmerek remifentanila na 0,3 mikro g/kg/min. Pet minut pred rezom kože smo bolnikom v remifentanilski skupini povečali odmerek remifentanila na 0,5 micro g/kg/min, bolniki v fentanilski skupini so dobili fentanil v odmerku 5 mikro g/kg i. v. Bolnikom smo 10 minut pred uvodom v anestezijo, med uvodom in še 30 minut po rezu kože invazivno neprekinjeno merili srednji arterijski tlak in srčno frekvenco ter spremljali potrebo po fenilefrinu oziroma nitroglicerinu. Rezultati. Med skupinama ni bilo statistično pomembne razlike v demografskih podatkih. Pogostost povečanja srednjega arterijskega tlaka in uporaba nitroglicerina za uravnavanje srednjega arterijskega tlaka sta bili statistično značilno večji v fentanilski skupini. Pogostost znižanja srednjega arterijskega tlaka in uporaba fenilefrina za uravnavanje srednjega arterijskega tlaka se med obema skupinama ni statistično značilno razlikovala. Tahiaritmičnih in bradiaritmičnih zapletov nismo zabeležili v nobeni skupini. Po uvodu v anestezijo sta se srednji arterijski tlak in srčna frekvenca statistično značilno zmanjšala v primerjavi z izhodiščno vrednostjo v obeh preiskovanih skupinah. V fentanilski skupini sta se v primerjavi z remifentanilsko skupino po laringoskopiji in vstavitvi dihalne cevke ter po rezu kože statistično značilno povečala srednji arterijski tlak in srčna frekvenca. Zaključki. V raziskavi smo ugotovili, da intravenska anestezija s propofolom-remifentanilom med operacijo za premostitev venčnih arterij zagotavlja večjo stabilnost obtočil med uvodom v anestezijo, rezom kože ter sternotomijo od anestezije s propofolom-fentanilom.

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Language: Slovenian
Year of publishing:
Typology: 1.01 - Original Scientific Article
Organization: UM - University of Maribor
UDC: 616-089.5
COBISS: 1315903 Link will open in a new window
ISSN: 1318-0347
Parent publication: Zdravniški vestnik
Views: 741
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Secondary language: English
Secondary title: Comparison of remifentanil and fentanyl anaesthesia for CABG surgery
Secondary abstract: Background. Haemodynamic response to surgical stimulation can cause myocardial ischemia, especially in a patient with coronary artery disease. This paper presents a comparison of the haemodynamic stability during induction of anaesthesia, skin incision and sternotomy for CABG surgery in patients with ischemic heart disease receiving remifentanil-propofol or fentanyl-propofol anaesthesia. Methods. 54 patients undergoing elective CABG surgery were studied. Included in this study were patients younger than 75 years, with a score of 2-3 according to NYHA classification, and whose ejection fraction of the left ventricle was more than 40%. For induction of anaesthesia, the patients received propofol 6 mg/kg/h and pancuronium 0.1 mg/kg i. v. The patients were randomly divided in two groups. The R group received remifentanil 0.5 micro g/kg/min while the F group received fentanyl 5 micro g/kg i. v. Five minutes after the induction of anaesthesia the patients were orotracheally intubated and artificially ventilated with a 50% air and oxygen mixture. After the orotracheal intubation remifentanyl was decreased in the R group to 0.3 micro g/kg/min and five minutes before skin incision it was increased to 0.5 micro g/kg/min. In the F group the patients received fentanyl 5 micro g/kg i. v. Invasively and continuously the mean arterial pressure and heart rate were measured 10 minutes before anaesthesia, during the induction of anaesthesia and 30 minutes after the skin incision. The need for phenyllephrine and nitroglycerin was also registered during these period. Results. No differences were established between the groups with respect to demographic and preoperative data. The incidence of increased mean arterial pressure and the use of nitroglycerine during induction of anaesthesia, skin incision and sternotomy for CABG surgery was statistically significantly higher in the F group than in the R group. The incidence of decreased mean arterial pressure and the use of phenylephrine for regulation of mean arterial pressure was equal in both groups. There were no cases of tachyarryhthmia or bradyarrhythmia in any of the groups. After induction of anaesthesia, the mean arterial pressure and heart rate decreased statistically significantly in both groups as compared to the baseline values. After orotracheal intubation and after skin incision, the mean arterial pressure and heart rate increased statistically significantly in the F group as compared to the R group. Conclusions. Our study shows more stable haemodynamics after the induction of anaesthesia, skin incision and sternotomy in patients receiving remifentanil-propofol with respect to patients receiving fentanyl-propofol in CABG surgery.
Secondary keywords: Fentanyl;Fentanil;Hemodynamics;Hemodinamika;Propofol;Coronary artery bypass;Koronarna arterija, premostitev;Anesthesia;Anestezija;
URN: URN:NBN:SI
Type (COBISS): Not categorized
Pages: str. 417-421
Volume: ǂLetn. ǂ72
Issue: ǂšt. ǂ7-8
Chronology: 2003
ID: 9100612