The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies

KURTCELEBI, Nevın; TUNCA, Savas Taner; Bakan, Nurten; ÖZDEMİR, Mehtap; ERBESLER, Zeynel Abidin; SAHIN, Omer Torun

The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies

Mehtap ÖZDEMİR, (Sağlık Bakanlığı, Ümraniye Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Nurten BAKAN, (Sağlık Bakanlığı, Ümraniye Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Omer Torun SAHIN, (Sağlık Bakanlığı, Ümraniye Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Nevın KURTCELEBI, (Sağlık Bakanlığı, Ümraniye Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Zeynel Abidin ERBESLER, (Sağlık Bakanlığı, Ümraniye Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Savas Taner TUNCA (Sağlık Bakanlığı, Ümraniye Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Journal of Clinical and Analytical Medicine

5 1

Yıl: 2013 Cilt: 4 Sayı: 4 Sayfa Aralığı: 313 - 317 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies

Öz:

Amaç: Robotik cerrahi, radikal prostatektomilerde gittikçe yaygın ve etkinbir şekilde kullanılmaktadır. Robotik cerrahi olgularında standart bir anesteziyöntemi olmayıp hem inhalasyon hem de intravenöz anestezikler kullanılmaktadır. Çalışmamızda radikal prostatektomilerde dengeli genel anestezi (DGA)ve total intravenöz anestezi (TiVA)nin klinik etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Etik kurul ve hasta onamlarını takiben robotik radikal prostatektomi geçirecek ASA I-III, 50-75 yaşları arası 42 hasta çalışmayaalındı. İndüksiyon propofol 2-2.5 mg/kg, veküronyum 0.1 mg/kg ve remifentanil 1 µg/kg ile yapıldıktan sonra olgular iki eşit gruba ayrıldı. Grup S(n=21)esevofluran (%1-2 MAC)-remifentanil (0.04-0.2µg/kg/dk) ve Grup P(n=21)epropofol (4-8 mg/kg/st)-remifentanil (0.04-0.2µg/kg/dk) ve her iki gruba da02/Hava(%40-%60) ile idame yapıldı. Hastaların Kalp Atım Hızı (KAH), Ortalama Arter Basıncı(OAB), Periferik Oksijen Saturasyonu(SpO2), End TidalCO2(ETCO2), Arteryel Kan Gazı (AKG) (pH, pO2, pCO2), Aldrete Derlenme Skoru (ADS) ve bulantı-kusma skorları, hasta memnuniyeti değerlendirildi. Bulgular: KAH ve OABında her iki grupta da anlamlı düşüklük vardı(p<0.05). ETCO2değerleri başlangıç değerleri ile karşılaştırıldığında her iki grupta da anlamlı yüksekti (p>0.05). pH; Grup Pde Grup Sden daha düşüktü (p 0.01). PCO2düzeyleri ise 2. stde Grup Pde Grup Sden, 4. stde ise Grup Sde Grup Pdenanlamlı düzeyde yüksekti(p 0.05). Grupiçi karşılaştırmalarda ise her iki grupta da pH anlamlı (p 0. 01) olarak azalmış, PCO2 ise anlamlı olarak artmıştı(p 0.05). ARS Grup Pde (ilk 1.st, 2.st ve 3.st) daha yüksek (p 0.01) bulunurken,bulantı-kusma skoru ise Grup Sde ilk iki saatte yüksekti. Hasta memnuniyetiaçısından gruplar arasında fark yoktu ve iki grupta da yüksekti. Tartışma: Robotik prostatektomi için TİVA; erken ve kaliteli derlenme sağlamakta yan etkileri (bulantı-kusma) daha az olmaktadır. Ancak trendelenburg pozisyonu veCO2 insüflasyonu TİVA grubunda daha fazla olmak üzere asidoz riskini artırmaktadır. Bu konuda daha geniş vaka serilerine ihtiyaç vardır.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Robotik Prostatektomilerde Sevofluran-Remifentanil ile Propofol-Remifentanil in Karşılaştırılması

Öz:

Aim: Robotic surgery is an effective and common surgery technique in radical prostatectomies. There isn t any standart anesthesia technique for robotic surgery so both inhalation and intravenous anesthetics are used . Inthis study we aimed that compared the clinical effects of balanced generalanesthesia and total intravenous anesthesia. Material and Method: AfterEthical Commitee and patient approval, 42 consecutive patients undergoingrobotic radical prostatectomy were included in this randomised-controlledstudy. Patients were divided in two equal group. We used sevoflurane (%1-2MAC) - remifentanyl (0.04-0.2 µgkg-1min-1) in Group S (n=21) and propofol(4-8mgkg-1h-1) - remifentanyl (0.04-0.2µgkg-1min-1) in Group P(n=21) and O2- Air (%40-%60) in two groups. Haemorespiratuar dynamics (HR, MAP, SPO2,ETCO2), Aldrete Recovery Score (ARS), nausea-vomiting score and patientsatisfaction were evaluated. Result: Heart Rate(HR) and Mean Arterial Pres- sure (MAP) decreased in the two groups (p<0.05). End tidal CO2(ETCO2) values significantly increased for two groups comparison with the initial values(p>0.05). pH was lower in Group P than Group S (p<0.01). PCO2 values significantly increased in group P than group S in 2nd h and in group S than group Pin 4th h (p<0.05). pH significantly decreased (p<0.01) and PCO2 increased forboth two intra-groups comparison (p<0.05). ARS was higher in group P for1st, 2nd, 3rd h and nausea-vomiting was lower for group P in first two hours.Patient satisfaction was higher and wasn t different in two groups. Discussion: TIVA for robotic prostatectomy supply early and better recovery andside-effects (nausea-vomiting) are less than balanced general anesthesia.But trendelenburg position and CO2 insuflation increases the risk of asidosis. In this issue there is need more studies.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Rassweiler J, Hruza M, Teber D, Su LM. Laparascopic and robotic assisted radical prostatectomy-critical analysis of the results.Eur Urol 2006; 49(4):612-24.
2. Baltayian S, A brief review:anesthesia for robotic prostatectomy. J.Robotic Srg 2008; 2:59-66.
3. Kalmar AF, Foubert L, Hendrickx JF, Mottrie A, Absalom A, Mortier EP. Influence of steep trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular and respiratory hemostasis during robotic prostatectomy.Br J An- aesth. 2010; 104(4) :433-9.
4. Malhorta V.Anesthesia considerations radical prostatectomy.Revista Mexicana de Anesthesiologia. Vol 29.Supl 1. Abril-Junio 2006; 89-92.
5. Cunningham AJ, Turner J, Rosenbaum S, Rafferty T. Transesophageal echocar- diographic assessment of haemodynamic function during laparascopic cholecys- tectomy.Br J Anaesth 1993; 70(6):621-5.
6. Odeberg S, Ljungqvist O, Svenberg T, Gannedahl P, Backdahl M, von Rosen A. Haemodynamic effects of pneumoperitoneum and the influence of posture during anesthesia for laparascopic surgery.Acta Anesthesiol Scand. 1994; 38(3):276-83.
7. Wilcox S, Vandam LD. Alas, poor trendelenburg and his position! A critique of its uses and effectiveness.Anesth Analg.1988; 67(6):574-8.
8. Hirvonen EA, Nuutinen LS, Kauko M. Hemodynamic changes due to Trendelen- burg positioning and pneumoperitoneum during laparascopic hysterectomy.Acta An- aesthesiol Scand. 1995; 39(7):949-55.
9. Falabella A, Moore-Jeffries E, Sullivan MJ, Nelson R, Lew M. Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic as- sisted prostatectomy:a trans-oesophageal Doppler probe study. Int J Med Robotics Comput Assist Surg.2007; 3(4):312-5.
10. OMalley C, Cunningham AJ. Physiologic changes during laparascopy.Anesthe- siol Clin North America 2001; 19(1):1-19.
11. Atallah MA, Othma MM. Robotic laparoscopic radical cystectomy inhalational versus total intravenous anesthesia: A pilot study. MEJ Anesth 2009; 20(2): 257- 63.
12. Sullivan MJ, Frost EAM, Lew MW. Anesthetic Care of the patient for robotic surgey. MEJ Anesth 2008; 19(5):967-82.
13. Alfonsi P, Vieillard-Baron A, Coggia M, Guignard B, Goeau-Brissonniere O, Jardin F. Cardiac function during intraperitoneal CO2 insufflation for aortic surgery : a trans-oessophageal echocardiographic study .Anesth Analg 2006; 102(5):1304- 10.
14. Collins VJ. Principles of anesthesiology . Philadelphia, USA.Lea and Febiger, 2nd edition 1976.
15. Wahba RWM, Beique F, Kleiman SJ. Cardiopulmonary function and laparoscopic cholecystectomy.Can J Anaesthiol 1995; 42(1):51-63.
16. Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiol- ogy and pathophysiology as a consequence of laparascopic surgery.Chest 1996; 110(3):810-5.
17. Taura P, Lopez A, Lacy AM, Anglada T, Beltran J, Fernandez-Cruz L. Pro- longed pneumoperitoneum at 15 mmHg causes lactic asidosis.Srg Endosc.1998; 12(3):198-201.
18. Cravens GT, Packer DL, Johnson ME. Incidence of propofol ınfusion syndrome during noninvasive radiofrequency ablation for atrial flutter or fibrillation. Anesthesiology 2007; 106(6):1134-8.
19. Kim YS. Arterial and end-tidal carbon dioxide pressure differences during laparoscopic colorectal surgery. EJA 2008; 25(1):74-5.
20. Lien CA, Hemmings HC, Belmont MR, Abalos A, Hollman C, Kelly RE. A compari- son : the efficacy of sevoflurane-nitrous oxide or propofol-nitrous oxide for the induction and maintenance of general anesthesia. J Clin Anesth. 1996; 8(8);639-43.
21. Raeder J, Gupta A, Pedersen FM. Recovery characteristics of sevoflurane or propofol based anaesthesia for day-care surgery.Acta Anesth Scand 1997; 41(8): 988-994.
22. Ku A.S, Hu Y, Irwin MG, Chow B, Gunawardene S, Tan EE. Effect of sevoflu- rane/nitrousoxide versus propofol anaesthesia on somatosensory evoked po- tential monitoring of the spinal cord during surgery to correct scoliosis. Br J Anaesth.2002; 88(4);502-7.
23. Matsumoto H, Shingu K, Numata K, Ogura S, Hanaoka K, Ito H. Total intrave- nous anesthesia with propofol is advantegeous than thiopental-sevoflurane anes- thesia in the recovery phase.Masui.1998; 47(9):1046-58.
24. Schmidt J, Fechner J, Fritsch B, Schmitz B, Carbon R, Rösch W. Propofolremi- fentanil versus sevoflurane-remifentanil for anesthesia for pediatric procedures in infants, children and adolescents. Anaesthesist. 2001; 50(10):757-66.

APA	ÖZDEMİR M, Bakan N, SAHIN O, KURTCELEBI N, ERBESLER Z, TUNCA S (2013). The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. , 313 - 317.
Chicago	ÖZDEMİR Mehtap,Bakan Nurten,SAHIN Omer Torun,KURTCELEBI Nevın,ERBESLER Zeynel Abidin,TUNCA Savas Taner The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. (2013): 313 - 317.
MLA	ÖZDEMİR Mehtap,Bakan Nurten,SAHIN Omer Torun,KURTCELEBI Nevın,ERBESLER Zeynel Abidin,TUNCA Savas Taner The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. , 2013, ss.313 - 317.
AMA	ÖZDEMİR M,Bakan N,SAHIN O,KURTCELEBI N,ERBESLER Z,TUNCA S The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. . 2013; 313 - 317.
Vancouver	ÖZDEMİR M,Bakan N,SAHIN O,KURTCELEBI N,ERBESLER Z,TUNCA S The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. . 2013; 313 - 317.
IEEE	ÖZDEMİR M,Bakan N,SAHIN O,KURTCELEBI N,ERBESLER Z,TUNCA S "The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies." , ss.313 - 317, 2013.
ISNAD	ÖZDEMİR, Mehtap vd. "The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies". (2013), 313-317.

APA	ÖZDEMİR M, Bakan N, SAHIN O, KURTCELEBI N, ERBESLER Z, TUNCA S (2013). The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. Journal of Clinical and Analytical Medicine, 4(4), 313 - 317.
Chicago	ÖZDEMİR Mehtap,Bakan Nurten,SAHIN Omer Torun,KURTCELEBI Nevın,ERBESLER Zeynel Abidin,TUNCA Savas Taner The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. Journal of Clinical and Analytical Medicine 4, no.4 (2013): 313 - 317.
MLA	ÖZDEMİR Mehtap,Bakan Nurten,SAHIN Omer Torun,KURTCELEBI Nevın,ERBESLER Zeynel Abidin,TUNCA Savas Taner The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. Journal of Clinical and Analytical Medicine, vol.4, no.4, 2013, ss.313 - 317.
AMA	ÖZDEMİR M,Bakan N,SAHIN O,KURTCELEBI N,ERBESLER Z,TUNCA S The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. Journal of Clinical and Analytical Medicine. 2013; 4(4): 313 - 317.
Vancouver	ÖZDEMİR M,Bakan N,SAHIN O,KURTCELEBI N,ERBESLER Z,TUNCA S The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies. Journal of Clinical and Analytical Medicine. 2013; 4(4): 313 - 317.
IEEE	ÖZDEMİR M,Bakan N,SAHIN O,KURTCELEBI N,ERBESLER Z,TUNCA S "The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies." Journal of Clinical and Analytical Medicine, 4, ss.313 - 317, 2013.
ISNAD	ÖZDEMİR, Mehtap vd. "The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies". Journal of Clinical and Analytical Medicine 4/4 (2013), 313-317.