Çocuklarda sevofluran ile nitröz oksit veya kaudal blok uygulamasının gözlemsel karşılaştırılması

Year 2019, , 1 - 5, 21.03.2019

Nesrin Alpaslan Demet Coskun Sıdıka Hülya Çelebi

https://doi.org/10.18663/tjcl.472892

Abstract

Amaç:  Sevofluran
çocuklarda anestezi indüksiyonu ve idamesinde en sık tercih edilen volatil
anestezik ajandır. Çalışmamızda genel anestezinin analjezik komponentini N₂O
veya kaudal blok ile sağlayarak ve anestezi süresince bisepektral indeks (BIS)
monitörizasyonu ile anestezi derinliğini sabit tutarak; bu iki uygulama
şeklinin minimal alveolar konsantrasyon (MAK) ve hemodinami üzerindeki
etkilerini gözlemsel olarak karşılaştırmayı amaçladık.

Gereç ve
Yöntemler: Genel anestezi
altında günübirlik operasyon geçirecek 40 çocuk hastaya; %40 O2/hava (grup K)
veya %40 O2/N2O (grup N) karışımı içinde %8 sevofluran kullanılarak
inhalasyon indüksiyonu uygulandı. Gurup K’daki çocuklara yan yatar
pozisyonda,  22 G kaudal iğneyle 0.7 mL/kg,  % 0.2  bupivakain
solüsyonu kullanılarak kaudal blok uygulandı. Operasyon süresince her iki
grubun hemodinamik parametreleri, BIS ve MAK değerleri takip edilerek kaydedildi.

Bulgular: Her iki grubun hemodinamik parametreleri benzer bulunmuştur.
Sevofluranın, N2O katkısı olmaksızın kaudal blok yapılan grupta istatiksel yönden anlamlı olmamakla birlikte daha düşük MAK değerlerinde
sürdürülebildiği tespit edilmiştir.

Sonuç: İntraoperatif ve postoperatif analjezi sağlamanın yanı sıra çevre kirliliğini azaltması
yönünden de bir avantaj sağladığı için kaudal bloğun, anestezi sırasında
uygun koşullarda N₂O’e göre daha öncelikle tercih edilmesi gerektiği düşüncesindeyiz.

Keywords

Sevofluran anestezisi, nitröz oksit, kaudal blok

Observational comparison of sevoflurane and nitrous oxide or caudal block in pediatric patients

Abstract

Aim: Sevoflurane is the most preferred volatile anesthetic
agent for the induction and maintenance of anesthesia in children. In our
study, the analgesic component of general anesthesia was provided by N₂O
or caudal block and during anesthesia, the depth of the anesthesia was kept
constant by means of the monitoring of bispectral index (BIS). We aimed to make
an observational comparison the effects of these two methods on minimal
alveolar concentration (MAC) and hemodynamics.

Material
and Methods: Forty pediatric patients scheduled to undergo on day case based surgery
under general anesthesia were included in the study. Inhalation induction using
8% sevoflurane in a mixture of 40% O2/Air (group K) or 40% O2/N2O (group N)
were used in all children.  Then,
patients in Group K received caudal block in lateral decubitus position with 0.7
mL/kg, 0.2% bupivacaine solution using 22 G caudal needle. Hemodynamic
parameters, BIS and MAC values were recorded during the operation in all patients.

Results: Hemodynamic
parameters were similar in both groups. It was determined that sevoflurane was
not statistically significant in the caudal block group without the
contribution of N2O, but could be maintained in lower MAC values.

Conclusion: We recommend
use of caudal block since it ensures adequately satisfactory intraoperative and
postoperative analgesia without any harm to atmosphere in comparison to N₂O
during general anesthesia in the presence of no medical contraindications.

Keywords

sevoflurane anesthesia, nitrous oxide, caudal block

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