Author/Editor		Mekiš, Dušan; Kamenik, Mirt
Title		Primerjava učinkov remifentanila in fentanila na obtočila med anestezijo za premostitev zožitev venčnih arterij
Translated title		Comparison of remifentanil and fentanyl anasthesia for CABG surgery
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. 7-8
Publication year		2003
Volume		str. 417-21
Language		slo
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 ischaemic 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 forphenylephrine 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. (Abstract truncated at 2000 characters).
Summary		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 premostitve zožitev venčnih arterij. Metode. V raziskavo smo vključili 30 bolnikov. Vključili smo bolnike, mlajše od 75 let, po NYHA ocenjene z ll-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. u Bolnike smo naključno razdelili v dve skupini. Remifentanilska skupina je za analgezijo dobila infuzijo remifentanila 0,5 mikro 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 mikro 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. (Izvleček skrjašan pri 2000 znakih).
Descriptors		FENTANYL ANESTHESIA, GENERAL CORONARY ARTERY BYPASS MYOCARDIAL ISCHEMIA ANALGESIA PREANESTHETIC MEDICATION PROPOFOL PANCURONIUM RESPIRATION, ARTIFICIAL BLOOD PRESSURE NITROGLYCERIN PHENYLEPHRINE HEART RATE