Rinoplasti cerrahisinde melatonin premedikasyonun ve subanestezik dozlarda ketamin uygulamasının postoperatif uyku kalitesi üzerine etkilerinin karşılaştırılması
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Postoperatif uyku bozuklukları cerrahi hastalarında sık gözüken morbiditeyi ve hastane yatış süresini
uzatan önemli bir cerrahi ve/veya anestezi komplikasyonudur. Bu komplikasyonu önlemek ve tedavi etmek için
medikal veya non medikal birçok yöntem araştırılmaktadır. Bu çalışma en çok yapılan kozmetik cerrahilerinden
biri olan rinoplasti cerrahisi geçirecek hastalarda melatoninin ve ketaminin postoperatif uyku bozuklukları üzerine
etkisini araştırmayı amaçlamıştır.
Yöntem: Yeterli çalışma gücü baz alınarak rinoplasti yapılacak 183 hasta çalışmaya alındı. Hastalar melatonin
(m) ve ketamin (k) verilmesine göre 61’ rer kişilik M, K ve MK olarak 3 gruba ayrıldı. M grubuna preoperatif ve
postoperatif 0,1 mg/kg oral melatonin, K grubuna intraoperatif 0,3 mg/kg iv ketamin, MK grubuna preoperatif ve
postoperatif 0,1 mg/kg oral melatonin ve intraoperatif 0,3 mg/kg iv ketamin verildi. Hastaların preoperatif son gün
uyku kaliteleri (RCUÖ) ile, demografik verileri ve ASA skorları kaydedildi. 0.01 mg/kg iv midazolam ile
premedikasyon uygulanan hastalara non invaziv (Ekg, SpO2, KB, NMT) monitörizasyon yapıldıktan sonra iv 2
mg/kg propofol, 1 μg/kg fentanil, 1 mg/kg lidokain ve 0.6 mg/kg rokuronyum ile anestezi indüksiyonu yapıldı.
İdamede ise iv 0.1-0.3 μg/kg/dk remifentanil (SPI, 40-60 arası olacak şekilde) ve 0.5-1 MAK sevofluran
inhalasyonu ameliyat öncesi vital değerlerin (KH, SAB ve OAB) %20'si içinde tutulmasına özen gösterilerek
uygulandı. Hastalara aynı cerrahi ekip tarafından rinoplasti cerrahisi yapıldı. Hastaların bazal, entübasyon sonrası
,30 dakika aralıklı ve ekstübasyon sonrası vital değerleri (KH, SAB, DAB OAB), cerrahi süre, ekstübasyon süresi,
remifentanil ve sevofluran tüketimi kayıt edildi. Ekstübasyon sırasında öksürme, soluk tutma, desatürasyon, kusma
ve laringospazm erken komplikasyon olarak ve PABÜ’de geç komplikasyonlar olarak kayıt edildi. PABÜ’de
Modifiye Aldrete skorları, skora ulaşma süreleri ve 1. Saat NRS skorları kaydedildi. Postoperatif 1.günde
hastaların uyku kaliteleri RCUÖ ile ve NRS skorları değerlendirildi.
Bulgular: Hastaların entübasyon sonrası, 30. dakika, ekstübasyon sonrası vital değerleri ortalaması MK grubunda
diğer iki gruba göre istatiksel olarak anlamlı düşüktü. Bazal ve 60. dakika verilerinde gruplar arası anlamlı fark
yoktu. Remifentanil ve sevofluran tüketimi MK grubunda diğer iki gruptan düşüktü fakat istatiksel olarak sadece
M grubu ile arasındaki fark anlamlıydı. M ve K grupları arasında tüketim açısından fark yoktu. Modifiye Aldrete
skoru ve skora ulaşma süreleri açısından gruplar arası fark yoktu. PABÜ ve 24. Saat NRS skorları MK grubunda
diğer iki gruba göre daha düşüktü. 24.saat NRS skorlarında ise M ve MK gruplarının değerleri K grubundan
anlamlı derece düşüktü. Grupların ekstübasyon sonrası ve PABÜ komplikasyonları arasında bir fark saptanmadı.
Postoperatif 1. gün sabahında bakılan RCUÖ toplam puanında MK grubu diğer iki gruptan daha yüksek puana
sahipti. RCUÖ cut off değeri 50 alındığında rinoplasti hastalarında preoperatif ilk gece uyku bozukluğu %17,5
postoperatif ise %20,2 bulundu. MK grubunda uyku bozukluğu diğer iki gruptan anlamlı derecede düşük bulundu
Sonuç: Bu randomize, kontrollü, prospektif, çalışma rinoplasti cerrahisi geçiren hastaların postoperatif uyku
bozuklukları üzerine melatonin ve ketaminin etkilerini araştırmıştır. Sonuçlarımız melatonin ve ketaminin
postoperatif u
Purpose: Postoperative sleep disorders are an important complication of surgery and/or anesthesia, which is common in surgical patients and prolongs the morbidity and hospital stay. Many medical or non-medical methods are being investigated to prevent and treat this complication. This study aimed to investigate the effects of melatonin and ketamine on postoperative sleep disorders in patients who will undergo rhinoplasty, one of the most commonly performed cosmetic surgeries. Method: Based on sufficient working strength, 183 patients who would undergo rhinoplasty were included in the study. The patients were divided into 3 groups as M, K and MK of 61 people according to the administration of melatonin and ketamine. Group M was given 0.1 mg/kg oral melatonin preoperatively and postoperatively, group K was given 0.3mg/kg iv ketamine intraoperatively, group MK was given preoperative and postoperative 0.1 mg/kg oral melatonin and intraoperatively 0.3mg/kg iv ketamine. Preoperative last day sleep quality of the patients was recorded by RCU, demographic data and ASA scores were recorded. After non-invasive (ECG, SpO2, BP, NMT) monitoring in patients who were premedicated with 0.01 mg/kg iv midazolam, anesthesia was induced with iv 2 mg/kg propofol, 1 μg/kg fentanyl, 1 mg/kg lidocaine and 0.6 mg/kg rocuronium. In maintenance, iv 0.1-0.3 μg/kg/min remifentanil (SPI, between 40-60) and 0.5-1 MAK sevoflurane inhalation were administered, taking care to keep it within 20% of preoperative vital values (HR, SAB and MAP). Rhinoplasty surgery was performed on the patients by the same surgical team. Basal, post-intubation, 30-minute intervals and post-extubation vital values (HR, SAB, DAB MAP), surgery time, extubation time, remifentanil and sevoflurane consumption were recorded. Coughing, breath holding, desaturation, vomiting and laryngospasm during extubation were recorded as early complications and late complications in PABU. Modified Aldrete scores, time to score and 1st hour NRS scores were recorded in PABU. On the first postoperative day, the sleep quality of the patients was evaluated with RCU and NRS scores. Results: Post-intubation, 30th minute, post-extubation vital values of the patients were statistically significantly lower in the MK group compared to the other two groups. There was no significant difference between groups in baseline and 60th minute data. Remifentanil and sevoflurane consumption were lower in the MK group than the other two groups, but the difference was statistically significant only with the M group. There was no difference in consumption between M and K groups. There was no difference between the groups in terms of the modified Aldrete score and the time to reach the score. PABU and 24th hour NRS scores were lower in the MK group than in the other two groups. In the 24th hour NRS scores, the values of the M and MK groups were significantly lower than the K group. There was no difference between the post-extubation and PABU complications of the groups. The MK group had a higher score than the other two groups in the total score of RCWS measured on the morning of the first postoperative day. When the RCUÖ cut-off value was taken as 50, preoperative first night sleep disturbance was found to be 17.5% and postoperatively 20.2% in rhinoplasty patients. Sleep disturbance was found to be significantly lower in the MK group than in the other two groups. Conclusion: This randomized, controlled, prospective, study investigated the effects of melatonin and ketamine on postoperative sleep disturbances in patients undergoing rhinoplasty surgery. Our results showed that the effects of melatonin and ketamine on postoperative sleep quality were similar, and the combination improved the results more.
Purpose: Postoperative sleep disorders are an important complication of surgery and/or anesthesia, which is common in surgical patients and prolongs the morbidity and hospital stay. Many medical or non-medical methods are being investigated to prevent and treat this complication. This study aimed to investigate the effects of melatonin and ketamine on postoperative sleep disorders in patients who will undergo rhinoplasty, one of the most commonly performed cosmetic surgeries. Method: Based on sufficient working strength, 183 patients who would undergo rhinoplasty were included in the study. The patients were divided into 3 groups as M, K and MK of 61 people according to the administration of melatonin and ketamine. Group M was given 0.1 mg/kg oral melatonin preoperatively and postoperatively, group K was given 0.3mg/kg iv ketamine intraoperatively, group MK was given preoperative and postoperative 0.1 mg/kg oral melatonin and intraoperatively 0.3mg/kg iv ketamine. Preoperative last day sleep quality of the patients was recorded by RCU, demographic data and ASA scores were recorded. After non-invasive (ECG, SpO2, BP, NMT) monitoring in patients who were premedicated with 0.01 mg/kg iv midazolam, anesthesia was induced with iv 2 mg/kg propofol, 1 μg/kg fentanyl, 1 mg/kg lidocaine and 0.6 mg/kg rocuronium. In maintenance, iv 0.1-0.3 μg/kg/min remifentanil (SPI, between 40-60) and 0.5-1 MAK sevoflurane inhalation were administered, taking care to keep it within 20% of preoperative vital values (HR, SAB and MAP). Rhinoplasty surgery was performed on the patients by the same surgical team. Basal, post-intubation, 30-minute intervals and post-extubation vital values (HR, SAB, DAB MAP), surgery time, extubation time, remifentanil and sevoflurane consumption were recorded. Coughing, breath holding, desaturation, vomiting and laryngospasm during extubation were recorded as early complications and late complications in PABU. Modified Aldrete scores, time to score and 1st hour NRS scores were recorded in PABU. On the first postoperative day, the sleep quality of the patients was evaluated with RCU and NRS scores. Results: Post-intubation, 30th minute, post-extubation vital values of the patients were statistically significantly lower in the MK group compared to the other two groups. There was no significant difference between groups in baseline and 60th minute data. Remifentanil and sevoflurane consumption were lower in the MK group than the other two groups, but the difference was statistically significant only with the M group. There was no difference in consumption between M and K groups. There was no difference between the groups in terms of the modified Aldrete score and the time to reach the score. PABU and 24th hour NRS scores were lower in the MK group than in the other two groups. In the 24th hour NRS scores, the values of the M and MK groups were significantly lower than the K group. There was no difference between the post-extubation and PABU complications of the groups. The MK group had a higher score than the other two groups in the total score of RCWS measured on the morning of the first postoperative day. When the RCUÖ cut-off value was taken as 50, preoperative first night sleep disturbance was found to be 17.5% and postoperatively 20.2% in rhinoplasty patients. Sleep disturbance was found to be significantly lower in the MK group than in the other two groups. Conclusion: This randomized, controlled, prospective, study investigated the effects of melatonin and ketamine on postoperative sleep disturbances in patients undergoing rhinoplasty surgery. Our results showed that the effects of melatonin and ketamine on postoperative sleep quality were similar, and the combination improved the results more.
Açıklama
Anahtar Kelimeler
Rinoplasti, Rhinoplasty, Uyku Bozukluğu, Sleep Disorder, Melatonin, Ketamin, Ketamine.
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Keklicek, Ö. (2024). Rinoplasti cerrahisinde melatonin premedikasyonun ve subanestezik dozlarda ketamin uygulamasının postoperatif uyku kalitesi üzerine etkilerinin karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Anesteziyoloji ve Reanimasyuon Anabilim Dalı, Konya.
