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  • Primerjava učinkov remifentanila in fentanila na obtočila med uvodom v anestezijo za premostitev venčnih arterij : magistrsko delo
    Mekiš, Dušan
    During induction of anesthesia the anesthesiologist has to insert the orotracheal tube by means of direct laryngoscopy. This is a painful procedure during which stress hormones can be released, which ... cause an increased blood pressure and heart rate. The response of the circulatory system to direct laryngoscopy and orotracheal intubation can cause myocardial ischemia and myocardial infarction. The classical anesthesiologic technique is general anesthesia with a large dose of fentanyl which successfully blocks the stress response of the organism, but on the other hand causes a prolonged postoperative respiratory depression. Respiratory depression averts the use the techique of fast track heart surgery, so smaller doses of fentanyl are recommended in modern anesthesia for heart surgery. Because of the fast elimination of remifentanyl in the plasma we can alter the concentration of remifentanyl in plasma by altering the speed of infusion. This enables us to adjust the depth of analgesia to the phase of the operation and succesfully block the stress response of the organism followed by a quick awakening of thepatient with a quick transition to spontaneous breathing, which enables us to practice fast track heart surgery. In our study we compared the effects of fentanyl/remifentanyl on the circulatory system during induction of anesthesia in patients with ischemic heart disease, which undergoing elective aortocoronary bypass surgery. Our hypothesis stated that, compared to fentanyl, we can reach a greater stability of the circulatory system and reduce the need for fenylefrin or nitroglycerin for regulation of the blood pressure during the induction of anesthesia for heart surgery by altering the constant dose of remifentanyl. We studied 54 patients undergoing elective aortocoronary bypass surgery. Included in this study were patients younger than 75 years with a score of 2-3 of the NYHA classification and whose ejection fraction of the left ventricle was more than 40%. For induction of anesthesia the patients received propofol in form of an intravenous infusion with a dosage of 6 mg/kg/h and a dosage of 0.1 mg/kg of body weight of pancuronium, i.v.. The patients were randomly devided in two groups. The first group received remifentanyl 0.5 micro g/kg of body weight per minute for analgesia in form of continuous infusion (remifentanil group), while the second group received fentanyl 5 micro g per kg of body weight i.v. (fentanyl group). Five minutes after induction of anesthesia patients were orotrachealy intubated and artificaly ventilated with 50% mixture of air and oxygen. After the orotracheal intubation the dosage of remifentanyl was decreased to 0.3 micro g/kg/min in the respective group. We invasively and continuously measured the blood pressure, the heart rate and the central venous pressure for 10 minutes before anesthesia, during the induction of anesthesia and 30 minutes after the orotracheal intubation. The need for phenylephrine and nytroglycerin was also registered during these period. The incidence of increased mean arterial pressure during induction of anesthesia for coronary artery bypass grafting was higher in the fentanyl group. The patients in the fentanyl group more often needed an additional dose of fentanyl and statistically significantly more often nitroglycerine for regulation of the mean arterial pressure than the patients in the remyfentanil group. The incidence of decreased mean arterial pressure was equal in both groups. There were no cases of tachyarryhthmia or bradyarrhythmia in any of the groups. The difference in use of phenylephrine for regulation of the mean arterial pressure and heart rate during induction of anesthesia for coronary artery bypass grafting was not statistically significant between the two groups. After induction of anesthesia the mean arterial pressure and heart rate decreased statistically significantly in both groups compared to baseline values. After direct laryngoscopy and orotracheal intubation the mean arterialpressure and heart rate increased statistically significantly in the fentanyl group compared to the remyfentanil group. Our study has shown that during induction of anesthesia for coronary artery bypass surgery, intravenous anesthesia with propofol-remifentanyl blocks the stress response of the organism more effectively and also assures a greater haemodynamic stability than anesthesia with propofol-fentanyl.
    Type of material - master's thesis ; adult, serious
    Publication and manufacture - Ljubljana : [D. Mekiš], 2002
    Language - slovenian
    COBISS.SI-ID - 1015615

Library/institution City Acronym For loan Other holdings
MF, Central Medical Library, Ljubljana Ljubljana CMK outside loan 1 cop.
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