دوره 36، شماره 505: هفته اول بهمن ماه 1397:1421-1427

مقایسه‌ی اثربخشی دو ترکیب دارویی کتوفول و فنوفول در ‌ایجاد آرام‌بخشی عمیق و بی‌دردی در بیماران تحت جراحی تعبیه و خروج کاتترپورت

حمیدرضا شتابی , بهزاد ناظم رعایا , امیر شفا , شهاب سرلک

DOI: 10.22122/jims.v36i505.10711

چکیده


مقدمه: کارگذاری و برداشت کاتتر پورت اغلب با بی‌حسی موضعی و آرام‌بخشی انجام می‌شود. با توجه به مدت زمان انجام اين جراحی، لازم است از داروها يا تركيبي از داروها استفاده نمود که دارای شروع اثر و بازگشت هوشیاری سریع باشد و از آرام‌بخشی و ضد دردی کافی برخوردار باشد و بتواند عملکرد قلبی- عروقی و تنفسی، فراموشی و بی‌تحرکی مناسبی را ایجاد کنند.

روش‌ها: 68 بیمار کاندیدای تعبیه یا خروج کاتتر به روش تخصیص تصادفی در دو گروه 34 نفره توزیع و وارد مطالعه شدند و در دو گروه دریافت کننده‌ی پرپووفول- کتامین (کتوفول) و پروپوفول- فنتانیل (فنوفول) تقسیم شدند. بیهوشی در گروه کتوفول با تزریق 1 میلی‌گرم/کیلوگرم پروپوفول و 5/0 میلی‌گرم/کیلوگرم کتامین و در گروه فنوفول با تزریق 1 میلی‌گرم/کیلوگرم پروپوفول و 5/1 میکروگرم/کیلوگرم فنتانیل صورت گرفت. در حین انجام فرایند، ارزیابی عمق آرام‌بخشی با معیار Ramsay و شدت درد بر اساس معیار دیداری سنجش درد (Visual analog scale یا VAS) صورت گرفت. بیماران از نظر تغییرات همودینامیک قبل، حین و پس از جراحی پایش شدند.

یافته‌ها: سطح آرام‌بخشی (94/0 = P) و درد (58/0 = P) و همچنین، تغییرات همودینامیک (05/0 < P برای همه) در گروه کتوفول بهتر، مدت زمان جراحی (04/0 = P) و ریکاوری (12/0 = P) در این گروه بیشتر و میزان حرکت حین عمل (54/0 = P) و نیاز به دز مجدد دارو (01/0 = P) در این گروه کمتر بود.

نتیجه‌گیری: تجویز کتوفول در بیماران تحت شیمی درمانی به لحاظ آرام‌بخشی و بی‌دردی توصیه می‌گردد.

Background:Placement and removal of port catheter is often done by local anesthesia and sedation. Due to
the duration of this surgery, it is necessary to use drugs or drugs combination. These drugs should have two distinct features, firstly, the onset of the effect and the return of alertness should be fast, and secondary it should have adequate sedation and analgesia, and can provide proper cardiovascular and respiratory function, amnesia, and inactivity.

Methods:Using convenience sampling method, and considering inclusion and exclusion criteria, 68 patients candidate for placement and removal of port catheter were entered randomly into two groups receiving propofol-ketamine (ketofol) and propofol-fentanyl (fenofol). Anesthetics induction was done in ketofol group with propofol (1 mg/kg) and ketamine (0.5 mg/kg), and in fenofol group with propofol (1 mg/kg) plus fentanyl
(1.5 μg/kg). Then, the procedure was performed by the surgeon. During the procedure, depth of sedation was assessed using Ramsay scale, as well as pain intensity using visual analogue scale (VAS). Patients were monitored for hemodynamic changes before, during, and after the surgery.

Findings:Sedation (P = 0.94) and analgesia (P = 0.58), as well as hemodynamic changes (P > 0.05 for all) were reported better in ketofol group. The duration of surgery (P = 0.04) and recovery (P = 0.12) in the ketofol group was upper, but the amount of motion during operation (P = 0.54) and the need for a re-dose of drug (P = 0.01) was lower in this group.

Conclusion: The drug combination of propofol-ketamine is suggested to be used in patients under chemotherapy

واژگان کلیدی


کاتتر پورت؛ فنتانیل؛ کتامین؛ پروپوفول؛ آرام‌بخشی؛ بی‌دردی

تمام متن:

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مراجع


Carlo JT, Lamont JP, McCarty TM, Livingston S, Kuhn JA. A prospective randomized trial demonstrating valved implantable ports have fewer complications and lower overall cost than nonvalved implantable ports. Am J Surg 2004; 188(6): 722-7.

Krupski G, Froschle GW, Weh FJ, Schlosser GA. Central venous access devices in treatment of patients with malignant tumors: Venous port, central venous catheter and Hickman catheter. Cost-benefit analysis based on a critical review of the literature, personal experiences with 135 port implantations and patient attitude. Chirurg 1995; 66(3): 202-7. [In German].

Biffi R, Corrado F, de BF, de LF, Scarpa D, Testori A, et al. Long-term, totally implantable central venous access ports connected to a Groshong catheter for chemotherapy of solid tumours: experience from 178 cases using a single type of device. Eur J Cancer 1997; 33(8): 1190-4.

Niederhuber JE, Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 1982; 92(4): 706-12.

Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012; (3): CD004084.

Arora S. Combining ketamine and propofol (ketofol) for emergency department procedural sedation and analgesia: A review. West J Emerg Med 2008; 9(1): 20-3.

Singh Bajwa SJ, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: Propofol-ketamine and propofol-fentanyl. Saudi J Anaesth 2010; 4(2): 72-9.

Benito MC, Gonzalez-Zarco LM, Navia J. Total intravenous anesthesia in general surgery. Rev Esp Anestesiol Reanim 1994; 41(5): 292-5. [In Spanish].

Singh R, Ghazanwy M, Vajifdar H. A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation. Saudi J Anaesth 2013; 7(1): 24-8.

Miner JR, Burton JH. Clinical practice advisory: Emergency department procedural sedation with propofol. Ann Emerg Med 2007; 50(2): 182-7, 187.

Nazemoroaya B, Sayedmoalemi S, Emami SA. Comparison of cardiovascular effects of propofol versus sodium thiopental anesthesia in children undergoing electroconvulsive therapy (ECT). J Isfahan Med Sch 2017; 35(427): 463-9. [In Persian].

Marx CM, Stein J, Tyler MK, Nieder ML, Shurin SB, Blumer JL. Ketamine-midazolam versus meperidine-midazolam for painful procedures in pediatric oncology patients. J Clin Oncol 1997; 15(1): 94-102.

Parker RI, Mahan RA, Giugliano D, Parker MM. Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children. Pediatrics 1997; 99(3): 427-31.

Nazemroaya B, Shafa A, Khizab M. Comparison of the effect of ketamine and sodium thiopental on blood pressure and heart rate during electroconvulsive therapy in patients admitted to the ward of psychiatry; a double-blind randomized clinical trial. J Isfahan Med Sch 2016; 34(402): 1197-204. [In Persian].

Aouad MT, Moussa AR, Dagher CM, Muwakkit SA, Jabbour-Khoury SI, Zbeidy RA, et al. Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand 2008; 52(4): 561-5.

Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: propofol dosing and adverse events. Pediatr Crit Care Med 2008; 9(6): 616-22.

Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. J Clin Anesth 2005; 17(3): 187-90.

Kb N, Cherian A, Balachander H, Kumar CY. Comparison of propofol and ketamine versus propofol and fentanyl for puerperal sterilization, a randomized clinical trial. J Clin Diagn Res 2014; 8(5): GC01-GC04.

Bryson EO, Sejpal D. Anesthesia in remote locations: Radiology and beyond, international anesthesiology clinics: gastroenterology: endoscopy, colonoscopy, and ERCP. Int Anesthesiol Clin 2009; 47(2): 69-80.

Cote GA, Hovis RM, Ansstas MA, Waldbaum L, Azar RR, Early DS, et al. Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol 2010; 8(2): 137-42.

Harrison NL, Simmonds MA. Quantitative studies on some antagonists of N-methyl D-aspartate in slices of rat cerebral cortex. Br J Pharmacol 1985; 84(2): 381-91.

Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet 2006; 367(9512): 766-80.

Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med 1998; 31(6): 688-97.

Warncke T, Stubhaug A, Jorum E. Ketamine, an NMDA receptor antagonist, suppresses spatial and temporal properties of burn-induced secondary hyperalgesia in man: A double-blind, cross-over comparison with morphine and placebo. Pain 1997; 72(1-2): 99-106.

Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 2(5920): 656-9.

Reips UD, Funke F. Interval-level measurement with visual analogue scales in Internet-based research: VAS Generator. Behav Res Methods 2008; 40(3): 699-704.

Naghibi K, Moradi-Farsani D, Hirmandpour A, Forutan A. Comparison of the effect of dexamethasone, acetaminophen, and normal saline on the prevention of headache in patients under elective cesarean section. J Isfahan Med Sch 2017; 35(424): 345-50. [In Persian].

Nazemroaya B, Mohammadi AH, Najafian J, Moradi-Farsani D. Effect of preemptive midazolam on post-electroconvulsive-therapy (ect) headache, myalgia, and nausea and vomiting. J Isfahan Med Sch 2017; 35(417): 26-31. [In Persian].

Rahimi M, Montazeri K, Kamali L, Moradi M, Naghibi Kh. Comparing the effects of magnesium sulfate and nitroglycerin on the control of hypertension during and after cataract surgery under local anesthesia and intravenous sedation. J Isfahan Med Sch 2016; 33(361): 2076-83. [In Persian].

Naghibi K, Kashefi P, Abtahi AM. The comparison of preemptive effects of propofol, remifentanil and ketamine on post-operative pain scores and analgesic requirements in elective lower abdominal surgery under general anesthesia: A randomized, double-blinded study. J Res Med Sci 2013; 18(7): 567-72.

Nazemroaya B, Majedi MA, Shetabi H, Salmani S. Comparison of propofol and ketamine combination (ketofol) and propofol and fentanyl combination (fenofol) on quality of sedation and analgesia in the lumpectomy: A randomized clinical trial. Adv Biomed Res 2018; 7: 134.




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