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

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه بیهوشی، دانشکده‌ی پزشکی و مرکز تحقیقات بیهوشی ومراقبت‌های ویژه، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشجوی پزشکی، کمیته‌ی تحقیقات دانشجویی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: کارگذاری و برداشت کاتتر پورت اغلب با بی‌حسی موضعی و آرام‌بخشی انجام می‌شود. با توجه به مدت زمان انجام این جراحی، لازم است از داروها یا ترکیبی 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

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of the Efficacy of Two-Drug Combination, Ketofol and Fenofol, on Sedation and Analgesia in Patients under the Surgery of Port Catheter Placement and Removal

نویسندگان [English]

  • Hamidreza Shetabi 1
  • Behzad Nazemroaya 1
  • Amir Shafa 1
  • Shahab Sarlak 2
1 Assistant Professor, Department of Anesthesiology, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

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.

کلیدواژه‌ها [English]

  • Port catheters
  • Propofol
  • Ketamine
  • Fentanyl
  • Sedation
  • Analgesia

مراجع

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مجله دانشکده پزشکی اصفهان
دوره 36، شماره 505 - شماره پیاپی 505
بهمن و اسفند 1397
صفحه 1421-1427

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سابقه مقاله

  • تاریخ دریافت: 05 شهریور 1397
  • تاریخ بازنگری: 01 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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