مقایسه‌ی اثر آرام‌بخشی دکسمدتومیدین- فنتانیل و میدازولام- فنتانیل در جراحی کاتاراکت با روش Phacoemulsification

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه بیهوشی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

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

چکیده

مقدمه: جراحی کاتاراکت، یکی از متداول‌ترین اعمال جراحی در سراسر دنیا می‌باشد. داروهای متعددی برای کاهش اضطراب و آرام‌بخشی طی این جراحی استفاده می‌شود. میدازولام از پرکاردبردترین داروی بنزودیازپین جهت آرام‌بخشی طی این جراحی است. به تازگی، داروی دکسمدتومیدین نیز برای این نوع جراحی طرفداران خود را پیدا کرده است. هدف از انجام این مطالعه، مقایسه‌ی تأثیر آرام‌بخشی ترکیب دکسمدتومیدین- فنتانیل و میدازولام- فنتانیل در بیماران کاندیدای جراحی کاتاراکت به روش Phacoemulsification بود.روش‌ها: این مطالعه کارآزمایی بالینی تصادفی شده‌ی دو سو کور، بر روی 71 بیمار کاندیدای جراحی ‌کاتاراکت انجام گرفت. بیماران به دو گروه دریافت کننده‌ی دکسمدتومیدین- فنتانیل و میدازولام- فنتانیل تقسیم شدند و اطلاعات دموگرافیک، همودینامیک، درصد اشباع اکسیژن شریانی، کیفیت آرام‌بخشی و رضایت بیمار و جراح در زمان‌های مشخص ثبت و با استفاده از نرم‌افزار SPSS واکاوی گردید.یافته‌ها: بین دو گروه اختلاف معنی‌داری بر اساس سن (940/0 = P)، جنس (630/0 = P) و شاخص توده‌ی بدنی (390/0 = P) مشاهده نشد. همچنین، اختلاف معنی‌داری در میانگین نمره‌ی آرام‌بخشی (970/0 = P) و رضایت‌ جراح (600/0 = P) و بیمار (850/0 = P) وجود نداشت. آزمون Repeated measures ANOVA تفاوت معنی‌داری در ضربان قلب (002/0 = P) و درصد اشباع اکسیژن (002/0 = P) طی جراحی نشان‌ داد. بروز عوارض حین جراحی شامل افت درصد اشباع اکسیژن، افت فشار خون و برادی‌کاردی بین دو گروه تفاوت معنی‌داری نداشت (289/0 = P). مدت زمان ریکاوری در گروه دکسمدتومیدین- فنتانیل بیشتر بود (001/0 > P).نتیجه‌گیری: ترکیب دکسمدتومیدین- فنتانیل می‌تواند آرام‌بخشی و رضایت جراح و بیمار را معادل ترکیب میدازولام- فنتانیل برای بیماران تحت جراحی کاتاراکت با همودینامیک پایدار و بدون افت اکسیژن ایجاد کند؛ هر چند مدت زمان ریکاوری طولانی می‌گردد.

کلیدواژه‌ها

عنوان مقاله [English]

A Comparison of Sedative Effect of Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl during Cataract Surgery with Phacoemulsification Technique

نویسندگان [English]

  • Leili Adinehmehr 1
  • Hamidreza Shetabi 1
  • Mahsa Motieian 2
1 Assistant Professor, Department of Anesthesiology, School of Medicine, 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: Cataract surgery is one of the common surgeries worldwide. There are various medications for reducing anxiety and inducing sedation induction during this surgery. Midazolam is a benzodiazepine that is widely used for sedation in this surgery. Recently dexmedetomidine has its own adherents for sedation in cataract surgery, and is more preferred than midazolam in recent reports. This study aimed to compare the sedation effects of dexmedetomidine-fentanyl and midazolam-fentanyl in patients who were candidates for cataract surgery with phacoemulsification method.Methods: This double-blinded randomized clinical trial study was performed on 71 patients undergoing cataract surgery. Patients were divided into two groups receiving fentanyl-dexmedetomidine and fentanyl-midazolam. Demographic and hemodynamic data, arterial oxygen saturation, sedation quality, as well as patient’s and surgeon’s satisfaction were recorded at specific times and analyzed using SPSS software.Findings: There was no significant difference between the two groups based on age (P = 0.940), sex (P = 0.630), and body mass index (P = 0.390). Besides, there was no significant difference in terms of the mean score of sedation (P = 0.970) and the degree of patient’s (P = 0.600) and surgeon’s (P = 0.850) satisfaction. Repeated measures ANOVA showed significant differences between the groups in heart rate (P = 0.002) and oxygen saturation (P = 0.002) during the surgery. The prevalence of complications during surgery, including a decrease in oxygen saturation, hypotension, and bradycardia, was not significantly different between the two groups, too (P = 0.289). Recovery duration was significantly longer in dexmedetomidine-fentanyl group (P < 0.001).Conclusion: In cataract surgery, combination of dexmedetomidine-fentanyl produced sedation, as well as patient’s and surgeon’s satisfaction comparable to midazolam-fentanyl combination, with hemodynamic stability and no respiratory depression; however, it was accompanied by delayed recovery room discharge.

کلیدواژه‌ها [English]

  • Dexmedetomidine
  • Midazolam
  • Cataract
  • Phacoemulsification

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مجله دانشکده پزشکی اصفهان
دوره 36، شماره 494 - شماره پیاپی 494
مهر و آبان 1397
صفحه 1009-1017

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  • تاریخ دریافت: 20 تیر 1397
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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