부산대학교 도서관

Introduction In patients undergoing septorhinoplasty, anesthesia and postoperative airway managementcan be challenging, especially during extubation period, related to upper airway obstruction and difficulty in mask ventilation due to nasal packing [...]
Objectives: In patients undergoing septorhinoplasty, anesthesia and management of postoperative care may be challenging, especially at extubation, due to nasal packing. Maintaining a patent airway is a critical issue in these patients. In this study, extubation characteristics of sugammadex in the absence of neuromuscular monitorization were evaluated. Materials and Methods: In this randomized, prospective trial, 90 patients who underwent septorhinoplasty were allocated to groups to reversal with either neostigmine or sugammadex, with or without neuromuscular monitorization guidance for extubation. The induction and maintenance were standardized for all groups and groups were differed according to the reversal agent and presence of neuromuscular monitorization. The extubation conditions were recorded. Extubation time and time spent in postanesthesia care unit were also recorded.Adverse events such as throat pain, cough, straining, or laryngospasm were recorded in the operating room and until discharge from the post anesthesia care unit. Nasal bleeding and change of packing were recorded. Results: The mean extubation time (time from the administration of reversal agent to extubation) and post anesthesia care unit stay time [Group 1: 20.5 [+ or -] 4.1 minute (min), Group 2: 21.3 [+ or -] 7.3 min, Group 3: 12 12.2 [+ or -] 2.9 min, Group 4: 12.7 [+ or -] 2.5 min] (p=0.001) were significantly shorter in the sugammadex groups than in the neostigmine groups. Number of patients in the sugammadex groups required less mask ventilation compared to the neostigmine groups, regardless of the neuromuscular monitorization. Conclusion: Sugammadex may provide favorable extubation conditions than neostigmine regardless of objective neuromuscular monitorization. Key Words: Extubation, Neostigmine, Sugammadex Amac: Septorinoplasti uygulanan hastalarda, anestezi ve postoperatif bakim yonetimi, ozellikle de ekstubasyonda nazal tampon nedeniyle zor olabilir. Bu hastalarda patent hava yolunun saglanmasi kritik bir konudur. Bu calismada, noromuskuler monitorizasyon yoklugunda, sugammadeksin ekstubasyon karakteristikleri degerlendirildi. Gerec ve Yontem: Bu randomize, prospektif calismada, septorinoplasti yapilan 90 hasta, ekstubasyon icin noromuskuler monitorizasyon rehberliginde veya olmaksizin, neostigmin veya sugammadeks ile geri dondurme icin gruplara ayrildi. Induksiyon ve idame, tum gruplar icin standardizeydi ve gruplar geri dondurucu ajan ve noromuskuler monitorizasyon varligina gore farklilik gosterdi. Ekstubasyon kosullari kaydedildi. Ekstubasyon suresi ve anestezi sonrasi bakim unitesinde gecirilen sure de kaydedildi. Bogaz agrisi, oksuruk, ikinma veya laringospazm gibi istenmeyen olaylar ameliyathanede ve anestezi sonrasi bakim unitesinden taburcu edilene kadar kaydedildi. Burun kanamasi ve tampon degisikligi kaydedildi. Bulgular: Ortalama ekstubasyon suresi (reversal ajan uygulamasindan ekstubasyona kadar gecen sure) ve anestezi sonrasi bakim unitesinde kalis suresi (Grup 1: 20,5 [+ or -] 4,1 dakika (dk), Grup 2: 21,3 [+ or -] 7,3 dk, Grup 3: 12 12,2 [+ or -] 2,9 dk, Grup 4: 12,7 [+ or -] 2,5 dakika) (p=0,001) sugammadeks gruplarinda, neostigmin gruplarindan anlamli olarak daha kisaydi. Noromuskuler monitorizasyondan bagimsiz olarak, sugammadeks gruplarinda neostigmin gruplarina kiyasla daha az hastaya maske ventilasyonu gerekti. Sonuc: Sugammadeks, objektif noromuskuler monitorizasyondan bagimsiz olarak, neostigminden daha uygun ekstubasyon kosullari saglayabilir. Anahtar Kelimeler: Ekstubasyon, Neostigmine, Sugammadeks