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dc.contributor.advisorPamuk, Almıla Gülsün
dc.contributor.advisorAkça, Başak
dc.contributor.authorHalis, Adem
dc.date.accessioned2020-06-09T07:50:07Z
dc.date.issued2020
dc.date.submitted2020
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dc.identifier.urihttp://hdl.handle.net/11655/22319
dc.description.abstractHalis A. Evaluation Of The Effects Of Different Infusion Doses Of Remifentanil On Postoperative Shivering. Hacettepe University School of Medicine, Department of Anesthesiology and Reanimation, Residency Thesis. Ankara 2020. Introduction: Postoperative shivering is a common anesthetic complication occurring mainly after general anesthesia just like pain and PONV. Postoperative shivering usually occurs as a type of thermoregulatory response toward hypothermia, but postoperative shivering may occur even when the body temperature is within normal temperature limits due to pain, uninhibited spinal reflexes, decreased sympathetic activity, respiratory alkalosis, age, sex, drug choice and duration of surgery. Exact mechanism for postoperative shivering is not understood yet. Remifentanil is a µ receptor agonist which is an ultra-short acting opioid that contributes to rapid recovery after anesthesia. Remifentanil is used mainly as an analgesic adjuvant to inhalation anesthetics. In literature postoperative shivering of remifentanil has been reported to increase according to increase in infusion dose. Our aim in this study is to compare the effects of different doses of remifentanil infusion on postoperative shivering. Material/Methods: After obtaining ethics committee approval and written informed consent from the patients, 80 ASA 1-2 patients scheduled for mastectomy and thyroidectomy between October-December 2019 were enrolled in the study. Hemodynamic variables, intraoperative temperature values and anesthetic management of the patients during the surgery and PACU stay were recorded. BSAS, VAS, MAS scores of the patients were also recorded. 37 patients were found to receive low dose (0.05-0.1 mcg/kg/min) remifentanil infusion and 43 patients were found to receive high dose (0.15-0.2 mcg/kg/min) remifentanil infusion. Results: Demographic variables, medical history of the patients and intraoperative body temperatures and their changes, visual analog scores at different time points were similar. Extubation time and MAS at PACU were different between groups. BSAS scores at 0 and 10.minutes were also statistically different. There was no statistically significant difference between patients with different genders, ages and BMIs. Conclusion: Thyroid and breast surgery patients anesthetized by inhalational anesthetics in combination with remifentanil infusion postoperative shivering was found to be higher in high dose group when compared to low dose. It should be kept in mind that a frequently used adjuvant remifentanil can result in shivering especially in high doses and this shivering should be treated with non/pharmacologic methods. Keywords: postoperative shivering, remifentanil, BSAStr_TR
dc.language.isoturtr_TR
dc.publisherTıp Fakültesitr_TR
dc.rightsinfo:eu-repo/semantics/openAccesstr_TR
dc.subjectpostoperatif titremetr_TR
dc.subject.lcshR/W - Tıptr_TR
dc.titleRemifentanilin Farklı İnfüzyon Dozlarının Postoperatif Titreme Üzerine Etkilerinin Karşılaştırılmasıtr_TR
dc.typeinfo:eu-repo/semantics/doctoralThesistr_TR
dc.description.ozetHalis A. Remifentanilin farklı infüzyon dozlarının postoperatif titreme üzerine etkilerinin karşılaştırılması. Hacettepe Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Uzmanlık Tezi. Ankara 2020. Giriş-Amaç: Anestezi sonrası titreme, genellikle genel anestezi sonrası erken dönemde gözlenen; ağrı, bulantı ve kusma ile beraber hastaları en çok rahatsız eden komplikasyonlardan biridir. Termoregülatuar sistemin hipotermiye cevabı olup, vücut sıcaklığı normalken dahi gelişebilir. Titremenin etiyolojisi yeterince anlaşılamamıştır. Soğuk kaynaklı termoregülatuar titreme belirgin bir neden olsa da; ağrı, inhibe olmamış spinal refleksler, azalmış sempatik aktivite, solunumsal alkaloz, yaş, cinsiyet, anestezi indüksiyonu ve idamesi için ilaç seçimi, ameliyat süresi gibi birçok faktörden etkilenir. Remifentanil, bir μ opioid reseptör agonistidir. Etki başlangıç ve sonlanma süreleri öngörülebilir olup, hızlı derlenme sağlayan kısa etkili bir opioiddir. İnhalasyon anestezikleri ile idamede adjuvan olarak kullanımı önerilmektedir. Bazı çalışmalarda remifentanil kullanımı ile postoperatif titreme insidansının arttığı gösterilmiştir. Bu araştırmada, remifentanilin farklı infüzyon dozları kullanılan hastaların postoperatif titreme açısından karşılaştırılması amaçlanmıştır. Gereç-Yöntem: Etik kurul onayı alındıktan sonra Ekim-Aralık 2019 tarihleri arasında genel anestezi altında tiroidektomi ve mastektomi geçirecek ASA 1-2 hastalar çalışmaya dahil edildi ve derlenme ünitesinde değerlendirildi. Hastaların intraoperatif hemodinamik verilerine intraoperatif sıcaklık ölçümlerine ve anestezi yönetimine anestezi formundan ulaşıldı. Derlenme ünitesinde de hastalara BSAS, VAS, MAS skorları değerlendirildi ve hemodinamik verileri kaydedildi. Toplamda 37 hastaya düşük doz (0.05-0.1 mcg/kg/dk) grubuna (Grup L), 43 hastaya ise yüksek doz (0.15-0.2 mcg/kg/dk) grubuna (Grup H) uyacak dozda remifentanil infüzyonu uygulanmıştır. Bulgular: Her iki grup için demografik veriler, medikal özellikler, kullanılan ilaçlar, vücut sıcaklığı ve ameliyathane odasından çıkıştaki ortalama vücut sıcaklık değerleri, farklı zamanlarda ortalama VAS skorları açısından istatistiksel olarak anlamlı bir farklılığa rastlanmamıştır. Remifentanil kesilmesinden itibaren ekstübasyon süresi ve derlenme ünitesinde farklı zamanlardaki MAS skorları gruplar arasında anlamlı olarak farklıdır. 0 ve 10.dakikada ölçülen BSAS skorları gruplar arasında farklıdır. Titreme görülen ve titreme görülmeyen hastalar arasında ise cinsiyet, yaş ve BMI açısından istatistiksel olarak anlamlı fark yoktur. Sonuç: Çalışmamızda, remifentanil infüzyonunun, inhalasyon anestezisine eklendiği genel anestezi uygulaması ile tiroidektomi ve meme cerrahisi geçiren hastalardan, ‘yüksek’ doz remifentanil almış olanlarda postoperatif titreme sıklığının, ‘düşük’ doz alanlardan daha fazla olduğu gözlenmiştir. Remifentanil gibi çok sık kullanılan bir adjuvan ilaçla sıklıkla ilişkilendirilen postoperatif titremenin özellikle yüksek doz infüzyon kullanılan hastalarda sıklıkla ortaya çıkabileceği unutulmamalı ve non/farmakolojik yöntemlerle tedavi edilmelidir. Anahtar kelimeler : postoperatif titreme, remifentanil, BSAStr_TR
dc.contributor.departmentAnesteziyoloji ve Reanimasyontr_TR
dc.embargo.terms6 aytr_TR
dc.embargo.lift2020-12-12T07:50:07Z
dc.fundingDiğertr_TR


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