Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Kraniotomide Analjezi Nosisepsiyon İndeks Kılavuzluğunda Anestezi Yönetimi
Analgesia Nociception Index-Guided Anesthesia Management in Craniotomy
Gözde İNANa, Zerrin ÖZKÖSE ŞATIRLARa
aGazi Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2021;19(1):8-16
doi: 10.5336/anesthe.2020-80390
Article Language: TR
ÖZET
Amaç: Analjezi nosisepsiyon indeksi (ANİ), cerrahi stimulusla oluşan kalp ritminde sempato-vagal denge değişkenliğinden türetilir ve genel anestezi sırasında analjezi/nosisepsiyon dengesini yansıtır. Kraniotomi geçiren hastalarda, intraoperatif opioidlerin titrasyonu ve noksius uyaranlara yanıtın değerlendirilmesi önem kazanmaktadır. Bu retrospektif çalışma ile hedef kontrollü total intravenöz anestezi altında skalp blok ile elektif kraniotomi geçiren hastalarda intraoperatif dönemde ANİ monitörizasyonunun etkinliğini değerlendirmek ve hemodinamik parametreler ve bispektral indeks (BİS) ile ilişkisini araştırmak amaçlanmıştır. Gereç ve Yöntemler: Etik kurul onamının alınmasını takiben, anestezi kayıtları taranarak Ocak 2019 ve Mayıs 2019 elektif supratentoryal kraniotomi yapılan hastaların verileri retrospektif olarak incelendi. Hastalar veri taraması sonucunda, ANİ ile monitörize edilenler (grup ANİ) ve standart anestezi takibi uygulananlar (grup kontrol) olmak üzere 2 gruba ayrıldı. Hemodinamik veriler, BİS, ANİ ile takip edilen hastalarda ANİ değerleri, anestezi ve cerrahi süreleri, ekstübasyon zamanı ve tüketilen remifentanil tarandı. Bulgular: Demografik veriler, intraoperatif veriler, anestezi ve cerrahi süreleri, ortalama BİS değerleri, ekstübasyon zamanı her 2 grup için benzerdi. İntraoperatif dönemde remifentanil tüketiminde 2 grup arasında fark yoktu (grup kontrol=1,875±422 μg, grup ANİ=1,786±238 μg, p=0,32). Kalp hızı ve ortalama arter basıncı ile ANİ arasında anlamlı ters korelasyon bulundu (p<0,0001). BİS ile ANİ arasında istatistiksel olarak anlamlı bir korelasyon bulunmadı (p=0,758). Sonuç: Skalp blok ile elektif kraniotomi geçiren hastalarda intraoperatif ANİ onitörizasyonu rehberliğinde remifentanil uygulanması objektif intraoperatif analjezi yönetimi sunmuştur.

Anahtar Kelimeler: Anestezi; analjezi; nosisepsiyon; kraniotomi
ABSTRACT
Objective: The analgesia nociception index (ANI) is derived from the sympatho-vagal balance variability in heart hythm induced by surgical stimulus and reflects the analgesia/nociception balance during general anesthesia. Intraoperative titration of opioids and evaluation of the response to noxius stimuli in patients undergoing craniotomy gain importance. In this retrospective study, it was aimed to evaluate the effectiveness of ANI in patients who underwent elective craniotomy with scalp block under target-controlled total intravenous anesthesia and to investigate its relationship with hemodynamic parameters and bispectral index (BIS). Material and Methods: Following approval of the ethics committee, anesthesia records of patients who underwent elective supratentorial craniotomy from January 2019-May 2019 were retrospectively reviewed. As a result of data scanning, the patients were divided into two groups as those monitored with ANI (group ANI) and those undergoing Standard anesthesia follow-up (group control). Hemodynamic data, BIS, ANI (group ANI), duration of anesthesia and surgery, extubation time and consumed remifentanil were scanned. Results: Demographic data, intraoperative data, duration of anesthesia and surgery, mean BIS values, extubation time were similar for both groups. There was no difference between the two groups in the consumption of remifentanil (group control=1.875±422 μg, group ANI=1.786±238 μg, p=0.32). A significant inverse correlation was found between heart rate and mean arterial pressure and ANI (p<0.0001). There was no statistically significant correlation between the BIS and ANI (p=0.758). Conclusion: In patients who underwent elective craniotomy with scalp block, administration of remifentanil under the guidance of intraoperative ANI monitoring provided objective intraoperative analgesia management.

Keywords: Anesthesia; analgesia; nociception; craniotomy
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