Akademik Veri Yönetim Sistemi
Yeni Tıp Dergisi, cilt.25, sa.4, ss.217-222, 2008 (Hakemli Dergi)
N2O, widespreadly used in anesthesia, increases space volumes because of its high rate of diffusion and it increases pressure in non-compliant tissues such as middle ear cavity. Increase in middle ear pressure is an undesirable condition because of its potential complications. The aim of this cross-sectional randomized study is to compare effects of N2O plus desflurane or sevoflurane and remifentanil plus desflurane or sevoflurane on middle ear pressure and postoperative nausea and vomiting. Patients in American Society of Anesthesiologists (ASA) group I-II aged between 5-18 years undergoing tonsillectomy or adenotonsillectomy were randomized into groups according to anesthesia we performed as desflurane plus N2O group (Group DN, n=15), sevoflurane plus N2O group (Group SN, n=15), desflurane plus remifentanil group (Group DR, n=15) and sevoflurane plus remifentanil group (Group SR, n=15). Mean arterial pressure (MAP), heart rate (HR) monitorization of cases and preoperative (T0), after intubation (T1), before extubation (T2), after extubation (T3), 30 minutes after extubation (T4) middle ear pressures (MEP) were measured. Finally, MEP values and postoperative nausea vomiting (PONV) frequencies among groups were compared. T0 measurements of MEP were not different between groups, but T1 measurements were higher in N2O used groups than remifentanil used groups. Similar rise in MEP was observed in remifentanil used groups parallel to prolonged anesthesia duration. No difference observed among groups with respect to side effects. There was MEP difference between two ears in 17 cases with nausea and vomiting. When left and right MEP values of 17 patients with nausea and vomiting at T3 were compared, the average of higher cases was 8.9±97.2 and it was -156.8±107.8 for lower cases. The difference was statistically significant (p<0.0001). In middle ear surgery, remifentanil plus sevoflurane or desflurane is a better alternative than N2O for brief surgical interventions. Major factor in PONV seems to be the pressure difference between right and left ear independent of the anesthetic agent used, although future studies on this subject are required.