Effects of dexmedetomydin-remifentanil or propofol-remifentaniline postoperative cognitive functions in hysteroscopies

EFFECTS OF DEXMEDETOMYDIN-REMIFENTANIL OR PROPOFOL-REMIFENTANILINE POSTOPERATIVE COGNITIVE FUNCTIONS IN HYSTEROSCOPIES Aim: In our study, hysteroscopic interventions, which are the gold standard in the diagnosis and treatment of endometrial pathologies, We aimed to compare dexmedetomidine-remifentanil and propofol-remifentanil combinations in terms of postoperative cognitive functions, hemodynamics, sedation, analgesia, compilation, surgeon and patient satisfaction. Method: This study was carried out prospectively after the approval of the Ethics Committee of Van Yüzüncü Yıl University. A total of 70 patients were included in the study in ASA I-II, 2 groups of 35 people with ages of 18-65 years. On the operation day, stantard routine monitorisation was performed in the supine position of the patient taken to the surgical table before the procedure. The cognitive functions of Ramsey sedation score (RSS) groups before and after sedation were assessed by Minimal mental status test (MMDT). Patients were randomly divided into two groups, PR and DR. After administration of propofol 1 mg / kg bolus to Group PR, 25-100 μg / kg / min infusion dose was applied. Dexmedetomidine was administered to Group DR at a dose of 0.4-0.7 μg / kg / h after a 10-min bolus of 1 μg / kg. Both groups received remifentanil 0.25 μg / kg bolus followed by a 0.04 μg / kg / min infusion dose. All cases were treated with nasal cannula at 4-6 L min -1 O2 throughout the procedure. Patients were followed according to the Ramsay Sedation Scale (RSS) as RSS ≥4. In the case of RSS <4, additional propofol was added dexmedetomidine according to the group. Vital parameters were recorded as a control value before the administration of the drugs in the operation table of the cases and then recorded every 5 minutes during the pre- and post-challenge periods after the loading. The compilation score was measured by Modifiye aldrete score (MAS). Facial pain scale (CAM) was used in the evaluation of pain. Findings: Demographic characteristics of the cases in both groups were evaluated. There was no statistically significant difference between groups in terms of age, height, weight, ASA risk classification and hysteroscopy durations (p>0.05). Minimal mental status test (MMDT) values in group DR did not change preop and postop; There was statistically significant decrease in Group PR according to Postop and Preop (p<0,05). Peripheral oxygen saturation (SpO2) values were evaluated in both groups. In the group DR, only the 5th minute post-induction value was statistically significant higher than the Group PR (p<0.05). In Group DR, values of HRR at 1, 5, 10 and 15 minutes after induction and at 5, 10 and 15 minutes after hysteroscopy were statistically significantly lower than Group PR (p<0.05). Statistical significance was low (p <0.05) in group DR when 5, 10 and 15 minutes after hysteroscopy were evaluated in terms of SBP, DBP and OCD. In group DR, modifiye aldrete score was higher than Group PR in terms of scoring, and facial pain scale scores were lower (p<0.05). Surgeon, Patient and Anesthesiologist satisfaction were found to be statistically significantly higher after treatment according to Group PR in Group DR (p<0,05). Desaturation and respiratory depression were not observed in Group DR, but Group PR was statistically significantly higher (p<0,05). Result: Dexmedetomidine-Remifentanil combination for sedation in hysteroscopes; We believe that better postoperative cognitive function, recovery conditions, analgesia, patient and surgeon satisfaction are better than propofol-remifentanil combination. This combination caused low blood pressure at various time periods, but did not require treatment at all. Keywords: Hysteroscopy, sedation, dexmedetomidine, propofol, cognitive functions