두경부 재건술 후 중환자실 환자 관리에 있어 미다졸람 기반의 진정 프로토콜과레미펜타닐 기반의 진정 프로토콜의 비교 = Comparison of Two Sedation Protocols for Postoperative Intensive Care Unit Care after Head and Neck Reconstructive Surgery: Midazolam/Morphine versus Remifentanil Sedation

다국어 초록 (Multilingual Abstract)

Background and Objectives In head and neck reconstructive surgery, the stability of vital signs is important for patient recovery and flap outcome. We aimed to determine the better sedation protocol by comparing two protocols, namaely, midazolam/morphine (MM)-based and remifentanil (RF)-based sedation protocols, in the immediate postoperative settings of head and neck reconstructive surgery.
Subjects and Method We retrospectively reviewed the medical data of patients who underwent reconstructive surgery after the ablation of head and neck cancer involving MM sedation (n=34) or RF sedation (n=28). Parameters related to vital signs, flap outcomes, occurrence of delirium, length of stay and nursing burden were compared between the groups.
Results The length of stay at the intensive care unit and flap outcomes were similar in the two groups. However, blood pressure as measured by frequency of variation was more stable in the RF group than in the MM group. In addition, the number of medical calls from the attending nurse due to the fluctuation of vital signs was less in the RF group than in the MM group.
Conclusion RF-based sedation for the postoperative intensive care unit care after head and neck reconstructive surgery is more effective in cases where vital signs are less stable. This type of sedation may decrease the nursing burden for these patients.
Korean J Otorhinolaryngol-Head Neck Surg 2014;57(3):172-7

참고문헌 (Reference)

1 최의제, "하인두암종에서 전후두인두절제술 후 유리피판 재건술의 비교 연구" 대한이비인후과학회 56 (56): 569-573, 2013

2 이진우, "진행된 하인두암 환자의 수술적 절제 후 재건시 이용된 위간치술의 유용성" 대한이비인후과학회 52 (52): 57-61, 2009

3 안순현, "유리피판을 이용한 두경부 재건의 초기 경험" 대한이비인후과학회 51 (51): 350-354, 2008

4 Sessler CN, "The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients" 166 (166): 1338-1344, 2002

5 McLeod AD, "Successful use of remifentanil for major head and neck surgery in a heart-lung transplant recipient" 93 (93): 473-474, 2004

6 Muellejans B, "Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open-label, pharmacoeconomic trial" 10 (10): R91-, 2006

7 Karabinis A, "Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial ISRCTN50308308" 8 (8): R268-R280, 2004

8 Bauer C, "Remifentanil-propofol versus fentanyl-midazolam combinations for intracranial surgery: influence of anaesthesia technique and intensive sedation on ventilation times and duration of stay in the ICU" 56 (56): 128-132, 2007

9 Radtke FM, "Remifentanil reduces the incidence of post-operative delirium" 38 (38): 1225-1232, 2010

10 Pandharipande P, "Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients" 65 (65): 34-41, 2008

11 Glass PS, "Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (GI87084B)" 77 (77): 1031-1040, 1993

12 Godden DR, "Need for intensive care after operations for head and neck cancer surgery" 37 (37): 502-505, 1999

13 Ely EW, "Monitoring sedation status over time in ICU patients:reliability and validity of the Richmond Agitation-Sedation Scale (RASS)" 289 (289): 2983-2991, 2003

14 Spiegel JH, "Microvascular flap reconstruction by otolaryngologists: prevalence, postoperative care, and monitoring techniques" 117 (117): 485-490, 2007

15 Wong CH, "Microsurgical free flap in head and neck reconstruction" 32 (32): 1236-1245, 2010

16 Gommers D, "Medications for analgesia and sedation in the intensive care unit: an overview" 12 (12): S3-, 2008

17 Allak A, "Immediate postoperative extubation in patients undergoing free tissue transfer" 121 (121): 763-768, 2011

18 Radtke FM, "How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study" 38 (38): 1974-81, 2012

19 Sebel PS, "Histamine concentrations and hemodynamic responses after remifentanil" 80 (80): 990-993, 1995

20 Kruse AL, "Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review" 30 (30): 242-248, 2010

21 Marsh M, "Early postoperative care for free flap head & neck reconstructive surgery--a national survey of practice" 47 (47): 182-185, 2009

22 Girard TD, "Delirium in the intensive care unit" 12 (12): S3-, 2008

23 Breen D, "Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial ISRCTN47583497" 9 (9): R200-R210, 2005

24 Shafer A, "Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens" 26 (26): 947-956, 1998