gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Effects of fentanyl and S(+)-ketamine on gastrointestinal motility and catecholamine dosages in neurosurgical patients – A pilot study

Einfluss von Fentanyl und S(+)-Ketamin auf gastroinstinale Motilität und Katecholaminbedarf in der Langzeitanalgosedierung neurochirurgischer Patienten - Pilotstudie

Meeting Abstract

  • corresponding author Marc Schmittner - Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • S. Renn - Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • P. Vajkoczy - Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim
  • M. Quintel - Zentrum für Anästhesiologie, Rettungs- und Intensivmedizin, Universitätsklinikum Göttingen, Göttingen
  • E. Münch - Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 07.70

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0353.shtml

Veröffentlicht: 23. April 2004

© 2004 Schmittner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

In neurosurgical patients, narcotics are ususally administered to prevent secondary cerebral damage due to elevated intracranial pressure (ICP) and to provide conditions favouring the recovery of brain tissue. Intestinal atonia and a decrease in blood pressure affording the use of vasopressors, however represent complications often related to the type of anesthesia being used. The aim of the present study was to evaluate gastrointestinal motility and catecholamine consumption in neurosurgical patients undergoing two different protocols of anesthesia using fentanyl/methohexital, and S(+)-ketamine/methohexital.

Methods

Twenty-four patients (mean age 52±17 years) who sustained severe traumatic brain injury or aneurysmal subarachnoid hemorrhage received either fentanyl/methohexital or S(+)-ketamine/methohexital in a prospectively controlled randomized trial. In both groups, dosage of methohexital was 3mg/kgBW/h. Dosage of analgesia (fentanyl or S(+)-ketamine) was titrated to establish a comparable level of sedation, monitored by Bispectral-Index (BIS). ICP was treated according to the AANS guidelines. The dosage of norepinephrine was adapted to reach a cerebral perfuison pressure (CPP) of under 70 mmHg mmHg. BIS, ICP, CPP and norepinephrine dosage were recorded over 5 days. Indirect calorimetry was performed to determine the energetic requirements of each patient and enteral nutrition was started via a stomach tube following an increasing nutrition scheme. Metoclopramid, neostigmin and ceruletid were applied in a standardized fashion. In order to assess gastrointestinal motility, time intervals to full enteral nutrition and first defecation were recorded. Based on the results of this pilot study, sample size estimation was performed to evaluate the number of patients required to reach statistically significant differences.

Results

Patients, who underwent analgesia with S(+)-ketamine had a lower demand of norepinephrine compared with the fentanyl-group (3.6 ± 5.1 µg/kgBW/h vs. 12.8 ± 18.4 µg/kgBW/h). Sample size estimation revealed that 42 patients in each group would be required in order to demonstrate a significant difference regarding catecholamine consumption. In contrast, there was no difference between the two groups regarding the time period to achieve full enteral nutrition (85.3 ± 47.2 hrs vs. 94.4 ± 72.9 hrs) or time until first defecation (40.9 ± 22.9 hrs vs. 43.5 ± 46 hrs).

Conclusions

In patients receiving S(+)-ketamine, lower dosages of norepinephrine are needed to maintain an adequate CPP than in patients sedated with fentanyl. The influence of fentanyl and S(+)-ketamine on gastrointestinal motility is comparable.