Jinekolojik laparoskopik operasyonlarda intraabdominal karbondioksit insüflasyonuna bağlı end-tidal karbondioksit değişiklikleri serebral oksijenizasyonu etkiliyor mu?
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Laparoskopik cerrahi son yıllarda; daha noninvaziv olduğu, daha iyi kozmetik sonuçlar doğurduğu, hastanede kalım süresini kısalttığı ve dolayısıyla medikal harcamaları düşürdüğü, daha az postoperatif komplikasyona ve postoperatif ağrıya neden olduğu için oldukça popüler bir cerrahi teknik haline gelmiştir. Günümüzde pek çok jinekolojik hastalığın tanı ve tedavisi için de laparoskopik teknik cerrahi uygulamalar ilk tercih olarak kullanılmaktadır. Laparoskopik teknikte cerrahi alanda yeterli görüntünün sağlanması ve trokarların yerleştirilmesi için pnömoperitoneum oluşturulması gerekmektedir. Pnömoperitoneum oluşumunda ise distansiyon sıklıkla karbondioksit (CO2) gazı ile sağlanmaktadır. Ancak CO2 peritondan hızla emilerek hiperkarbi ve asidoza neden olmaktadır. Yapılan çalışmalarda; karbondioksit insüflasyonunun hastalarda kardiyovasküler, solunumsal ve asit-baz dengesinde değişikliklere neden olabileceği ve bunların sonucunda serebral perfüzyon ve oksijenizasyon üzerine çeşitli değişiklikler görülebileceği saptanmıştır. Jinekolojik endikasyonlarla laparoskopik operasyona alınan toplam 43 hasta bu çalışmaya alındı. Operasyon süresince izlenen monitördeki end-tidal parsiyel karbondioksit (EtCO2) değerlerine göre hastalar 2 gruba ayrıldı. Grup 1 ılımlı hipokarbik, Grup 2 ise ılımlı hiperkarbik seyreden hasta grupları olarak kabul edildi. Bütün hastaların anestezi öncesi (T1), anestezi sonrası (T2), insüflasyonda (T3), sonrasında 20.dk (T4), 50.dk (T5), 80. Dk (T6), desüflasyondan sonra (T7), ekstübasyon sonrası (T8) hemodinamik verileri ve Near İnfra Red Spektroskopisi (NIRS) değerleri kaydedildi. Bütün hastalara ayrıca preoperatif 1 saat önce ve postoperatif 1. saatte standardize mini mental test (SMMT) uygulandı. Hastaların tamamında operasyon süresi ile birlikte EtCO2, parsiyel karbondioksit basıncı (PaCO2) ve NIRS değerlerinde artış saptanırken gruplar arasında anlamlı fark gözlenmedi. Bununla birlikte çalışmaya katılan sadece 1 hastada ekstübasyon sonrası bronkospazma bağlı olarak serebral desatürasyon saptandı. Sonuç olarak, intraoperatif EtCO2 değerlerinden bağımsız olarak hastalarda; laparoskopik cerrahinin getirdiği CO2 insüflasyonuna bağlı, zamanla ilişkili olarak NIRS değerlerinde artış gözlendi. Ayrıca hastaların postoperatif SMMT puanları preoperatif değerlerine göre yüksekti. Bu sonucun, CO2 gazının serebral damarlar üzerine yaptığı vazodilatasyonla ilişkili olduğunu düşünmekteyiz. Ancak bu sonuç klinik olarak önemli bir fark yaratmamıştır.
Laparoscopic surgery in recent years; A popular surgical procedure that requires less invasive intervention, leads to better cosmetic results, reduces hospitalization and therefore decreases medical expenditures, causes fewer postoperative complications and postoperative pain has become technically technical. Nowadays, laparoscopic surgery is used as the first choice for the diagnosis and treatment of many gynecological diseases. In laparoscopic surgery, Pneumoperitoneum should be created to ensure adequate image and placement of Trocaras. In the formation of pneumoperitoneum, distension is often provided with carbon dioxide (CO2). However, CO2 is rapidly absorbed from the peritoneal cause of hypercarbi and acidosis. In studies; It was determined that carbon dioxide insuflation could cause changes in cardiovascular, respiratory and acid-base balance, as a result of various changes in cerebral perfusion and oxygenation. A total of 43 patients received in the laparoscopic operation with gynecologic indications were enrolled in this study. The patients were divided into 2 groups according to the EtCO2 values on the monitored monitor during the operation. Group 1 was considered to be a moderate hypocarbic and group 2 was treated as patient groups with moderate hypercarbic. All patients were pre-anaesthesia (T1), after Anesthesia (T2), in insuflation (T3), after 20. minutes (T4), 50. minutes (T5), 80. minutes (T6), after the desufflation (T7), after the Extubation (T8) hemodynamic data and the values of the NIRS were recorded. All patients also preoperative 1 hour before and postoperative 1. Per hour SMMT applied. There was no significant difference between the groups while the duration of the operation was determined by the EtCO2, PaCO2 and NIRS values. However, in only 1 patient who participated in the study, cerebral desaturation was detected due to bronchospasm after extubation. Consequently, in patients independent of intraoperative EtCO2 values; due to the CO2 infertility of laparoscopic surgery, the increase in the values of the NIRS was observed in relation to time. In addition, postoperative SMMT scores of patients were higher than their course values. We think that this result is related to the vasodilation of carbondioxide gas on cerebral vessels. However, this result did not make a significant clinical difference.
Laparoscopic surgery in recent years; A popular surgical procedure that requires less invasive intervention, leads to better cosmetic results, reduces hospitalization and therefore decreases medical expenditures, causes fewer postoperative complications and postoperative pain has become technically technical. Nowadays, laparoscopic surgery is used as the first choice for the diagnosis and treatment of many gynecological diseases. In laparoscopic surgery, Pneumoperitoneum should be created to ensure adequate image and placement of Trocaras. In the formation of pneumoperitoneum, distension is often provided with carbon dioxide (CO2). However, CO2 is rapidly absorbed from the peritoneal cause of hypercarbi and acidosis. In studies; It was determined that carbon dioxide insuflation could cause changes in cardiovascular, respiratory and acid-base balance, as a result of various changes in cerebral perfusion and oxygenation. A total of 43 patients received in the laparoscopic operation with gynecologic indications were enrolled in this study. The patients were divided into 2 groups according to the EtCO2 values on the monitored monitor during the operation. Group 1 was considered to be a moderate hypocarbic and group 2 was treated as patient groups with moderate hypercarbic. All patients were pre-anaesthesia (T1), after Anesthesia (T2), in insuflation (T3), after 20. minutes (T4), 50. minutes (T5), 80. minutes (T6), after the desufflation (T7), after the Extubation (T8) hemodynamic data and the values of the NIRS were recorded. All patients also preoperative 1 hour before and postoperative 1. Per hour SMMT applied. There was no significant difference between the groups while the duration of the operation was determined by the EtCO2, PaCO2 and NIRS values. However, in only 1 patient who participated in the study, cerebral desaturation was detected due to bronchospasm after extubation. Consequently, in patients independent of intraoperative EtCO2 values; due to the CO2 infertility of laparoscopic surgery, the increase in the values of the NIRS was observed in relation to time. In addition, postoperative SMMT scores of patients were higher than their course values. We think that this result is related to the vasodilation of carbondioxide gas on cerebral vessels. However, this result did not make a significant clinical difference.
Açıklama
Anahtar Kelimeler
Near-Infrared Spektroskopi, Laparoskopi, Serebral Perfüzyon, Jinekolojik Anestezi, Mini Mental Durum Testi, Near-Infrared Spectroscopy, Laparoscopy, Cerebral Perfusion, Gynecologic Anesthesia, Mini Mental Status Examination
