Günübirlik anestezi uygulamalarımız ve gelişen komplikasyonlar
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ / AMAÇ: Günübirlik cerrahi operasyon süresinin kısa olduğu, operasyon esnasında kanama ve sıvı kaybının olmadığı ayrıca intraoperatif veya postoperatif cihaz gereksinimin olmadığı ve hastaların cerrahi sonrası aynı gün evine gönderilebildiği uygulamalardır. Bu çalışmada ameliyathanelerimizde gerçekleşen günübirlik cerrahi sonuçlarımızın sunulması hedeflenmiştir. GEREÇ / YÖNTEM: Ege Üniversitesi Tıp Fakültesi Etik Kurulu ve bilgilendirilmiş hasta onamı alındıktan sonra, günübirlik cerrahi geçiren 907 hasta prospektif gözlemsel olarak çalışmaya alındı. Günübirlik olmayan hastalar, acil hastalar, ameliyathane dışı anestezi uygulamaları ve anestezi ekibinin eşlik etmediği operasyonlar çalışma dışı bırakıldı. Hastalara yapılacak işleme göre genel anestezi, rejyonal anestezi veya sedo-analjezi uygulandı. Hastaların demografik verileri, operasyonun türü, anestezi ve cerrahi süresi, kullanılan anestezik ve analjezik ilaçlar, intraoperatif ve postoperatif komplikasyonları, hastanede yatış oranı kaydedildi. Komplikasyonlarla ilişkili risk faktörleri ile demogrofik veriler, intraoperatif ve postoperatif değişkenler arasında istatiksel anlamlılık araştırıldı. BULGULAR: Proje kapsamında Şubat 2020’de 2194 hasta değerlendirmeye alındı. Hastalardan 907’si (%41.3) kriterleri karşılamaktaydı. Göz hastalıkları (%67) en sık günübirlik işlem yapılan klinik iken; beyin cerrahisi (%3.8) ise en az idi. Hastaların %26.8’ini (243 hasta) pediyatrik hastalar oluşturmakta idi. Hastaların %52’si (472 hasta) ASA I grubunda idi. Çocuk hastalar genellikle ASA I grubunda iken, erişkin hastaların çoğunluğu ASA II grubunda idi (χ²: 82.68, p<0,001). En sık uygulanan anestezi türleri intratrakeal genel anestezi (%36.7), maske anestezisi (%18.7) ve laringeal maske anestezisi (%18.1) idi. İntraoperatif komplikasyon hastaların %2.9’da; postoperatif komplikasyon ise %1.9’da gelişti. En sık görülen komplikasyonlar hipertansiyon, laringospazm, hipoksi, hipotansiyon ve alerjik reaksiyonlardır. Operasyonun endoskopik yapılması ve bazal kalp hızı yükseklikleri komplikasyonları ile ilişkili saptanmıştır. Çeşitli nedenlerle hastaların %1.65’i (15 hasta) hastaneye yatırıldı. TARTIŞMA / SONUÇ: Tıbbi teknolojideki ve monitörizasyondaki gelişmeler günübirlik cerrahi uygulamalarında hızlı bir artışa neden olmuştur. Hızlı ve kısa etkili anesteziklerin, analjeziklerin ve nöromuskuler blokörlerin yanı sıra geliştirilmiş monitörizasyon yöntemlerinin kullanımı iyileşme sırasında anestezi komplikasyonlarını azaltacaktır. Operasyonların endoskopik uygulanması ve bazal kalp hızının yüksekliği komplikasyonlarla ilişkili iken, anestezi türü ile ilişkili saptanamadı.
INTRODUCTION / AIM: These are the applications where the duration of the outpatient surgery is short, there is no bleeding and fluid loss during the operation, there is no need for intraoperative or postoperative devices and the patients can be sent home on the same day after surgery. In this study, it is aimed to present our daily surgery results in our operating theatres. MATERIAL / METHOD: After obtaining the consent of Ege University Faculty of Medicine Ethics Committee and informed patients, 907 patients who had outpatient surgery were included in the prospective observational study. Non-day patients, emergency patients, non-operating room anesthesia applications and operations not accompanied by the anesthesia team were excluded from the study. General anesthesia, regional anesthesia or sedo-analgesia was applied to the patients according to the procedure to be performed. Demographic data of the patients, type of operation, duration of anesthesia and surgery, anesthetic and analgesic drugs used, intraoperative and postoperative complications, hospitalization rate were recorded. Statistical significance was investigated between risk factors associated with complications and demographics data, intraoperative and postoperative variables. RESULTS: Within the scope of the project, 2194 patients were evaluated in February 2020 and 907 (41.3%) of the patients met the criteria. Ophthalmology (67%) was the most frequent day-to-day clinic; neurosurgery (3.8%) was the least. Pediatric patients accounted for 26.8% (243 patients). The 52% of the patients (472 patients) were in the ASA I group. While pediatric patients were generally in the ASA I group, the majority of adult patients were in the ASA II group (χ²: 82.68, p˂0,001). The most common types of anesthesia were intratracheal general anesthesia (36.7%), mask anesthesia (18.7%) and laryngeal mask anesthesia (18.1%). Intraoperative complications and postoperative complications developed respectively in 2.9% of patients and in 1.9% of patients. The most common complications were hypertension, laryngospasm, hypoxia, hypotension and allergic reactions. It was found that the complications were associated with endoscopic operations and high basal heart rate. For various reasons, 1.65% of the patients (15 patients) were hospitalized. DISCUSSION / CONCLUSION: Advances in medical and monitoring technologies have led to a rapid increase in daily surgical practices. The use of fast and short-acting anesthetics, analgesics and neuromuscular blockers, as well as improved monitoring methods, will reduce anesthesia complications during recovery. While the endoscopic application of the operations and high basal heart rate were associated with complications, no anesthesia type was found.
INTRODUCTION / AIM: These are the applications where the duration of the outpatient surgery is short, there is no bleeding and fluid loss during the operation, there is no need for intraoperative or postoperative devices and the patients can be sent home on the same day after surgery. In this study, it is aimed to present our daily surgery results in our operating theatres. MATERIAL / METHOD: After obtaining the consent of Ege University Faculty of Medicine Ethics Committee and informed patients, 907 patients who had outpatient surgery were included in the prospective observational study. Non-day patients, emergency patients, non-operating room anesthesia applications and operations not accompanied by the anesthesia team were excluded from the study. General anesthesia, regional anesthesia or sedo-analgesia was applied to the patients according to the procedure to be performed. Demographic data of the patients, type of operation, duration of anesthesia and surgery, anesthetic and analgesic drugs used, intraoperative and postoperative complications, hospitalization rate were recorded. Statistical significance was investigated between risk factors associated with complications and demographics data, intraoperative and postoperative variables. RESULTS: Within the scope of the project, 2194 patients were evaluated in February 2020 and 907 (41.3%) of the patients met the criteria. Ophthalmology (67%) was the most frequent day-to-day clinic; neurosurgery (3.8%) was the least. Pediatric patients accounted for 26.8% (243 patients). The 52% of the patients (472 patients) were in the ASA I group. While pediatric patients were generally in the ASA I group, the majority of adult patients were in the ASA II group (χ²: 82.68, p˂0,001). The most common types of anesthesia were intratracheal general anesthesia (36.7%), mask anesthesia (18.7%) and laryngeal mask anesthesia (18.1%). Intraoperative complications and postoperative complications developed respectively in 2.9% of patients and in 1.9% of patients. The most common complications were hypertension, laryngospasm, hypoxia, hypotension and allergic reactions. It was found that the complications were associated with endoscopic operations and high basal heart rate. For various reasons, 1.65% of the patients (15 patients) were hospitalized. DISCUSSION / CONCLUSION: Advances in medical and monitoring technologies have led to a rapid increase in daily surgical practices. The use of fast and short-acting anesthetics, analgesics and neuromuscular blockers, as well as improved monitoring methods, will reduce anesthesia complications during recovery. While the endoscopic application of the operations and high basal heart rate were associated with complications, no anesthesia type was found.
Açıklama
Anahtar Kelimeler
Ayaktan Cerrahi İşlemler, İzlem, Ayaktan Hasta, Anestezi, Postoperatif Komplikasyonlar, Ambulatory Surgical Procedures, Monitoring, Outpatient, Anesthesia, Postoperative Complications.
