Meme cerrahisinde vücut sıcaklığının ekstübasyon, derlenme zamanı ve postoperatif titreme üzerine etkileri
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Perioperatif hipotermi, genellikle pediyatrik ve geriyatrik hasta grubunda görüldüğü için diğer yaş gruplarında sıklıkla göz ardı edilen bir durumdur. İntraoperatif ve postoperatif dönemde birçok soruna neden olan hipotermi gelişiminde, hastaların yaşlarının yanı sıra aslında uygulanan operasyonun tipi ve süresi dahil olmak üzere pek çok faktör etkilidir. Meme cerrahisi gibi gövdenin açık olduğu bazı cerrahi girişimlerde hipotermi insidansı her yaş grubunda yüksek olabilir. Bu çalışmada, meme cerrahisi uygulanan 65 yaş altı erişkin hastalarda intraoperatif vücut ısısı değişikliklerinin; ekstübasyon ve derlenme zamanı ile postoperatif bulantı-kusma, titreme ve ağrı üzerine olan etkilerinin araştırılması amaçlandı. Gereç ve yöntem: Ege Üniversitesi genel cerrahi ile plastik ve rekonstruktif cerrahi ameliyathanelerinde 2019-2020 yılları arasında elektif meme cerrahisi uygulanan toplam 120 hasta çalışmaya dahil edildi. Hastaların demografik verileri, uygulanan operasyonlar, anestezi ve cerrahi süreleri, vücut ısıları, uygulanan toplam sıvı miktarı, kas gevşetici ve opioid dozları kaydedildi. Operasyon sonunda ise hastaların ekstübasyon ve Modifiye Aldrete Skoru ≥9 olma zamanları, bulantı-kusma, titreme ve ağrı skorları kaydedildi. Bulgular: Çalışmaya dahil edilen toplam 120 hastadan 7'si, olgu rapor formundaki eksik bilgiler ve operasyon sırasında ısı ölçümünde yaşanan teknik sorunlar nedeniyle çalışmadan çıkarıldı ve 113 hastanın verileri istatistiksel olarak değerlendirildi. Meme cerrahisi geçiren erişkin hastalarda hipotermi insidansı %65,4 olarak bulundu. Anestezi ve cerrahi sürenin, intraoperatif ölçülen en düşük vücut sıcaklığının, verilen total sıvı miktarı ve toplam remifentanil dozlarının hastaların ekstübasyon zamanı ve Aldrete skorlarını etkilediği görüldü (p<0,05). Anestezi ve cerrahi süre uzadıkça hastalara verilen total sıvı miktarı, remifentanil ve kas gevşetici dozlarında artış olduğu görüldü. İntraoperatif dönemde ölçülen en düşük vücut ısısının hastaların kilosu (p=0,02) ve vücut kitle indeksi (p=0,004) ile pozitif bir ilişki gösterdiği, anestezi ve cerrahi süre (p=0,01), toplam sıvı miktarı (p=0,015) ve kas gevşetici dozu (p=0,004) arasında ise negatif bir ilişki olduğu saptandı. Bazal vücut sıcaklığı ile en düşük vücut sıcaklığı arasındaki farka göre incelendiğinde; vücut sıcaklık değişimi ≥1,5°C olan hastaların ekstübasyon ve derlenme süresinin, vücut sıcaklık değişimi <0,5°C olan gruba göre anlamlı şekilde uzun olduğu görülmüştür (ekstübasyon için fark:320 sn, p<0,0001 ve derlenme için fark 497 sn, p<0,0001). Vücut sıcaklık değişimlerinin bulantı kusma (p=0,37) ve ağrı skorlarına (p=0,88) etkisi olmadığı ancak titreme skorlarını (p<0.0001) etkilediği saptandı. Sonuç: Meme cerrahisi geçiren 65 yaş altı erişkin hastalarda hipotermi insidansının yüksek olduğu, özellikle intraoperatif dönemde vücut ısısının 1˚C'den fazla düşmesinin hastaların ekstübasyon ve derlenme sürelerini uzattığı, postoperatif titreme skorlarını arttırdığı sonucuna varılmıştır.
Aim: Perioperative hypothermia is a condition that is often overlooked in other age groups because it is usually seen in pediatric and geriatric patients. In the development of hypothermia, which causes many problems in the intraoperative and postoperative period, many factors are effective, including the age of the patients, as well as the type and duration of the operation performed. The incidence of hypothermia may be high in all age groups in some surgical procedures where the trunk is completely open, such as breast surgery. In this study, it was aimed to investigate the effects of intraoperative body temperature changes on extubation and recovery time, and postoperative nausea-vomiting, tremor, and pain in adult patients under the age of 65 who underwent breast surgery. Materials and Methods: A total of 120 patients who underwent elective breast surgery in Ege University general surgery, plastic and reconstructive surgery operating rooms between 2019-2020 were included in the study. Demographic data of the patients, operations performed, duration of anesthesia and surgery, body temperatures, total amount of fluid administered, muscle relaxant and opioid doses were recorded. At the end of the operation, extubation and Modified Aldrete Score ≥9, nausea-vomiting, tremor, and pain scores were recorded. Results: 7 out of 120 patients included in the study were excluded from the study due to missing information in the case report form and technical problems in temperature measurement during the operation and the data of 113 patients were evaluated statistically. The incidence of hypothermia in adult patients undergoing breast surgery was found to be 65.4%. It was observed that the duration of anesthesia and surgery, the lowest body temperature measured intraoperatively, the total amount of fluid administered, and the total dose of remifentanil affected the extubation time and Aldrete scores of the patients (p<0.05). It was observed that the total amount of fluid given to the patients, the doses of remifentanil and muscle relaxants increased as the duration of anesthesia and surgery was prolonged. The lowest body temperature measured during the intraoperative period showed a positive correlation with the patients' weight (p=0.02) and body mass index (p=0.004), anesthesia and surgery time (p=0.01), total fluid amount (p=0.015) and muscle relaxant dose (p=0.004) was found to be a negative relationship. When examined according to the difference between basal body temperature and the lowest body temperature; ıt was observed that the extubation and recovery time of patients with body temperature change ≥1.5°C were significantly longer than the group with body temperature change <0.5°C. (difference for extubation: 320 sec, p<0.0001 and for recovery 497 sec, p<0.0001). It was determined that body temperature changes had no effect on nausea and vomiting (p=0.37) and pain scores (p=0.88) but affected tremor scores (p<0.0001). Conclusion: It has been concluded that the incidence of hypothermia is high in adult patients under the age of 65 who have undergone breast surgery, and that a decrease in body temperature of more than 1˚C, especially in the intraoperative period, prolongs the extubation and recovery times of the patients, and increases the postoperative shivering scores.
Aim: Perioperative hypothermia is a condition that is often overlooked in other age groups because it is usually seen in pediatric and geriatric patients. In the development of hypothermia, which causes many problems in the intraoperative and postoperative period, many factors are effective, including the age of the patients, as well as the type and duration of the operation performed. The incidence of hypothermia may be high in all age groups in some surgical procedures where the trunk is completely open, such as breast surgery. In this study, it was aimed to investigate the effects of intraoperative body temperature changes on extubation and recovery time, and postoperative nausea-vomiting, tremor, and pain in adult patients under the age of 65 who underwent breast surgery. Materials and Methods: A total of 120 patients who underwent elective breast surgery in Ege University general surgery, plastic and reconstructive surgery operating rooms between 2019-2020 were included in the study. Demographic data of the patients, operations performed, duration of anesthesia and surgery, body temperatures, total amount of fluid administered, muscle relaxant and opioid doses were recorded. At the end of the operation, extubation and Modified Aldrete Score ≥9, nausea-vomiting, tremor, and pain scores were recorded. Results: 7 out of 120 patients included in the study were excluded from the study due to missing information in the case report form and technical problems in temperature measurement during the operation and the data of 113 patients were evaluated statistically. The incidence of hypothermia in adult patients undergoing breast surgery was found to be 65.4%. It was observed that the duration of anesthesia and surgery, the lowest body temperature measured intraoperatively, the total amount of fluid administered, and the total dose of remifentanil affected the extubation time and Aldrete scores of the patients (p<0.05). It was observed that the total amount of fluid given to the patients, the doses of remifentanil and muscle relaxants increased as the duration of anesthesia and surgery was prolonged. The lowest body temperature measured during the intraoperative period showed a positive correlation with the patients' weight (p=0.02) and body mass index (p=0.004), anesthesia and surgery time (p=0.01), total fluid amount (p=0.015) and muscle relaxant dose (p=0.004) was found to be a negative relationship. When examined according to the difference between basal body temperature and the lowest body temperature; ıt was observed that the extubation and recovery time of patients with body temperature change ≥1.5°C were significantly longer than the group with body temperature change <0.5°C. (difference for extubation: 320 sec, p<0.0001 and for recovery 497 sec, p<0.0001). It was determined that body temperature changes had no effect on nausea and vomiting (p=0.37) and pain scores (p=0.88) but affected tremor scores (p<0.0001). Conclusion: It has been concluded that the incidence of hypothermia is high in adult patients under the age of 65 who have undergone breast surgery, and that a decrease in body temperature of more than 1˚C, especially in the intraoperative period, prolongs the extubation and recovery times of the patients, and increases the postoperative shivering scores.
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