Endoskopik Endonazal Transsfenoidal Hipofiz Cerrahisinde Farklı End Tidal CO2 Değerlerinin Hemodinami ve Cerrahiye Etkileri

Year 2023, Volume: 33 Issue: 1, 72 - 75, 28.02.2023

Nihal Gökbulut Özaslan , Filiz Banu Çetinkaya Ethemoğlu

https://doi.org/10.54005/geneltip.1215781

Abstract

Amaç: Endoskopik endonazal transsfenoidal hipofiz cerrahisinde farklı aralıklardaki end tidal CO2 (etCO2) değerlerinin hemodinamiye ve cerrahiye etkisini incelemeyi amaçladık.
Gereç ve Yöntem: Retrospektif olarak sellar rezeksiyon anındaki maksimum etCO2 değerlerine göre iki grup değerlendirildi. Grup 1:21hasta, etCO2 =25-37 mmHg ve Grup 2: 21 hasta ,etCO2=38-50 mmHg. Hastaların demografik özellikleri, anestezi indüksiyonu sonrası, sellar eksizyon anı ve ekstübasyon öncesi dönemlerde ortalama arter basıncı (OAB), nabız (KH), etCO2, pCO2 , total kanama miktarı, cerrahinin kolaylığı (iyi-orta-kötü) bilgisayar kayıtlarından, anestezi fişlerinden ve cerrahi raporlarından elde edilmiştir.
Bulgular:İki grup arasında demografik veriler, komplikasyon ve kanama açısından fark bulunmamıştır. Sellar eksizyon anındaki arteryal pCO2 arasında ilişki saptanmıştır. Grup1’de 9 hastada, Grup2’de ise 12 hastada cerrahi memnuniyet “iyi”olarak değerlendirilmiştir.
Sonuç: Yüksek etCO2 değerleri (38-50 mmHg) kitlenin cerrahi eksizyonunu kolaylaştırmış ve hemodinamiyi etkilememiştir. Cerrahi memnuniyeti artırmıştır. EtCO2 ‘yi normalden biraz daha yüksek tutmak bu vakalarda iyi bir seçim olabilir. İyi kurgulanmış prospektif çalışmalara ihtiyaç vardır.

Keywords

hipofiz cerrahisi, anestezi, etCO2, pCO2

The Effects of Different End Tidal CO2 Values on Hemodynamics and Surgery in Endoscopic Endonasal Transsphenoidal Pituitary Surgery

Abstract

Objective : We aimed to examine the effect of different intervals of end tidal CO2 ( etCO2 ) values on hemodynamics and surgery in endoscopic endonasal transsphenoidal pituitary surgery.
Material and Methods: Two groups were evaluated retrospectively according to the maximum etCO2 values at the time of sellar resection. Group 1: 21 patients, etCO 2 =25-37 mmHg and Group 2: 21 patients, etCO 2=38-50 mmHg. The demographic characteristics, mean arterial pressure (MAP), heart rate (HR), etCO2 , pCO2 at the time of anesthesia induction, sellar excision moment and pre-extubation periods , total amount of bleeding, ease of surgery (good-moderate-bad) obtained from computer records, anesthesia receipts and surgical reports.
Results: There was no difference between the two groups in terms of demographic data, complications or bleeding. A relationship was found between arterial pCO2 at the time of sellar excision. Surgical satisfaction was evaluated as "good" in 9 patients in Group 1 and 12 patients in Group 2.
Conclusion: High etCO 2 values (38-50 mmHg) facilitated surgical excision of the mass and did not affect hemodynamics. Surgery has increased satisfaction. Keeping EtCO2 slightly higher than normal may be a good choice in these cases. Well-designed prospective studies are needed.

Keywords

pituitary surgery, anesthesia, etCO2, pCO2

References

• Korula G, George SP, Rajshekhar V, Haran RP, Jeyaseelan L. Effect of controlled hypercapnia on cerebrospinal fluid pressure and operating conditions during transsphenoidal operations for pituitary macroadenoma. J Neurosurg Anesthesiol 2001;13(3): 255-9
• Baykal D, Özdamar D. Transsfenoidal hipofizektomilerde BİS monitörizasyonunun sevofluran tüketimine etkisi. Türk Anest Rean Der Dergisi 2011;39(5):257-264
• Garg SK. Permissive hypercapnia:Is there any upper limit? Indian J Crit Care 2014;18(9):612-614
• Danfeng Z, Jigang C, Zhenxing L.Clinical features and management of nonfunctioning giant pituitary adenomas causing hydrocephalus. Oncotarget 2018; 9:15409-15417
• Aghamohamodi D, Ahmadvand A, Salehpour F, et al. Effectiveness of lumbar drain versus hyperventilation to facilitate transsphenoidal pituitary (suprasellar) adenoma resection. Anesth Pain Med 2013;2(4):159–163
• Stewart T,Meade M.Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Clinical Trial N Engl J Med 1998;338(6):355-61
• Seung Ho Choi , Kyeong Tae Min, Jeong-Rim Lee et al. Determination of EC95 of remifentanil for smooth emergence from propofol anesthesia in patients undergoing transsphenoidal surgery. J Neurosurg Anesthesiol 2015; 27(2):160-6
• Young WL,Pile-Spellman.J Interventional neuroradiology.In:Al-bin MS, ed.Textbook of Neuroanesthesia: Neurosurgical and neuroscience perspective . New York, McGrawHill 1997; 807-843
• Julie Ryu, Gabriel Haddad. Clinical effectiveness and safety of permissive hypercapnia. Clin Perinatol 2012; 39: 603-612
• Michael D, Jason M. Carbon Dioxide Narcosis. StatPearls [Internet], 2022, October 2.
• Potkin R, Swenson E. Resuscitation from severe acut hypercapnia. Determinants of tolerence and survival. Chest 1992; 102:1742-5
• Petrucci N , Lacovelli W. Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev (2): 2004. Updated 2007.
• Price J, Sandbach DD, Ercole A, Wilson A, Barnard EBG. End-tidal and arterial carbon dioxide gradient in serious traumatic brain injury after prehospital emergency anaesthesia: a retrospective observational study. Emerg Med J. 2020 Nov;37(11):674-679