SİGARA İÇEN VE İÇMEYENLERDE GENEL ANESTEZİ SIRASINDA KULLANILAN TAZE GAZ AKIMININ KARBOKSİHEMOGLOBİN DÜZEYLERİNE ETKİSİ

Yıl 2023, Cilt: 4 Sayı: 1, 29 - 33, 29.03.2023

Ebru Özen , Alkin Colak , Sevtap Hekimoglu Sahin , Cavidan Arar

https://doi.org/10.48176/esmj.2023.100

Öz

Giriş: Sigara ve değişik şekillerde kullanılan tütün, sağlığa olan zararının bilinmesine karşın tüm dünyada oldukça yaygın bir şekilde kullanılmaktadır. Günümüzde birçok hastalık ile sigara kullanımı
arasındaki ilişki gösterilmiştir. Postoperatif dönemde en önemli mortalite ve morbidite nedeni pulmoner komplikasyonlardır ve sigara kullanımı postoperatif pulmoner komplikasyonların gelişimi için en önemli risk faktörlerinden birisidir. Bu çalışmada elektif olarak operasyona alınan sigara içen ve içmeyen hastalardaki farklı taze gaz akımlarının (4 ve 6 lt/dk) karboksihemoglobin düzeylerine olan etkisinin araştırılması amaçlandı.
Yöntemler: Genel anestezi altında elektif cerrahi planlanan Amerikan Anesteziyoloji Derneği risk skoru I-II risk grubunda, yaşları 18-80 arasında değişen 100 hasta çalışmaya dahil edildi. Operasyon öncesi olgular öncelikle, sigara içenler (Grup A, n=50) ve sigara içmeyenler (Grup B, n=50) şeklinde iki gruba ayrıldı. Tüm olguların indüksiyon öncesi, indüksiyon sonrası, entübasyon sonrası, intraoperatif her 30 dakikada bir, operasyon sonu, ekstübasyon sonrası, postoperatif 30. ve 60. dakikalarda kalp tepe atımı, sistolik arter basıncı (mmHg), diyastolik arter basıncı (mmHg), SpO2, end-tidal karbondioksit ve karboksihemoglobin değerleri ölçülerek kayıt edildi.
Bulgular: Çalışmaya dahil edilen olgular arasında cinsiyet, yaş, kullanılan sigara miktarı, operasyon süresi ve ekstübasyon zamanı açısından fark yoktu. Farklı taze gaz akım hızlarına göre (n=25)
karşılaştırıldıklarında operasyon öncesinde, sırasında ve sonrasında farklı zamanlarda ölçülen karboksihemoglobin değerleri açısından gruplar arasında istatistiksel anlamlı farklılık saptanmadı.
Sonuç: Bu durum, elektif operasyon planlanan hastalarda preoperatif değerlendirme sonrasında operasyona kadar geçen sürede sigaraya ara verilmesi nedeniyle bu süre içerisinde karboksihemoglobinin kandan elimine edilmesine bağlanmaktadır.

Anahtar Kelimeler

Sigara, taze gaz akımı, karboksihemoglobin., General anesthesia, smoking, carboxyhemoglobin

Destekleyen Kurum

Trakya Üniversitesi Bilimsel Araştırma Projeleri Birimi

Proje Numarası

TÜBAP- 2009/53

Teşekkür

Projeye vermiş oldukları destek nedeni ile Trakya Üniversitesi Bilimsel Araştırma Projeleri Birimi'ne teşekkür ederiz.

THE EFFECTS OF FRESH GAS FLOW ON CARBOXYHEMOGLOBIN LEVELS IN SMOKERS AND NON-SMOKERS DURING GENERAL ANESTHESIA

Öz

Introduction: Cigarettes and tobacco, which are used in different ways, are widely used all over the world, despite the known harm to health. Today, the relationship between many diseases and smoking has been shown. Pulmonary complications are the most important cause of mortality and morbidity in the postoperative period, and smoking is one of the most important risk factors for the development of postoperative pulmonary complications. In this study, we aimed to investigate the effect of different fresh gas flows (4 and 6 lt/min) on carboxyhemoglobin levels in smokers and non-smokers who were operated on electively.
Methods: A total of 100 patients, aged between 18-80, in the American Society of Anesthesiology risk score I-II risk group, who were scheduled for elective surgery under general anesthesia, were included in the study. Preoperatively, cases were divided into two groups smokers (n = 50) and non-smokers (n = 50). Pre-induction, post-induction, postintubation, intraoperatively every 30 minutes, post-operative, postextubation, postoperative 30th and 60th minutes, peak heart rate, systolic arterial pressure (mmHg), diastolic arterial pressure (mmHg), SpO2, End-tidal carbon dioxide, and carboxyhemoglobin values were measured and recorded.
Results: There was no difference between the cases included in the study in terms of gender, age, amount of cigarette smoked, operation time, and extubation time. When compared according to different fresh gas flow rates (n = 25), no statistically significant difference was found between the groups in terms of carboxyhemoglobin values measured at different times before, during, and after the operation.
Conclusion: This situation is attributed to the elimination of carboxyhemoglobin from the blood during this period, due to the cessation of smoking in patients scheduled for elective surgery after
the preoperative evaluation until the operation.

Anahtar Kelimeler

General anesthesia, smoking, carboxyhemoglobin

Proje Numarası

TÜBAP- 2009/53

Kaynakça

• Weinstock B, Niki H. Carbon monoxide balance in nature. Science 1972;176:290-2.
• Tran TT, Martin P, Ly H, Balfe D, Mosenifar Z. Carboxyhemoglobin and its correlation to disease severity in cirrhotics. J Clin Gastroenterol 2007;41:211-5.
• West JB. Respiratory Physiology -The essentials, 5th Ed. Baltimore, Williams & Williams; 1995.
• López-Herce J, Borrego R, Bustinza A, Carrillo A. Elevated carboxyhemoglobin associated with sodium nitroprusside treatment. Intensive Care Med 2005;31:1235-8.
• Uko GP, Gbadebo JA, Banjoko SO. Carboxyhaemoglobin levels in some Lagos dwellers--a pilot study. West Afr J Med 1998;17:202-5.
• Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002;359:114-7.
• Pearce AC, Jones RM. Smoking and anesthesia: preoperative abstinence and perioperative morbidity. Anesthesiology 1984;61:576-84.
• Wald N, Howard S, Smith PG, Bailey A. Use of carboxyhaemoglobin levels to predict the development of diseases associated with cigarette smoking. Thorax 1975;30:133-40.
• Takeda R, Tanaka A, Maeda T, et al. Perioperative changes in carbonylhemoglobin and methemoglobin during abdominal surgery: alteration in endogenous generation of carbon monoxide. J Gastroenterol Hepatol 2002;17:535-41.
• Puente-Maestu L, Bahonza N, Pérez MC, Ruiz de Oña JM, Rodriguez Hermosa JL, Tatay E. Relación entre la exposición al humo del tabaco y las concentraciones de carboxihemoglobina y hemoglobina [Relationship between tobacco smoke exposure and the concentrations of carboxyhemoglobin and hemoglobin]. Arch Bronconeumol 1998;34:339-43.
• Erskine RJ, Murphy PJ, Langton JA. Sensitivity of upper airway reflexes in cigarette smokers: effect of abstinence. Br J Anaesth 1994;73:298-302.
• Jeffrey CC, Kunsman J, Cullen DJ, Brewster DC. A prospective evaluation of cardiac risk index. Anesthesiology 1983;58:462-4.
• Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest 1998;113:883-9.
• Hasdai D, Garratt KN, Grill DE, Lerman A, Holmes DR Jr. Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization. N Engl J Med 1997;336:755-61.
• Moon RE, Meyer AF, Scott DI, Fox E, Millington DS, Norwood DL. Intraoperative carbon monoxide toxicity. Anesthesiology 1990;73:A1089.
• Moon RE, Ingram C, Brunner EA, Meyer AF. Spontaneous generation of carbon monoxide within anesthetic circuits. Anesthesiology 1991;75:A873.
• Lentz RE. CO poisoning during anesthesia poses puzzles. APSF Newsletter 1994;9:13-4.
• Kayhan Z. Klinik anestezi. Istanbul, Logos Yayincilik; 2004.
• Morgan GE, Mikhail MS, Murray MJ. Klinik Anesteziyoloji (3rd edition). Ankara, Güneş Kitabevi; 2004.
• Baum J.A. Düşük akımlı anestezi, minimal akımlı ve kapalı sistemle anestezide kuram ve uygulama. İstanbul, Nobel Tip Kitapevleri; 2002.
• Mazoit JX, Sandouk P, Scherrmann JM, Roche A. Extrahepatic metabolism of morphine occurs in humans. Clin Pharmacol Ther 1990;48:613-8.
• Boer F, Bovill JG, Burm AG, Mooren RA. Uptake of sufentanil, alfentanil and morphine in the lungs of patients about to undergo coronary artery surgery. Br J Anaesth 1992;68:370-5.
• Merrell WJ, Gordon L, Wood AJ, Shay S, Jackson EK, Wood M. The effect of halothane on morphine disposition: relative contributions of the liver and kidney to morphine glucuronidation in the dog. Anesthesiology 1990;72:308-14.
• Fang ZX, Eger EI 2nd, Laster MJ, Chortkoff BS, Kandel L, Ionescu P. Carbon monoxide production from degradation of desflurane, enflurane, isoflurane, halothane, and sevoflurane by soda lime and Baralyme. Anesth Analg 1995;80:1187-93.
• Berry PD, Sessler DI, Larson MD. Severe carbon monoxide poisoning during desflurane anesthesia. Anesthesiology 1999;90:613-6.
• Frink EJ Jr, Nogami WM, Morgan SE, Salmon RC. High carboxyhemoglobin concentrations occur in swine during desflurane anesthesia in the presence of partially dried carbon dioxide absorbents. Anesthesiology 1997;87:308-16.
• Strum DP, Eger EI 2nd. The degradation, absorption, and solubility of volatile anesthetics in soda lime depend on water content. Anesth Analg 1994;78:340-8.
• Davies MW, Potter FA. Carbon monoxide, soda lime and volatile agents. Anaesthesia 1996;51:90.
• Fan SZ, Lin YW, Chang WS, Tang CS. An evaluation of the contributions by fresh gas flow rate, carbon dioxide concentration and desflurane partial pressure to carbon monoxide concentration during low fresh gas flows to a circle anaesthetic breathing system. Eur J Anaesthesiol 2008;25:620-6.
• Woehlck HJ, Dunning M 3rd, Raza T, Ruiz F, Bolla B, Zink W. Physical factors affecting the production of carbon monoxide from anesthetic breakdown. Anesthesiology 2001;94:453-6.