THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES

Yıl 2023, , 89 - 95, 03.01.2023

Gül Kesimal Leyla Kazancıoğlu , Hizir Kazdal , Şule Batçık , Tolga Koyuncu

https://doi.org/10.18229/kocatepetip.1072254

Öz

OBJECTIVE: Intraoperative high fresh gas flow may cause Inadvertent perioperative hypothermia (IPH). For this reason, low and minimal flow anesthesia methods that improve the anesthesia climate are applied. We aimed to investigate the effects of minimal, low and high flow anesthesia on body temperature and tissue oxygenation in patients undergoing elective nasal surgery.
MATERIAL AND METHODS: Prospective randomized controlled study included 92 patients aged 18-60 years, ASA1-2 operation time 1-4 hours, scheduled for elective nasal surgery under hypotensive anesthesia. The patients were divided into Group 1 (0.5Lmin-1), Group 2 (1Lmin-1) and Group 3 (2 Lmin-1). Demographic and operative data of the patients, preoperative waiting room temperature, intraoperative operating room temperature, intraoperative body temperature, anesthesia breathing circuit humidity and temperature, tissue oxygen saturation, 0th, 15th, 30th, 60th, 90th, 120th, 150thmin and postoperative shivering, Aldrete score, room temperature and body temperatures in the recovery unit were recorded.
RESULTS: Perioperative hypothermia developed in all patients (p=0.001). Tympanic temperatures were similar in all three groups (p>0.05). In the subgroup comparison, it was found that the tissue oxygen saturation (StO2) 60 th min value of Group1 was higher than Group 2 (p=0.046). It was found statistically significant that the StO2 90 th min value of Group1 was higher than that of Group 2 and 3 (p=0.013, p=0.013). It was statistically significant that the StO2 120th min value of Group1 was higher than Group 3 (p=0.008).In Group1, postoperativeAldrete score was found to be significantly higher than the other two groups(p=0.002, p=0.002). A correlation was found between operating room temperature, postoperative recovery room temperature, and body temperature(r=.446, p<0.05;r=.531, p<0.01).
CONCLUSIONS: Inadvertent perioperative hypothermia developed in all patients who underwent elective nasal surgery with hypotensive anesthesia in minimal, low and high flow anesthesia applications. It was observed that body temperatures, humidity and the temperature of the anesthesia period were similar in all groups. Tissue oxygen saturation was higher in the minimal flow anesthesia group and Aldrete score was higher in the postoperative recovery unit. Minimal flow anesthesia applications can be a good alternative to prevent IPH. However, we think that more studies are needed for the effects of low-flow anesthesia techniques at the tissue level.

Anahtar Kelimeler

Oksijen satürasyonu, Düşük akımlı anestezi, Minimal akımlı anestezi, Hipotermi, Oxygen saturation, Low-Flow anesthesia, Minimal-Flow anesthesia, Hypothermia

NAZAL CERRAHİLERDE MİNİMAL, DÜŞÜK VE YÜKSEK AKIMLI ANESTEZİNİN VÜCUT SICAKLIĞI VE DOKU OKSİJENLENMESİ ÜZERİNE ETKİLERİ

Öz

AMAÇ: İntraoperatif yüksek taze gaz akışı istemsiz perioperatif hipotermi (İPH) oluşumuna neden olabilir. Bu nedenle anestezi iklimini iyileştiren düşük ve minimal akımlı anestezi yöntemleri uygulanmaktadır. Elektif nazal cerrahi geçiren hastalarda minimal, düşük ve yüksek akımlı anestezinin vücut sıcaklığı ve doku oksijenasyonu üzerine etkisini araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Prospektif randomize kontrollü çalışmaya hipotansif anestezi altında, elektif nazal cerrahi planlanan 18-60 yaş, ASA 1-2, operasyon süresi 1-4 saat olan 92 hasta dahil edildi. Hastalar, Grup1(0.5L dk-1), Grup2(1L dk-1) ve Grup 3(2L dk-1) olarak ayrıldı.Hastaların demografik ve operatif verileri, preoperatif bekleme odası sıcaklığı, intraoperatif ameliyathane sıcaklığı, intraoperatif vücut sıcaklığı, anestezi solunum devresi nemi ve sıcaklığı, doku oksijen satürasyonu, 0.,15.,30.,60.,90.,120.,150. Dakika(dk) ve postoperatif dönemde titreme, Aldrete skoru, derlenme ünitesindeki oda sıcaklığı ve vücut sıcaklıkları kaydedildi
BULGULAR: Hastaların tümünde perioperatif hipotermi gelişti (p=0.001). Her üç gruptada timpanik sıcaklıklar benzerdi(p>0.05). Alt grup karşılaştırmasında Grup 1'in StO2 60. dk değerinin Grup 2'ye göre yüksekti (p=0,046). Grup 1'in doku oksijen düzeyi (StO2) 90.dk değerinin grup 2 ve 3'ten yüksek olduğu istatistiksel olarak anlamlı olduğu belirlendi (p=0.013, p=0.013). Grup 1'in StO2 120.dk değerinin grup 3'ten yüksek olması istatistiksel olarak anlamlıydı (p=0,008 ). Grup 1’de postoperatif Aldrete skoru diğer iki gruba göre anlamlı derecede yüksek bulundu(p=0.002, p=0.002). Vücut sıcaklığı ile ameliyathane oda sıcaklığı,postoperatif derlenme oda sıcaklığı arasında korelasyon saptandı(r=.446, p<0.05; r=.531, p<0.01).
SONUÇ: Minimal, düşük ve yüksek akımlı anestezi uygulamalarında hipotansif anestezi ile elektif nazal cerrahi uygulanan tüm hastalarda istemsiz perioperatif hipotermi gelişti. Tüm gruplarda vücut sıcaklıkları, nem ve anestezi devresinin sıcaklığının benzer olduğu gözlendi. Minimal akımlı anestezi grubunda doku oksijen saturasyonu ve postoperatif derlenme ünitesinde Aldrete skoru daha yüksek bulundu. Minimal akımlı anestezi uygulamaları İPH önlemek için iyi bir alternatif olabilir.Ancak düşük akımlı anestezi tekniklerinin doku düzeyindeki etkileri için daha fazla çalışmaya ihtiyaç olduğunu düşünmekteyiz.

Anahtar Kelimeler

Oksijen satürasyonu, Düşük akımlı anestezi, Minimal akımlı anestezi, Hipotermi, Oxygen saturation, Low-Flow anesthesia, Minimal-Flow anesthesia, Hypothermia

Kaynakça

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