İntrakraniyal kitle cerrahisinde preoperatif dönemdeki ısıtmanın hipotermiyi önlemedeki etkisi

Yıl 2023, Cilt: 14 Sayı: 4, 678 - 684, 30.12.2023

Merve Sevim Artykov , Nihal Gökbulut Özaslan

https://doi.org/10.18663/tjcl.1320778

Öz

Amaç: Perioperatif hipotermi anestezi uygulaması sırasında sık karşılaşılan bir sorundur. Amacımız intrakraniyal kitle cerrahisinde hipoterminin hasta üzerindeki olumsuz etkilerini önlemek için preoperatif dönemden başlayarak ısıtmanın etkilerini araştırmaktır.
Gereç ve Yöntemler: Prospektif, randomize olarak intrakraniyal kitle cerrahisi geçiren hastalar iki gruba ayrıldı. Çalışma grubu aktif ısıtma cihazıyla operasyon öncesi ısıtıldı. Kontrol grubuna ise yalnızca pike örtüldü. Her iki grup da intraoperatif dönemde ısıtıldı. 15 dakikada bir vital bulgular (standart monitörizasyona ek olarak invaziv arteriyel kan basıncı),30 dakikada bir vücut sıcaklığı, saatlik olarak arter kan gazından laktat bakıldı. Titreme skorları, toplam anestezi ve operasyon süresi, tüketilen ilaç miktarları, iv mayi ve kanama miktarı not edildi.
Bulgular: Her grupta 36’şar olmak üzere toplam 72 hasta değerlendirildi. Gruplar arasında demografik ve klinik özellikler açısından anlamlı fark yoktu. Gruplar arasında cerrahinin 15-255. dakikaları arasında ölçülen ısı değerleri arasında anlamlı fark bulundu (p<0,05). Ön ısıtma yapılmayan hastaların tümünde en az bir defa hipotermik vücut sıcaklık değeri vardı. Önceden ısıtılan grupta ise yalnızca %11,1 hastada hipotermi saptandı.
Sonuç: İntrakraniyal kitle cerrahisi geçirecek hastalarda aktif eksternal ısıtıcı sistemler ile intraoperatif ve postoperatif dönemde hipoterminin önlenebileceği tespit edilmiştir.

Anahtar Kelimeler

hipotermi, preoperatif ısıtma, sıcak hava üflemeli ısıtma sistemleri, intrakraniyal kitle cerrahisi

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

The efficacy of preoperative warming at prevention of involuntary hypothermia in patients undergoing surgery for intracranial mass lesions

Öz

Aim: Perioperative hypothermia is a common problem during anesthesia procedure. In this study we aimed to determine if preoperative warming was effective at preventing involuntary hypothermia in patients undergoing neurosurgery for intracranial mass.
Material and Methods: Patients undergoing surgery for intracranial mass lesions were prospectively and randomly assigned into two groups. The study group was warmed up before the operation with an active warming device. In the control group, only the blanket was covered. Both groups were warmed intraoperatively. Vital signs (invasive arterial blood pressure in addition to standard monitoring), body temperature every 30 minutes, and lactate from arterial blood gas hourly were measured every 15 minutes. Shivering scores, total anesthesia and operation time, amount of drug consumed, amount of iv fluid and bleeding were noted.
Results: A total of 72 patients were included and divided into two groups of 36 patients each. There was no significant difference in terms of demographics and clinical characteristics between the groups. There was a statistically significant difference between the groups in terms of the temperature values during the period between 15–255 minutes of surgery. There was statistically significant difference between the groups in terms of inadvertent hypothermia incidence (p<0.05). At least one hypothermic measurement was spotted in all of control patients. Only %11.1 of patients in pre-warmed group had hypothermic temperature incidence.
Conclusion: Active pre-warming with body surface warming systems is effective at preventing of inadvertent hypothermia in patients undergoing intracranial surgery for mass lesions.

Anahtar Kelimeler

hypothermia, preoperative warming, active body surface warming systems, brain neoplasms

Proje Numarası

yok

Kaynakça

• Shenoy L, Krishna HM, Kalyan N, ve ark. A prospective comparative study between prewarming and cowarming to prevent intraoperative hypothermia. J Anaesthesiol Clin Pharmacol 2019;35(2):231.
• Rufiange M, Leung VS, Simpson K, ve ark. Pre-warming before general anesthesia with isoflurane delays the onset of hypothermia in rats. PLoS ONE 2020;15(3).
• Galvin IM, Levy R, Boyd JG, ve ark. Cooling for cerebral protection during brain surgery. The Cochrane database of systematic reviews 2015; Jan 28;1:CD006638.
• Elayat A, Jena SS, Nayak S, ve ark. Enhanced recovery after surgery–ERAS in elective craniotomies-a non-randomized controlled trial. BMC Neurol 2021;21:127.
• Yoo JH, Ok SY, Kim SH, ve ark. Efficacy of active forced air warming during induction of anesthesia to prevent inadvertent perioperative hypothermia in intraoperative warming patients: Comparison with passive warming, a randomized controlled trial. Medicine (Baltimore) 2021; 100(12):e25235.
• Thiel B, Mooijer BC, Kolff-Gart AS, ve ark. Is preoperative forced-air warming effective in the prevention of hypothermia in orthopedic surgical patients? A randomized controlled trial. J Clin Anesth 2020 (5)61:109633.
• Horn E, Bein B, Böhm R, ve ark. The effect of short time periods of pre-operative warming in the prevention of peri-operative hypothermia. Anaesthesia 2012. 67(6):612-17.
• Becerra Á, Valencia L, Ferrando C, ve ark. Prospective observational study of the effectiveness of prewarming on perioperative hypothermia in surgical patients submitted to spinal anesthesia. Sci Rep 2019 ;9(1):16477.
• Jun J-H, Chung MH, Kim EM, ve ark. Effect of pre-warming on perioperative hypothermia during holmium laser enucleation of the prostate under spinal anesthesia: a prospective randomized controlled trial. BMC Anesthesiol 2018;18 (1):201.
• Darvall J, Vijayakumar R, Leslie K. Prewarming neurosurgical patients to minimize hypotension on induction of anesthesia: a randomized trial. Can J Anaesth 2016;63(5):577-83.
• Shin KM, Ahn JH, Kim IS, ve ark. The efficacy of pre-warming on reducing intraprocedural hypothermia in endovascular coiling of cerebral aneurysms. BMC Anesthesiol 2015;15(1).
• Kaufner L, Niggemann P, Baum T, ve ark. Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial. BMC Anesthesiol 2019;19(1):1-10.
• Andrzejowski J, Hoyle J, Eapen G, ve ark. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. BJA 2008; 101(5):627-31.
• Xiao Y, Zhang R, Lv N, ve ark. Effects of a preoperative forced-air warming system for patients undergoing video-assisted thoracic surgery: A randomized controlled trial. Medicine 2020;99(48).
• Lau A, Lowlaavar N, Cooke EM, ve ark. Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial. Can J Anaesth 2018; 65(9):1029-40.
• Cho YJ, Lee SY, Kim TK, ve ark. Effect of Prewarming during Induction of Anesthesia on Microvascular Reactivity in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: A Randomized Clinical Trial. Plos One 2016;11(7):e0159772.
• Apfelbaum JL, Silverstein JH, Chung FF, ve ark. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology 2013;118(2):291-307.
• Becerra Á, Valencia L, Villar J, ve ark. Short-Periods of Pre-Warming in Laparoscopic Surgery. A Non-Randomized Clinical Trial Evaluating Current Clinical Practice. J Clin Med 2021;10(5):1047.
• Balki I, Khan JS, Staibano P, ve ark. Effect of Perioperative Active Body Surface Warming Systems on Analgesic and Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized ControlledTrials. Anesth Analg 2020; 131(5):1430-43.