Nöroşirurji hastalarında glasgow koma skalası'nın uygulanan genel anestezi
Yükleniyor...
Dosyalar
Tarih
2015
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Biz bu çalışmada intrakranial patolojisi sebebiyle ameliyat edilecek ve glasgow koma skalasını farklı üç gruba ayırdığımız hastalarda, bispektral indeks monitorizasyonu ile uyguladığımız genel anestezi yönetimini; hemodinamik stabilite, ilaç konsantrasyonları ve ilaç tüketimi açısından araştırmayı amaçladık. Çalışmamıza Trakya Üniversitesi Tıp Fakültesi Hastanesinde beyin ve sinir cerrahisi tarafından intrakranial patoloji nedeniyle opere edilecek 18-65 yaş arası 45 hasta çalışmaya dahil edildi. Hastaların operasyon öncesinde glasgow koma skalası hesaplandı. Hastalar glasgow koma skalasına göre 3 gruba ayrıldı. Grup I= 3-8 ağır hasarlı (n=15) Grup 2= 9-12 orta hasarlı (n=15) Grup 3= 13-15 hafif hasarlı (n=15) olacak şekilde oluşturuldu. Operasyon masasına alınan hastalara anestezi indüksiyonu, entübasyonu ve anestezinin devamı için; kullanılacak intraoperatif anestezik ajanlar (inhalasyon ajanları ve opioidler), preoperatif, intraoperatif ve postoperatif kalp hızı, sistolik kan basıncı ve diyastolik kan basıncı, ortalama kan basıncı, oksijen saturasyonu, intraoperatif end tidal karbondioksit ve bispektral indeks değerleri kaydedildi. Bispektral değerleri ile indeks değerinin operasyon süresince 30-60 düzeyinde olması sağlandı. İnhalasyon ajanlarının tüketimi (DİON formülüyle) ilk 20 dk'da 5 dk'da bir, 60. dk'ya kadar 10 dk'da bir, sonra 30 dk aralıklarala 180. dkya kadar kaydedildi. Toplam tüketilen opioid miktarı infüzyon pompasından kaydedildi. Verilerin analizinde; sonuçlar ortalama ± standart sapma olarak gösterildi. P<0,05 iststistiksel olarak anlamlı kabul edildi. Kolmogorov Smirnov, Tek Yönlü Anova testi, Ki-Kare testi ve Kruskal Wallis istatistiksel testleri kullanıldı. Glasgow koma skalası ile gruplara ayırdığımız hastalarda; bispektral indeks monitorizasyonu ile uyguladığımız genel anestezi yönetiminde gruplar arasında hemodinamik parametrelerde bukunan farklılıklar yanında, yapılan tüm ölçümlerde inhalasyon ajanı tüketim miktarları açısından istatistiksel anlamlı farklılık saptadık (p<0,05). Grup III'teki inhalasyon ajanı tüketim miktarının, ölçülen tüm zaman aralıklarında, Grup I'den ve intraoperatif 180.dk dışındaki tüm zaman aralıklarında ise Grup II'den istatistiksel olarak anlamlı derecede düşük olduğunu saptadık. Grup II'nin ise intraoperatif 15.dk ve sonrasındaki zaman aralıklarında Grup I'den anlamlı derecede düşük olduğunu bulduk. Anestezi süresine göre ajan tüketim oranı gruplar arasında farklılık göstermekte olduğu bulundu. Biz de çalışmamızda kafa travması şiddetinin artması ile bispektral indeks degerinin anlamlı olarak düştüğünü ve bunla beraber anestezik ajan tüketiminde de azalma olduğunu saptamakla beraber daha geniş serili araştırmalar yapılması gerektiği kanaatindeyiz.
abstract
In this study we aim to search the management of the general anesthesic application by Bispektral Index monitoring for screeing in terms of hemodynamic stability, drug concentrations and drug use within the patients whom we categorized into 3 different groups with glasgow coma scale who are going to be operated for intracranial pathology. A total of 45 patients with a age scale of 18-65 who are planned to be operated for an intracranial pathology in the Brain and Nerve Surgery Department of Trakya University Medicine Faculty were included in our study. Glasgow coma scale were calculated for each patient before the surgery. Patients were seperated into 3 groups for their Glaskow Coma Scales. Groups were created as Group 1: 3-8 severe damaged (n=15), Group 2: moderate damaged (n=15), Group 3: mild damaged (n=15). Intraoperative anesthetic agents (inhalation agents, opiods, and muscle relaxants) that are planned to be used for the anesthesic induction, intubation and for the continuation of the anesthesia, heart rate, systolic blood pressure and diastolic blood pressure, mean blood pressure, oxygen saturation, End tidal volume and bispektral index measurement device, the early bispektral index value before the onset of the anesthesia for the patients who were taken to the operation table were recorded. The bispektral index value was provided to be at 30-60 levels during the operation. The consumption of the inhalation agents (by using DION formulation) were recorded in every 5 minutes. At the end of the operation the concentration of the inhalation agents were also recorded just before the termination of the drug administration. The amount of total opioid consumption were recorded from the infusion pump. Descriptive statistics were given as mean and standard deviation. p<0.05 was considered statistically significant. Kolmogorov Smirnov, Anova and Kruskal Wallis statistical analysis tests were used. We found significant statistical differences in all measurements of the general anesthesia management among the groups, with the management of the general anesthesic application by bispektral index monitoring in terms of anesthetic agent comsumption in addition to differences in hemodynamic parameters within the patients whom we had grouped with glasgow coma scale (p<0,05). The comsumption amount of inhalation agents in Group III, was determined significantly lower than Group I for all time intervals and Group II only apart from intraoperative 180th. minute time interval. We found the comsumption amount of inhalation agents of Group II to be significantly lower than Group I for the intraoperative 15.th minute and after. The consumption rate of the agents according to the duration time of aneshtesia between groups is found to be different. In our study we came to a conclusion that with increasing severity of head trauma the bispektral index value is reduced significantly and besides we found a reduction in the consumption of anesthetic agents and yet we believe that larger series of research should be done.
abstract
In this study we aim to search the management of the general anesthesic application by Bispektral Index monitoring for screeing in terms of hemodynamic stability, drug concentrations and drug use within the patients whom we categorized into 3 different groups with glasgow coma scale who are going to be operated for intracranial pathology. A total of 45 patients with a age scale of 18-65 who are planned to be operated for an intracranial pathology in the Brain and Nerve Surgery Department of Trakya University Medicine Faculty were included in our study. Glasgow coma scale were calculated for each patient before the surgery. Patients were seperated into 3 groups for their Glaskow Coma Scales. Groups were created as Group 1: 3-8 severe damaged (n=15), Group 2: moderate damaged (n=15), Group 3: mild damaged (n=15). Intraoperative anesthetic agents (inhalation agents, opiods, and muscle relaxants) that are planned to be used for the anesthesic induction, intubation and for the continuation of the anesthesia, heart rate, systolic blood pressure and diastolic blood pressure, mean blood pressure, oxygen saturation, End tidal volume and bispektral index measurement device, the early bispektral index value before the onset of the anesthesia for the patients who were taken to the operation table were recorded. The bispektral index value was provided to be at 30-60 levels during the operation. The consumption of the inhalation agents (by using DION formulation) were recorded in every 5 minutes. At the end of the operation the concentration of the inhalation agents were also recorded just before the termination of the drug administration. The amount of total opioid consumption were recorded from the infusion pump. Descriptive statistics were given as mean and standard deviation. p<0.05 was considered statistically significant. Kolmogorov Smirnov, Anova and Kruskal Wallis statistical analysis tests were used. We found significant statistical differences in all measurements of the general anesthesia management among the groups, with the management of the general anesthesic application by bispektral index monitoring in terms of anesthetic agent comsumption in addition to differences in hemodynamic parameters within the patients whom we had grouped with glasgow coma scale (p<0,05). The comsumption amount of inhalation agents in Group III, was determined significantly lower than Group I for all time intervals and Group II only apart from intraoperative 180th. minute time interval. We found the comsumption amount of inhalation agents of Group II to be significantly lower than Group I for the intraoperative 15.th minute and after. The consumption rate of the agents according to the duration time of aneshtesia between groups is found to be different. In our study we came to a conclusion that with increasing severity of head trauma the bispektral index value is reduced significantly and besides we found a reduction in the consumption of anesthetic agents and yet we believe that larger series of research should be done.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Glasgow Koma Skalası, İntrakranial Patoloji, Bispektral İndeks, Glasgow Coma Scale,, Intracranial Pathology, Bispektreal Index
