Batın operasyonlarında peroperatif hipotermi insidansı
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Dosyalar
Tarih
2019
Yazarlar
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Yayıncı
Trakya Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Genel anestezi altında yapılan batın operasyonlarındaki perioperatif hipotermi insidansını araştırmayı amaçladık. Çalışmamız kadın doğum, üroloji ve genel cerrahi ameliyathanesinde gerçekleştirildi. Minimum 1 saatin üzerinde elektif batın operasyonu planlanan, ASA II-III sınıfı, 18 yaş üzeri 529 hasta çalışmaya dahil edildi. Hastaya ait demografik veriler, ameliyat sürecindeki değişimler, perioperatif vücut ısıları, titreme, bulantı ve kusma ile ilgili değerler kaydedildi. Ameliyat masasına alınan tüm olguların hemodinamik parametreleri monitörize edilerek; preoperatif, intraoperatif (0-105. dk) ve postoperatif dönemdeki sistolik, diyastolik, ortalama arter basıncı, kalp atım hızı, periferik oksijen satürasyonu ve vücut ısıları kaydedildi. Preoperatif değerler bazal değer olarak kabul edildi. Postoperatif kan gazı analizinde; parsiyel arteriyel oksijen basıncı, parsiyel arteriyel karbondioksit basıncı, arteriyel oksijen satürasyonu, bikarbonat ve baz açığı kaydedildi. Postoperatif dönemde; operasyonun türü, uygulanan anestezi yöntemi, hastaların perioperatif dönemde ısıtılıp ısıtılmadıkları, kanama miktarı, total sıvı ve kan ürünleri replasmanları perioperatif dönemdeki anestezi fişlerinden kaydedildi. Hipotermik grup ile normotermik grup karşılaştırılarak predispozan faktörler tespit edildi. Olguların % 63.3’ünde (n=335) hipotermi tespit edildi. Hipotermi gelişiminde erkek cinsiyet, ileri yaş, yüksek ASA skoru ve sigara kullanımının predispozan faktör olduğu bulundu. Hipotermik olgulardaki cerrahi süre daha uzun, sıvı ve kan transfüzyon ihtiyacı daha fazla, preoperatif ve postoperatif dönemlerdeki hematokrit ve hemoglobin değerleri daha düşüktü. Sonuç olarak, perioperatif hipotermi ile ameliyat süresinde uzama, artan kan kaybına sekonder olarak sıvı ve kan trasfüzyon ihtiyacında artma ve titreme insidansında artış olduğunu gösterdik. İstenmeyen hipotermiden korunmak için vücut ısısı takibi ve aktif ısıtma işlemine preoperatif dönemde başlamalı ve postoperatif dönemde de devam edilmelidir. Tüm bu yaklaşımlar sayesinde istenmeyen hipotermiye bağlı oluşabilecek çoğu komplikasyon önlenebilecektir.
In this study, we aimed to investigate the incidence of perioperative hypothermia in the abdominal operations under general anesthesia. Our study has been performed in gynecology, urology and general surgery operation rooms. 529 patients in ASA II-III class, over 18 years old, who were scheduled for elective abdominal surgery with a minimum of 1 hour of general anesthesia were included in the study. Demographic data, changes in the operative process, perioperative body temperature, shivering, nausea and vomiting incidences were recorded. By monitoring the hemodynamic parameters of all cases taken to the operating table; systolic, diastolic, mean arterial pressure, heart rate, peripheral oxygen saturation and body temperatures were recorded preoperatively, intraoperatively (0-105 min) and postoperatively. Preoperative values were considered as baseline values. In postoperative blood gas analysis; partial arterial oxygen pressure, partial arterial carbon dioxide pressure, arterial oxygen saturation, bicarbonate and base deficit were recorded. In the postoperative period; the type of operation, anesthesia method applied, whether patients were heated during perioperative period, amount of bleeding, total fluid and blood products were recorded from the anesthetic plugs in perioperative period. Predisposing factors were determined by comparing hypothermic group with normothermic group. Hypothermia was detected in %63,3 (n=335) of the cases. Being male, advanced age, high ASA scores and smoking are found to be predisposing factors in development of hypothermia. In Hypothermic cases; surgery time were longer, need for fluid and blood transfusions were greater, preoperative and postoperative hematocrit and hemoglobin values were lower. As a result, we showed that perioperative hypothermia was associated with an increase in the incidence of fluid and blood trasfusion and an increase in the incidence of shivering. Body temperature monitoring and active heating should be started preoperatively and should be continued in the postoperative period in order to prevent unwanted hypothermia. Patients should be actively warmed before the operation and heating should be continued during the intraoperative period. With all these approaches, many complications due to unwanted hypothermia can be prevented.
In this study, we aimed to investigate the incidence of perioperative hypothermia in the abdominal operations under general anesthesia. Our study has been performed in gynecology, urology and general surgery operation rooms. 529 patients in ASA II-III class, over 18 years old, who were scheduled for elective abdominal surgery with a minimum of 1 hour of general anesthesia were included in the study. Demographic data, changes in the operative process, perioperative body temperature, shivering, nausea and vomiting incidences were recorded. By monitoring the hemodynamic parameters of all cases taken to the operating table; systolic, diastolic, mean arterial pressure, heart rate, peripheral oxygen saturation and body temperatures were recorded preoperatively, intraoperatively (0-105 min) and postoperatively. Preoperative values were considered as baseline values. In postoperative blood gas analysis; partial arterial oxygen pressure, partial arterial carbon dioxide pressure, arterial oxygen saturation, bicarbonate and base deficit were recorded. In the postoperative period; the type of operation, anesthesia method applied, whether patients were heated during perioperative period, amount of bleeding, total fluid and blood products were recorded from the anesthetic plugs in perioperative period. Predisposing factors were determined by comparing hypothermic group with normothermic group. Hypothermia was detected in %63,3 (n=335) of the cases. Being male, advanced age, high ASA scores and smoking are found to be predisposing factors in development of hypothermia. In Hypothermic cases; surgery time were longer, need for fluid and blood transfusions were greater, preoperative and postoperative hematocrit and hemoglobin values were lower. As a result, we showed that perioperative hypothermia was associated with an increase in the incidence of fluid and blood trasfusion and an increase in the incidence of shivering. Body temperature monitoring and active heating should be started preoperatively and should be continued in the postoperative period in order to prevent unwanted hypothermia. Patients should be actively warmed before the operation and heating should be continued during the intraoperative period. With all these approaches, many complications due to unwanted hypothermia can be prevented.
Açıklama
Anahtar Kelimeler
Vücut Isısı, Hipotermi, Anestezi, Body Temperature, Hypothermia, Anesthesia
