BARİATRİK CERRAHİDE YÜKSEK İNTRAABDOMİNAL BASINÇ UYGULAMASININ SEREBRAL PERFÜZYON VE HEMODİNAMİ ÜZERİNE ETKİLERİ

EFFECTS OF INTRAABDOMINAL HIGH PRESSURE APPLICATION ON PERFUSION AND HEMODYNAMICS IN BARIATRIC SURGERY

Özet

Amaç: Bu çal›flmada bariatrik cerrahide uygulanan yüksek intraabdominal bas›nc›n serebral dolafl›m ve hemodinami üzerine etkilerinin araflt›r›lmas› planlanm›flt›r. Yöntem: Obezite cerrahisi yap›lacak 51 hasta çal›flmaya al›nd›. Hastalar operasyon odas›nda standart monitörizasyona ilave olarak serebral oksijenasyon (rSO 2 ) takibi için serebral oksimetre (NIRS) ve anestezi derinli¤i takibi için de bispektral indeks (B‹S) ile monitörize edildi. ‹ndüksiyon öncesi T 1 zaman› ve ekstübasyon zaman› T 7 olmak üzere 7 farkl› zamanda ölçümler yap›ld›. Bulgular: Hastalar›n soluk sonu karbondioksit (ETCO 2 ) ve B‹S de¤erleri sabit iken T 1 zaman› baz al›narak yap›lan de¤erlendirmelerde kalp h›z› T 2 , T 4 , T 5 , T 6 ’ da anlaml› olarak düflük, T 7 ’ de yüksek, ortalama arter bas›nc› (OAB) T 2 , T 3 , T 4 , T 5 , T 6 zaman›nda anlaml› düflük, NIRS sa¤ de¤erleri T 3 , T 4 , T 5 ’ te anlaml› düflük, NIRS sol de¤erleri T 2 , T 3 , T 4 , T 5 , T 6 ’ da anlaml› düflük bulundu. NIRS de¤erlerinde toplam 64 ölçümde T 1 zaman› baz al›narak yap›lan karfl›laflt›rmada %20’den fazla düflme saptand›. Sonuç: Bariatrik cerrahide uygulanan yüksek intraabdominal bas›nç serebral oksijenasyonu ve hemodinamiyi anlaml› olarak etkiler. Yüksek intraabdominal bas›nç uygulanan vakalarda serebral oksijenasyon takibi ve yak›n hemodinamik takip güvenli anestezi uygulamas› için faydal›d›r.

Abstract

Objective: In this study the effects of intraabdominal high pressure application on perfusion and hemodynamics in bariatric surgery was planned to investigate. Method: Fifty-one patients which are planned for obesity surgery were included to the study. Patients were monitorized with cerebral-oximetry (NIRS) to follow cerebral oxygenation (rSO 2 ) and bispectral index (BIS) to follow depth of anesthesia near the standard monitorization in operating room. Measurements were performed in seven different times and ‘before induction’ named as T1 time, and ‘extubation’ as T 7 time. Results: Evaluation with T 1 , when the carbondioxide (ETCO 2 ) and BIS values at the end of inspiration were constant, heart rate was found significantly low in T 2 , T 4 , T 5 , T 6 when high in T 7 ; mean arterial pressure (MAP) was found significantly low in T 2 , T 3 , T 4 , T 5 , T 6 ; NIRS right values was found significantly low in T 3 , T 4 , T 5 and NIRS left values was found significantly low in T 2 , T 3 , T 4 , T 5 , T 6 . In a correlation with T 1 based total 64 measurement 20% decreases in NIRS values were found. Conclusion: Application of intraabdominal high pressure in bariatric surgery effects cerebral oxygenation and hemodynamics significantly. For a safe anesthetic process in patients which were applied high intraabdominal pressure it is useful to follow the cerebral oxygenation and close monitoring for hemodynamic parameters.