Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Glioblastom Cerrahisinde Anestezi Türünün Postoperatif Etkileri: Retrospektif Çalışma
Postoperative Effects of Anesthesia Type in Glioblastoma Surgery: A Retrospective Study
Nihal GÖKBULUT ÖZASLANa , Süleyman TAYGURTa , Mehmet ŞAHAPa , Gökhan ERDEMa
aAnkara Bilkent Şehir Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Anest Reanim. 2025;23(2):43-8
doi: 10.5336/anesthe.2025-108337
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışma, glioblastom operasyonu geçiren hastalarda, total intravenöz anestezi (TİVA) ve volatil anestezi (VA) yöntemlerinin inflamatuar yanıt, hastanede kalış süresi ve yoğun bakım ünitesinde kalış süresi gibi klinik parametreler üzerindeki etkilerini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif çalışma, Ocak 2021-Aralık 2023 arasında şehir hastanesinde glioblastom ameliyatı geçiren 144 hastayı inceledi. Hastalar TİVA (n=95) ve VA (n=49) gruplarına ayrıldı. TİVA propofol ve remifentanil içerirken, VA sevofluran ve remifentanil içermekteydi. Perioperatif veriler, lökosit, nötrofil-lenfosit oranı, trombosit, hemoglobin, C-reaktif protein, albümin ve komplikasyonlar dâhil olmak üzere toplandı ve analiz edildi. Bulgular: Her iki grup yaş, cinsiyet, ASA sınıflandırması, kraniotomi yeri ve ağırlık açısından benzerdi. TİVA hastalarında infratentorial tümörlerin daha yüksek prevalansı, daha uzun anestezi süreleri ve artan intraoperatif sıvı gereksinimleri gözlemlendi. Buna karşılık, VA grubunun idrar çıkışı önemli ölçüde daha düşüktü. İnflamatuar belirteçler, preoperatif ve postoperatif dönemler arasında önemli grup içi değişiklikler gösterdi; postoperatif dönemde lökosit, nötrofil lenfosit oranı [neutrophil to lymphocyte ratio (NLR)] ve: Creaktif protein seviyeleri yükselirken, trombosit, hemoglobin ve albumin seviyeleri düşüktü. TİVA grubu, VA grubuna kıyasla daha yüksek bir postoperatif NLR sergiledi, ancak diğer inflamatuar belirteçler veya klinik sonuçlar arasında gruplar arası önemli bir fark gözlemlenmedi. Yoğun bakım ünitesinde kalış süreleri gruplar arasında benzer olmakla birlikte TİVA grubunda biraz daha kısaydı. Sonuç: TİVA, glioblastom cerrahisinde perioperatif yönetim ve yoğun bakım ile hastane yatış süresi konusunda avantaj sağlamış, literatürden farklı olarak VA ise postoperatif dönemde NLR değerlerini düşürmüştür. Gliobastom cerrahisinde en uygun anestezi tipinin belirlenmesinde daha geniş ölçekli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Total intravenöz anestezi; volatil anestezi; glioblastom; inflamatuar belirteçler
ABSTRACT
 Objective: This study aims to compare the effects of total intravenous anaesthesia (TIVA) and volatile anesthesia (VA) methods on clinical parameters such as inflammatory response, length of hospital and intensive care unit stay of patients undergoing glioblastoma surgery. Material and Methods: This retrospective study examined 144 patients who underwent glioblastoma surgery at a city hospital between January 2021 and December 2023. Patients were divided into TIVA (n=95) and VA (n=49) groups. TIVA contained propofol and remifentanil, while VA contained sevoflurane and remifentanil. Perioperative data, including leukocyte count, neutrophillymphocyte ratio, platelet count, hemoglobin, C-reactive protein, albumin, and complications, were collected and analyzed. Results: Both groups were similar in terms of age, gender, ASA classification, craniotomy location, and weight. TIVA patients exhibited a higher prevalence of infratentorial tumors, longer anesthesia durations, and increased intraoperative fluid requirements. In contrast, the VA group had significantly lower urine output. Inflammatory markers showed significant intra-group changes between preoperative and postoperative periods, with elevated leukocyte, neutrophil to lymphocyte ratio (NLR) and C-reactive protein levels postoperatively, and reduced platelet, hemoglobin, and albumin levels. The TIVA group exhibited a higher postoperative NLR compared to the VA group, but no significant intergroup differences were observed in other inflammatory markers or clinical outcomes. Although the lengths of stay in the intensive care unit were similar between the groups, they were slightly shorter in the TIVA group. Conclusion: TIVA has provided advantages in perioperative management and intensive care, as well as hospital stay duration in glioblastoma surgery, while VA, contrary to the literature, has reduced NLR values in the postoperative period. In determining the most suitable type of anesthesia for glioblastoma surgery, larger-scale studies are needed.

Keywords: Total intravenous anesthesia; volatile anesthesia; glioblastoma; inflammatory markers
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