Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Laparoskopik Bariatrik Cerrahinin Serebral Oksijenizasyon Üzerine Etkisi
Effect of Laparoscopic Bariatric Surgery on Cerebral Oxygenation
Ezgi TURANa, İclal ÖZDEMİR KOLb, Onur AVCIb, Ahmet Cemil İSBİRb, Kenan KAYGUSUZb, Sinan GÜRSOYb
aAnesteziyoloji ve Reanimasyon Kliniği, Sivas Yıldızeli Devlet Hastanesi,
bAnesteziyoloji ve Reanimasyon AD, Sivas Cumhuriyet Üniversitesi Tıp Fakültesi, Sivas, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2019;39(2):135-43
doi: 10.5336/medsci.2018-62558
Article Language: TR
Full Text
ÖZET
 Amaç: Bariatrik cerrahi yöntemleri morbid obez hastalarda tedavinin önemli bir parçasıdır. Bu çalışmada; genel anestezi altında laparoskopik bariatrik cerrahinin ters trendelenburg pozisyonu, karbondioksit insuflasyonu ve pnömoperitonyum süresince serebral oksimetri ile takip edilen rSO2 değerleri üzerine olan etkilerini araştırdık. Gereç ve Yöntemler: Çalışmaya, Cumhuriyet Üniversitesi etik kurul onayı alındıktan sonra 40 gönüllü bariatrik cerrahi operasyonu uygulanacak, 18-60 yaş arası, ASA I- III olan genel cerrahi hastası dahil edildi. Hastaların hemodinamik parametreleri ve rSO2 değerleri başlangıçta, operasyon süresince her 5 dakikada bir, anestezi indüksiyonundan hemen sonra (T1), CO2 insuflasyonunun başlangıcında (T2), pnömoperitonyumun 10. dakikasında (T3), pnömoperitonyumun 20. dakikasında (T4) ve 30. dakikasında (T5), hasta pozisyonunun ters trendelenburg yapılmasının 5. Dakikasında (T6), 10. dakikasında (T7), cerrahi bittikten sonra hasta supin pozisyona getirildikten sonra (T8) ve ekstübasyon sonrası (T9) değerler ölçülüp kaydedildi. Bulgular: Çalışmaya alınan bireylerin değişik zamanlarda ölçülen rSO2 değerleri karşılaştırıldığında farklılık anlamlı bulundu. Ölçümler ikişerli olarak karşılaştırıldığında; bazal ile T1, T2, T8 arası farklılık, T1 ile T9 arası farklılık anlamlı bulunurken, diğer değerler arasındaki fark anlamsız bulundu. Çalışmamızda rSO2 değerleri izleminde bazal değere göre indüksiyon sonrası, CO2 insüflasyon başlangıcı ve ters trendelenburg 10. dk değerlerinde istatistiksel olarak artış saptandı. İndüksiyon sonrası ölçülen rSO2 değerine göre ekstübasyon sonrası değerde azalma görüldü. Hiçbir hastamızda operasyon boyunca serebral desatürasyon gözlenmedi. Sonuç: Genel anestezi altında bariatrik cerrahi yapılan sınırlı sayıdaki hastalarda uygulanan ters trendelenburg pozisyonun ve pnömoperitonyumun serebral oksijen satürasyonu açısından belirgin bir farklılık oluşturmadığını, cerrahi pozisyonun hastalarda hemodinamik olarak iyi tolere edildiğini ve rSO2'deki değişimlerin hemodinamik değişikliklerle de paralellik gösterdiğini tespit ettik.

Anahtar Kelimeler: Obezite; bariatrik cerrahi; yakın-kızılötesi spektroskopi
ABSTRACT
 Objectives: Bariatric surgery methods are an important piece of morbid obesity treatment. In this research; we investigated the effects of laparoscopic bariatric surgery on rSO2, which is measured by using cerebral oxymeter, during reverse trendelenburg position, carbon dioxide insuflation and pneumoperitonium under general anesthesia. Material and Methods:After the patients' and Cumhuriyet University Ethics Committee's approval are taken; 40 voluntary, ASA I-III bariatric surgery patients at the age of 18-60 years were taken into the research. Hemodynamic parameters and rSO2 values were recorded at every 5 minutes of the operation, immediately after anesthesia induction (T1), at the starting of CO2 insuflation (T2), at 10th (T3), 20th (T4) and 30th (T5) minute of pneumoperitonium (T3), at 5th (T6) and 10th (T7) minute of positioning the patient into reverse trendelenburg, after positioning the patient into supine position at the end of the surgery (T8) and after extubation (T9). Results: When we compare the rSO2 values which were measured at different times, the difference was significant. When the measurements were compared as in double; differences between basal and T1, T2, T8 and difference between T1 and T9 were significant and differences between the other values were insignificant. In our research; there was a statistically increase in rSO2 after induction, at the start of CO2 insuflation and at 10th minute of positioning into reverse trendelenburg when compared to basal value. There was a decrease in rSO2 values that measured after extubation compared to values that measured after induction. Cerebral desaturation was not observed in any patient during the operation. Conclusion: It was seen that there was no significant difference in terms of cerebral oxygen saturation of the pneumoperitoneum and reverse trendelenburg position applied in limited number of patients undergoing bariatric surgery under general anesthesia. Surgery position was hemodynamically well-tolerated by the patients and the changes on rSO2 have parallels with hemodynamic changes.

Keywords: Obesity; bariatric surgery; near infrared spectroscopy
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