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Lomber ve Servikal Disk Hernisi Ameliyatlarında İki Farklı Sıvı Rejiminin Karşılaştırılması

Year 2020, Volume: 6 Issue: 1, 13 - 29, 02.02.2020

Abstract

Peroperatif sıvı tedavisi, perioperatif hasta yönetiminin tartışılan konularından biridir. Yetersiz sıvı verilmesi ile efektif dolaşım hacminin azalması ve yetersiz doku perfüzyonu görülebilirken, fazla sıvı verilmesi ile de venöz dolaşımdaki basıncın artması ve interstisyel alana sıvı geçişinde artış görülebilir, bu da sistemik ve lokal doku oksijenizasyonunu bozar. Biz, lomber ve servikal disk hernisi ameliyatı geçirecek hastalarda, peroperatif sıvı kısıtlamasının ameliyat sırasında ve sonrasındaki etkilerini görebilmek için bu çalışmayı planladık. Disk hernisi sebebiyle opere edilecek ASA I-II sınıfından, yaşları 18-55 yıl arası olan hastalarda standart ve restriktif sıvı rejimlerinin perioperatif hemodinamik özellikleri, anestezik ve analjezik ihtiyaçları, derlenme özellikleri, bulantı-kusma insidansları ve preoperatif ve postoperatif laboratuar değerlerini karşılaştırdık. Standart grupta (S) sıvı replasmanı, defisit ve idame miktarı hesaplanarak kristalloidler ile yapıldı. Restriktif grupta (R) peroperatif sıvı verilmedi. Tüm hastaların demografik verileri, preoperatif ve postoperatif üre, kreatinin, elektrolitler ve hemogram değerleri kaydedildi. Hemodinamik veriler, anestezik ilaç dozları, derlenme skorları, bulantı, kusmanın varlığı, sıklığı, kullanılan antiemetik miktarı, ilk analjezik gereksinim zamanı ve 24 saatlik toplam analjezik kullanım miktarı ve sıvı dengeleri kaydedildi. Grup S ve R arasında demografik veriler, ameliyat öncesi ve sonrası üre, kreatinin, Na++, K+, hemogram değerleri, kan gazı ve laktat değerleri, kullanılan anestezik miktarları, derlenme özellikleri, analjezik ve antiemetik ihtiyaçları, 24 saat sonundaki sıvı dengeleri, ayağa kalkarken baş dönme insidansları, peroperatif hemodinamik verileri açısından fark bulunmadı. İdrar ve kanama miktarı grup S’de istatistiksel olarak anlamlı yüksek olmasına
rağmen klinik fark görülmedi. Restriktif sıvı yaklaşımı ile disk hernisi operasyonlarında hastada olumsuz bir etkiye rastlanılmamıştır.

References

  • Twigley AJ, Hillman KM. The end of the crystalloid era? A new approach to peri-operative fluid administration. Anaesthesia 1985; 40: 860-71.
  • Rosenthal MH. Intraoperative fluid management-what and how much? Chest 1999; 115: 1068-12.
  • Arkilic CF, Taguchi A, Sharma N, et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133: 423-9.
  • Grocott MPW, Mythen MG, Kan TJ. Perioperative fluid management and clinical outcomes in adults. Anesth Analg 2005; 100: 1093-106.
  • Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucasal perfusion during cardiac surgery. Arch Surg 1995; 130: 423-9.
  • Bennett-Guerrero E, Welsby I, Dunn TJ, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate risk, elective surgery. Anesth Analg 1999; 89: 514-9.
  • Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healty volunteers. Anesth Analg 2003; 96: 1504-9. Baker JW, Deitch ED, Li M, et al. Hemorrhagic shock induces bacterial translocation from the gut. J Trauma 1988; 28: 896-906.
  • Wilmore DW, Smith RJ, O’Dwyer ST, et al. The gut: a central organ following surgical stres. Surgery 1988; 104: 917-23.
  • Moore FD. Metabolic care of the surgical patient. Philadelphia: WB Saunders, 1959.
  • Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures. Ann Surg 1961; 154: 803-810.
  • Cook R, Anderson S, Riseborough M, Blogg CE. Intravenous fluid load and recovery. Anaesthesia 1990; 45: 826-30.
  • Gan TJ, Soppitt A, Maroof M, et al. Goal-directed intraoperative fluid administration reduces legth of hospital stay after major surgery. Anesthesiology 2002; 97: 820-26.
  • Katherine H, Birthe K, Dorte Stig C, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy. Ann Surg 2004; 240: 892-99.
  • Jordan S, Mitchell JA, Quinlan GJ, Goldstraw P, Evans TW. The pathogenesis of lung injury following pulmonary resection. Eur Respir J 2000; 15: 790–9.
  • Slinger PD. Perioperative fluid management for thoracic surgery: The puzzle of postpneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth 1995; 9: 442–51.
  • Moller AM, Pederson T, Svenden P-E, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance. Eur J Anaesthesiol 2002; 19:57-62.
  • Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens. Ann Surg 2003; 238: 641-8.
  • Alpert RA, Roizen MF, Hamilton WK, et al. Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery 1984; 95: 707–11.
  • Pull ter Gunne AJ, Bruining HA, Obertop H. Haemodynamics and ‘optimal’ hydration in aortic cross clamping. Neth J Surg 1990; 42: 113–7.
  • Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised control trial. Lancet 2002; 359: 1812–18.
  • Yogendran S, Asokumar B, Cheng D, Ghung F. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995; 80: 682-6.
  • Cook R, Anderson S, Riseborough M, Blogg CE. Intravenous fluid load and recovery. Anaesthesia 1990; 45: 826-30.
  • Jia FJ, Yan QY, Sun Q, Tuxun T. Liberal versus restrictive fluid management in abdominal surgery: a meta-analysis. Surg Today. 2017 Mar; 47(3):344-356.
  • Yeager MP, Spence BC. Perioperative fluid management: Current s and controversies. Semin Dial. 2006 Nov-Dec;19(6):472-9.
Year 2020, Volume: 6 Issue: 1, 13 - 29, 02.02.2020

Abstract

References

  • Twigley AJ, Hillman KM. The end of the crystalloid era? A new approach to peri-operative fluid administration. Anaesthesia 1985; 40: 860-71.
  • Rosenthal MH. Intraoperative fluid management-what and how much? Chest 1999; 115: 1068-12.
  • Arkilic CF, Taguchi A, Sharma N, et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133: 423-9.
  • Grocott MPW, Mythen MG, Kan TJ. Perioperative fluid management and clinical outcomes in adults. Anesth Analg 2005; 100: 1093-106.
  • Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucasal perfusion during cardiac surgery. Arch Surg 1995; 130: 423-9.
  • Bennett-Guerrero E, Welsby I, Dunn TJ, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate risk, elective surgery. Anesth Analg 1999; 89: 514-9.
  • Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healty volunteers. Anesth Analg 2003; 96: 1504-9. Baker JW, Deitch ED, Li M, et al. Hemorrhagic shock induces bacterial translocation from the gut. J Trauma 1988; 28: 896-906.
  • Wilmore DW, Smith RJ, O’Dwyer ST, et al. The gut: a central organ following surgical stres. Surgery 1988; 104: 917-23.
  • Moore FD. Metabolic care of the surgical patient. Philadelphia: WB Saunders, 1959.
  • Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures. Ann Surg 1961; 154: 803-810.
  • Cook R, Anderson S, Riseborough M, Blogg CE. Intravenous fluid load and recovery. Anaesthesia 1990; 45: 826-30.
  • Gan TJ, Soppitt A, Maroof M, et al. Goal-directed intraoperative fluid administration reduces legth of hospital stay after major surgery. Anesthesiology 2002; 97: 820-26.
  • Katherine H, Birthe K, Dorte Stig C, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy. Ann Surg 2004; 240: 892-99.
  • Jordan S, Mitchell JA, Quinlan GJ, Goldstraw P, Evans TW. The pathogenesis of lung injury following pulmonary resection. Eur Respir J 2000; 15: 790–9.
  • Slinger PD. Perioperative fluid management for thoracic surgery: The puzzle of postpneumonectomy pulmonary edema. J Cardiothorac Vasc Anesth 1995; 9: 442–51.
  • Moller AM, Pederson T, Svenden P-E, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance. Eur J Anaesthesiol 2002; 19:57-62.
  • Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens. Ann Surg 2003; 238: 641-8.
  • Alpert RA, Roizen MF, Hamilton WK, et al. Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery 1984; 95: 707–11.
  • Pull ter Gunne AJ, Bruining HA, Obertop H. Haemodynamics and ‘optimal’ hydration in aortic cross clamping. Neth J Surg 1990; 42: 113–7.
  • Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised control trial. Lancet 2002; 359: 1812–18.
  • Yogendran S, Asokumar B, Cheng D, Ghung F. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995; 80: 682-6.
  • Cook R, Anderson S, Riseborough M, Blogg CE. Intravenous fluid load and recovery. Anaesthesia 1990; 45: 826-30.
  • Jia FJ, Yan QY, Sun Q, Tuxun T. Liberal versus restrictive fluid management in abdominal surgery: a meta-analysis. Surg Today. 2017 Mar; 47(3):344-356.
  • Yeager MP, Spence BC. Perioperative fluid management: Current s and controversies. Semin Dial. 2006 Nov-Dec;19(6):472-9.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Ayfer Kaya Gök

Ercüment Yentür This is me

Publication Date February 2, 2020
Submission Date October 21, 2019
Published in Issue Year 2020 Volume: 6 Issue: 1

Cite

APA Kaya Gök, A., & Yentür, E. (2020). Lomber ve Servikal Disk Hernisi Ameliyatlarında İki Farklı Sıvı Rejiminin Karşılaştırılması. Aydın Sağlık Dergisi, 6(1), 13-29.

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