Obez hastalarda düşük akım ve normal akım anestezisinin etkinlik ve güvenirliliğinin araştırılması: Randomize bir çalışma

Year 2019, , 453 - 458, 25.12.2019

Mehmet Tercan , Ayşe Güsün Halitoğlu , Ahmet Kaya Tuğba Bingöl Tanrıverdi , Gülçin Patmano

https://doi.org/10.35440/hutfd.614532

Abstract

Amaç: Vücut kitle indeksinin 30 ve üstü değerleri obezite olarak
tanımlanmaktadır. Obezlerde kilo ile beraber vücut yüzey alanı artar, böylece
bazal metabolik hız normal kiloda olanlara kıyasla daha yüksek hale gelir.
Düşük akım anestezisi (DAA), taze gaz akımının (TGA) 1L/dk’nın altında olduğu
anestezi yöntemidir. Literatürde, laparoskopik cerrahi uygulanan obez
hastalarda farklı gaz akımlarının etkilerini karşılaştıran çalışmalar çok
sınırlıdır. Çalışmamızın amacı, düşük akım anestezisinin obez hastalardaki
etkinlik ve güvenilirliğini incelemektir. 

Materyal ve
Metod: Bu randomize prospektif
çalışmaya, laparaskopik kolesistektomi uygulanan, 18-65 yaş arası 100 hasta
dâhil edildi. Randomizasyon için kapalı zarf yöntemi kullanıldı. DAA uygulaması
TGA’nın 0.5 L/dk’dan verilmesi olarak tanımlanırken, normal akım anestezi (NAA)
TGA’nın  2 L/dk’dan verilmesi olarak
tanımlandı. 100 hasta randomize olarak 4 gruba ayrıldı. Grup 1: normal kilolu
ve DAA uygulan hastalar, Grup 2: normal kilolu ve NAA uygulanan hastalar, Grup
3: obez olup DAA uygulan hastalar, Grup 4: obez olup NAA uygulan hastalar.

Bulgular: Çalışmaya dâhil edilen hastaların hiçbirinde entübasyon sonrası
inspiratuar oksijen düzeyi (insO2) değeri %35’in altına düşmedi. Dolayısıyla da
hiçbir hastada hipoksi gözlenmedi. Bununla beraber; grup 2 hastalar ile
karşılaştırıldığında, grup 1 hastalarında anestezi süresi anlamlı olarak daha
uzun iken, desflurane tüketimi ise anlamlı olarak daha az idi. Benzer şekilde,
grup 4 hastalar ile karşılaştırıldığında, grup 3 hastalarında anestezi süresi
anlamlı olarak daha uzun iken, desflurane tüketimi ise anlamlı olarak daha az
idi.

Sonuç: Çalışmamızdan elde edilen bulgular DAA uygulamasının normal kilolu
hastalarda olduğu gibi, obez hastalarda da güvenle kullanılabileceğini ve maliyeti
düşürmede etkili bir yöntem olduğunu düşündürmektedir.

Keywords

Düşük akım anestezi, Laparaskopik kolesistektomi, obezite

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

Investigation of the efficacy and safety of low-flow and normal-flow anesthesia in obese patients: A randomized trial

Abstract

 

Background: Body mass index values ≥30 are defined as obesity. In obese, body
surface area increases with weight; thus, the basal metabolic rate becomes
higher compared to those at normal weight. Low-flow anesthesia (LFA) is an
anesthetic method where fresh gas flow (FGF) is less than 1L /min. There are
limited studies in the literature comparing the effects of different gas flows
in obese patients undergoing laparoscopic surgery. The aim of this study was to
investigate the efficacy and safety of LFA in obese patients.

Materials and Methods: This randomized prospective study included 100
patients aged between 18-65 years undergoing laparoscopic cholecystectomy.
Sealed envelope method was used for randomization. LFA was defined as the
administration of FGF at 0.5 L/min, while normal flow anesthesia (NFA) was defined
as FGF at 2 L/min. 100 patients were randomly divided into 4 groups. Group 1: normal
patients with weight and LFA, Group 2: normal patients with weight and NFA,
Group 3: obese patients and LFA, Group 4: obese patients with and NFA.

Results: None
of the patients had an inspiratory oxygen level (insO2) value below 35% after
intubation. Therefore, hypoxia was not observed in any patient. However; when
compared to group 2, group 1 had significantly longer anesthesia time and lower
desflurane consumption. Similarly, when compared to group4, group 3 had
significantly longer anesthesia time and lower desflurane consumption.

Conclusion: Our results suggest that LFA can be used safely in obese patients as
well as in normal weight patients and it is an effective method to reduce the
cost.

Keywords

Low flow anesthesia, laparoscopic cholecystectomy, obesity

Project Number

Yok

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