AĞIR OBEZİTE HASTALARIN SPİNAL ANESTEZİ ALTINDA PERKÜTAN NEFROLİTİTOMİ UYGULANMASI POSTOPERATİF ERKEN DÖNEM İYİLEŞME VE CERRAHİ SONUÇLARINI ETKİLER Mİ?

Abstract

Amaç: Bu çalışmanın birincil amacı, spinal anestezi altında perkütan nefrolititomi (PNL) uygulanan hastalarda ağır obezitenin erken postoperatif seyir üzerinde zararlı bir etkisinin olup olmadığını değerlendirmektir. İkinci olarak, ağır obezitenin cerrahi sonuçları değiştirip değiştirmediğini belirlemektir. Gereç ve Yöntem: Çalışmaya kliniğimizde ≥2cm böbrek taşı nedeniyle PNL operasyonu yapılan 100 hasta dahil edildi. Buna göre birinci grupta VKİ<35 kg/m2 olanlar, ikinci grupta ise ciddi derecede obez BKİ≥35 kg/m2 olanlar oluşturuldu. Yaş, cinsiyet, taş yükü, ameliyat öncesi/sonrası hemoglobin seviyeleri, giriş sayısı ve bölgeleri, ameliyat süresi, perioperatif komplikasyonlar ve 24. saatte Görsel Analog Skala skoru, PACU yatış/taburculuk Aldrete skorları ve PACU kalış süresi kaydedildi. Bulgular: Grup 1’de VAS puanı 5,0±1,3 iken grup 2’de 5,3±1,8 idi (p=0,32). Hastanede kalış süresi VKİ <35 kg/m2 olan hastalarda 3,3±1,3 gün, VKİ≥35 kg/m2 olan hastalarda 3,0±1,0 idi (p=0,36). Ağır obez grupta %98, normal vücut kitle indeksi grubunda %96 taşsızlık oranı saptandı ve gruplar arasında anlamlı fark yoktu (p=0,672). Gruplar arasında PACU taburcu Aldrete skorları açısından istatistiksel olarak anlamlı fark vardı (Grup 1 ve 2’de sırasıyla 9,9±0,3 ve 9,6±0,4) (p=0,03). Son olarak PACU’da zaman aralığı grup 1’de 39,0±7,5 dk iken grup 2’de 58,8±14,0 dk idi (p<0,0001). Sonuç: Şiddetli obezite, spinal anestezi altında PNL uygulanan hastalarda cerrahi sonuçları değiştirmez ve bize göre PNL’de spinal anestezi, obez ve morbid obez hastalarda renal taş(lar) için güvenli ve etkili bir anestezi yöntemidir.

Keywords

• obezite
• PACU
• PNL
• spinal anestezi
• prospektif

DOES SEVERE OBESITY EFFECT EARLY POSTOPERATIVE RECOVERY AND SURGICAL OUTCOMES IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY UNDER SPINAL ANESTHESIA?

Abstract

Objective: The primary aim of this study is to evaluate if severe obesity has any deleterious effect on the early postoperative course in patients undergoing percutaneous nephrolithotomy (PNL) under spinal anesthesia, and the secondary aim is to determine whether severe obesity changes surgical results. Material and Method: The study included 100 patients who underwent a PNL operation for kidney stones of ≥2cm in our clinic. Accordingly, those with BMI <35 kg/m2 formed the first while the severely obese BMI ≥35 kg/m2 formed the second group. Age, gender, stone burden, pre/postoperative hemoglobin levels, number and regions of access, duration of surgery, perioperative complications and Visual Analogue Scale score at 24h, PACU admission/ discharge Aldrete scores, and PACU length of stay were recorded. Results: The VAS score was 5.0±1.3 in group 1 while it was 5.3±1.8 in group 2 (p=0.32). The length of the hospital stay was 3.3±1.3 days in patients with BMI <35 kg/m2 and 3.0±1.0 in patients with BMI ≥35 kg/m2 (p=0.36). A 98% stone-free rate was found in the severely obese group and 96% in the normal BMI group, and there was no significant difference between the groups (p=0.672). There was a statistically significant difference in terms of PACU discharge Aldrete scores between groups (9.9±0.3 vs. 9.6±0.4 in groups 1 and 2, respectively) (p=0.03). Finally, the time interval in PACU was 39.0±7.5 mins in group 1 while it was 58.8±14.0 mins in group 2 (p<0.0001). Conclusions: Severe obesity does not alter surgical outcomes in patients undergoing PNL under spinal anesthesia, and in our opinion, spinal anesthesia in PNL is a safe and effective anesthesia modality for renal stone(s) in obese and morbidly obese patients.

Keywords

• obesity
• PACU
• PNL
• spinal anesthesia
• prospective

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