Eras Protokollerine Uygun Olarak Radikal Sistektomi Yapılan Hastalarda Anestezi Derinliği Klinik Sonuçları Etkiler Mi?

Year 2023, Volume: 18 Issue: 3, 230 - 239, 25.10.2023

Nalan Saygı Emir , Fatma Çıtak Karacaer

https://doi.org/10.33719/yud.2023-18-3-1350497

https://izlik.org/JA32HJ68HW

Abstract

Amaç: Radikal sistektomi ameliyatı geçiren hastalarda cerrahi sonrası hızlandırılmış iyileşme (ERAS [Enhanced Recovery After Surgery]) protokollerine uygun olarak uygulanan, düşük ve yüksek MAC (Minimum Aleveolar Concentration) anestezi düzeyinin anestezi derinliği üzerine etkisinin olup olmadığını araştırmak.
Gereç ve Yöntemler: Hastanemizin yerel etik kurulunun onayı alındıktan sonra 2019-2022 yılları arasında radikal sistektomi uygulanan 41 hastanın retrospektif verileri toplandı, 35 hasta çalışmaya dahil edildi. Anestezisi 0,5 MAC ile sürdürülen hastalar düşük MAC (Grup L), 1 MAC ile sürdürülenler ise yüksek MAC (Grup H) olarak ayrıldı. Tüm hastalara ERAS protokolleri doğrultusunda hazırlanan standart anestezi protokolü uygulandı. Anestezi derinliği hasta durum indeksi (Pneumonia Severity Index [PSI]) ve baskılama oranı (Supression Ratio [SR]), preoperatif ve postoperatif 24. saat Mini Mental Test sonuçları, postoperatif yoğun bakım (post-anesthesia care unit [PACU]) yatış sürelerini ve komplikasyonlarını içeren parametreler karşılaştırıldı.
Bulgular: Hastaların yaş ortalaması (Grup H ve L’de sırasıyla 61 ve 65 yaş) her iki grupta da benzerdi (p=0.234). PSI Grup H’de 60., 120. dakikalarda ve fasya kapanışında anlamlı olarak daha düşük bulundu (sırasıyla p=0.004, p=0.001 ve p=0.000). PSI <25 süresi grup H’de anlamlı olarak daha yüksekti (grup H ve L’de sırasıyla 139.0±186.7 ve 17.6±54.8, p=0.001). SR>0 süresi Grup H’de anlamlı olarak daha yüksekti (p=0.000). Hem anestezi (474 dk) hem de ameliyat (432 dk) süreleri Grup H’de anlamlı olarak daha yüksekti (sırasıyla p=0.013 ve 0.029). Ameliyat sonrası 12. saatte bulantı ve kusma da Grup H’de yaygındı (p=0.008). Mini Mental Test de dahil olmak üzere karşılaştırılan diğer parametreler benzerdi.
Sonuç: MAC değerleri peroperatif ve erken postoperatif sonuçları anlamlı olarak etkilememiştir. Yüksek MAC seviyesi daha derin bir anestezi oluştururken, düşük MAC seviyesi daha düşük bir inhalasyon anestezi ajanı tüketimi sağlayarak etkili bir alternatif gibi görünmektedir.

Keywords

ERAS , radikal sistektomi , MAC , anestezi

Supporting Institution

YOK

Project Number

YOK

Thanks

Bu çalışmayı yapmakta desteklerini esirgemeyen klinik arkadaşlarıma ve uzun yıllardır birlikte çalıştığım üroloji camiasına teşekkürü borç bilirim Çalışmanın yayınlanmasında destek olan siz editör ve arkadaşlarına teşekkürler ve saygılar

Does Depth of Anesthesia Effect Clinical Results of Patients Who Underwent Radical Cystectomy in Accordance with Eras Protocols?

https://izlik.org/JA32HJ68HW

Abstract

Objective: To investigated whether low and high MAC (Minimum Aleveolar Concentration) level of anesthesia have an effect on the depth of anesthesia, clinical results paremeters in patients underwent radical cystectomy in accordance with ERAS (Enhanced Recovery After Surgery) protocols
Material and Methods: Retrospective data of 41 patients underwent radical cystectomy between 2019-2022 were collected, 35 of them were included. The patients were divided in two groups: Group H (1 MAC, n:18) and Group L (0.5 MAC, n:17). All patients were prepared and managed in line with ERAS protocols. Perioperative and early postoperative parameters including depth of anesthesia which was followed by PSI (Pneumonia Severity Index) and SR (Supression Ratio), preoperative and postoperative 24th hours Mini Mental Test results, post-anesthesia care unit (PACU) unit admission and duration and complications were compared.
Results: The mean age of the patients (61 and 65 years, in the Group H and L, respectively) were similar (p=0.234) in both groups. PSI was found to be significantly lower in Group H at the 60th, 120th minutes and fascia closure (p=0.004, p=0.001, and p=0.000 respectively). PSI <25 duration was significantly higher in group H (139.0±186.7 and 17.6±54.8 in group H and L, respectively, p=0.001). The duration of SR>0 was significantly higher in Group H (p=0.000). Both anesthesia (474 min) and surgery (432 min) times were significantly higher in Group H (p=0.013 and 0.029 respectivelly). Nausea and vomiting at 12 hours postoperatively was also common in Group H (p=0.008). The rest of parameters that compared were similar, including the minimental test.
Conclusion: The MAC values did not significantly affect perioperative and early postoperative outcomes. While high MAC level MAC level generates a deeper anesthesia, low MAC level seems an effective alternative providig a lower inhalation anestesia agent consumption.

Keywords

ERAS , radical cystectomies , MAC , anesthesia

Project Number

YOK

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