İntraoperatif Sıvı Yönetiminin Değerlendirilmesi

Öz

ÖZ Giriş/Amaç:Büyük cerrahi işlemlerde, hemodinamik monitörizasyon ve hastanın ihtiyacına göre sıvı tedavisinin yapılması önerilmektedir. Biz intraoperatif sıvı tedavilerini gözden geçirmeyi ve intraoperatif sıvı ilkelerine farkındalığı arttırmayı amaçladık. Gereç ve Yöntemler:Genel anestezi uygulanan hastalar (393) çalışmaya dahil edildi. İntraoperatif sıvı uygulamaları, hastaların demografik özellikleri ve yapılmış olan operasyonun türüne göre verilmesi gereken sıvı miktarları ve türü belirlendi. Hastaların mevcut kayıtlarından verilmiş olan sıvı miktarlarına ait verilerle karşılaştırılma yapılarak sonuçlar analiz edildi. Bulgular:Çalışmamızda hastalara verilen ortalama sıvı miktarı 2677,61 ml (11,3 ml/kg/saat) olarak bulunmuştur. IV vazopressör kullanılan hastalarda intraoperatif verilen ortalama sıvı miktarlarının kullanılmayan hastalara göre daha yüksek olduğu görüldü (3477,27 ml). ASA-3 grubu hastalar ASA1-2 grubu hastalarla kıyaslandığında, ASA-3 grubu hastalara intraoperatif dönemde verilen sıvı miktarı yüksekti (2795 ml). Cerrahi tipi ve intraoperatif verilen sıvı miktarları karşılaştırıldığında; yüksek riskli cerrahi grubunda intraoperatif verilen sıvı miktarının anlamlı olarak daha yüksek olduğunu gözlendi (3601,65 ml). Sıvı yönetiminde liberal uygulamalara yakın değerlerde olduğumuzu söyleyebiliriz. Kristaloid kullanımı klinik pratiğimizde en sık tercih ettiğimiz sıvı tipi olarak karşımıza çıkmaktadır. Sonuç:Liberal ve restriktif sıvı rejimi kavramlarının değişkenliği, hedeflenen klinik ve fizyolojik parametrelerin standart olmaması nedeniyle kanıta dayalı kılavuz veya prosedüre özel bir sıvı tedavisi ortaya konamamıştır. Yüksek riskli hastalarda sıvı yönetimi için tek tip yaklaşım uygun olmayacaktır. Bizim çalışmamızda standart sıvı tedavisi uygulamaktayız, sonuçlarımız liberal sayılabilir. Hemodinamik monitorizasyon yöntemlerine ve hastanın sıvı gereksinimlerine dikkat edilerek replasman yapılmasının faydalı olacağını düşünmekteyiz. Anahtar Sözcükler: Sıvı, Liberal, Restriktif, Perioperatif, Kristalloid, Kolloid

Anahtar Kelimeler

• Sıvı
• Liberal
• Restriktif
• Perioperatif
• Kristalloid
• Kolloid

Evaluation of Intraoperative Fluid Management

Abstract

ABSTRACT Objective:Especially in large surgical procedures, it is recommended that the fluid treatment be performed according to the needs of the patient in the presence of hemodynamic monitoring during the operation. We aimed to review intraoperative fluid treatments and to increase awareness of intraoperative fluid management. Methods:The patients (393) who underwent general anesthesia were included in the study. According to the information of intraoperative fluid applications, the demographic characteristics of the patients and the amount and type of fluid that should be given according to the type of operation performed were determined. Results:In our study, the mean amount of fluid given to patients was found to be 2677.61 ml. The mean intraoperative fluid volume was higher in patients who were treated with IV vasopressors than in untreated patients (3477.27 ml). When compared with patients with ASA 1-2 group, the amount of fluid given to the patients in the ASA-3 group was high (2795 ml). Comparing the type of surgery and the amount of fluid given intraoperatively, we observed that the amount of intraoperative fluid was significantly higher in the high-risk surgical group (3601.65 ml). We can say that we are close to liberal practices as a liquid strategy. The use of balanced crystalloid with the closest content to plasma is the most preferred liquid type in our clinical practice. Conclusion:Due to the variability of the concepts of liberal and restrictive fluid regimen and the lack of standardized targeted clinical and physiological parameters, no specific evidence-based guideline or procedure specific fluid treatment could be demonstrated. In our study, we see that fluid replacement is performed under standard fluid treatment, which still can be considered liberal. We think that it can be useful to use hemodynamic monitoring methods more frequently in patients who need them, also in selected patient groups. Key Words: Fluid, Liberal, Restrictive, Perioperative, Crystalloid, Colloid

Keywords

• Fluid
• Liberal
• Restrictive
• Perioperative
• Crystalloid
• Colloid

Kaynakça

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