Kulak burun boğaz cerrahisi geçiren pediatrik hastalarda intraoperatif uygulanan sıvı volümünün postoperatif kusmaya etkisi

Öz

Giriş ve Amaç:Çocuklarda postoperatif bulantı ve kusmayı önlemek için, uluslararası kılavuzlarda intravenöz sıvı tedavisi önerilmektedir. Fakat, sıvı tedavisinin uygun miktarı henüz belli değildir. Bu gözlemsel çalışmanın amacı, adenoidektomi, tonsillektomi ve adenotonsillektomi yapılan çocuklarda intraoperatif intravenöz sıvı uygulamasının postoperatif kusma üzerine etkisini değerlendirmektir.

Yöntem ve Gereçler: Genel anestezi altında elektif adenoidektomi, tonsillektomi ve adenotonsillektomi yapılacak, 2-10 yaş arası 160 çocuk, intraoperatif infüzyon uygulamasına göre, düşük volümlü (grup 1 = 10 ml/kg/s) veya yüksek volümlü (grup 2 = 20 ml/kg/s)% 0.9 NaCl solüsyonu olarak randomize edildi. Standart bir anestezi protokolü uygulandı. Tüm hastaların kusma ve ağrı skorları değerlendirildi.

Bulgular: Anestezi sonrası bakım ünitesinde (PACU) birinci ve 15. dakikadaki kusma sıklığı, kısıtlı sıvı alan grup 1 hastalarda grup 2 hastalardan anlamlı derecede yüksekti. Anestezi sonrası bakım ünitesinde (PACU) 1. ve 15. dakikada çocuk hastanesi doğu ontario ağrı ölçeği (CHEOPS) skorları, grup 2'de grup 1'den anlamlı yüksek bulundu (p = 0.021, p = 0.026). Ancak, iki grup arasında CHEOPS skorlarıyla ilgili daha sonraki zamanlarda anlamlı bir fark bulunmadı.

Sonuç: Sonuçlarımız, intraoperatif 20 ml/kg/saat % 0.9 NaCl solüsyonu uygulamasının, adenoidektomi, tonsillektomi ve adenotonsillektomi uygulanan çocuklarda, postoperatif birinci ve 15. dakikalarda hafif kusma şikayetini azaltmada yararlı olabileceğini desteklemektedir.

Anahtar Kelimeler

• postoperatif kusma,çocuklar,intravenöz sıvı

The effect of intraoperative fluid volume on postoperative vomiting in pediatric patients undergoing otorhinolaryngological surgery

Öz

Aim:Intravenous fluid therapy is recommended in international guidelines to prevent the postoperative nause and vomiting in children. But the proper amount of fluid therapy is not clear yet. The aim of this observational study is to evaluate the effect of intraoperative intravenous fluid administration on postoperative vomiting in children after adenoidectomy, tonsillectomy and adenotonsillectomy.

Material and Methods: 160 children, aged between 2-10 years, undergoing elective adenoidectomy, tonsillectomy and adenotonsillectomy under general anaesthesia were randomized to administration of intraoperative infusions of low-volume (group 1=10 ml/kg/h) or high volume (group 2=20/ml/kg/h) 0.9 % NaCl solution. A standardized anaesthesia protocol was performed. The vomiting and pain scores of all patients were evaluated.

Results: The frequency of vomiting in patients who received limited fluid in group 1 was significantly higher than those in group 2 at first and 15^th minute in post-anesthesia care unit (PACU). The Children’s Hospital East Ontario Pain Scale (CHEOPS) scores at 1^st and 15^th minutes of PACU were significantly higher in group 2 than in group 1 (p = 0.021, p = 0.026) However, no significant difference was found between the two groups regarding CHEOPS scores at the further time-points.

Conclusion: Our results suggest that intraoperative administration of 0.9% NaCl solution at a rate of 20 ml/kg/h can be useful in reducing mild vomiting complaint in the postoperative first and 15^th minutes in children undergoing adenoidectomy, tonsillectomy, and adenotonsillectomy.

Anahtar Kelimeler

• postoperative vomiting,children,intravenous fluid

Kaynakça

1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States,2006. Natl Health Stat Report. 2009;(11):1-25.
2. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.
3. Mythen MG. Postoperative gastrointestinal tract dysfunction: an overview of causes and management strategies. Cleve Clin J Med. 2009; 76(4): 66–71.
4. Elgueta MF, Echevarría GC, De la Fuente N, et al. Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy. Br J Anaesth. 2013 ;110(4):607-14. doi: 10.1093/bja/aes453.
5. Gan TJ, Diemunsch P, Habib AS, et al. Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014 ;118(1):85-113. doi: 10.1213/ANE.0000000000000002.
6. McGrath PJ, Jhonson G, Goodman JT, et al. CHEOPS: A behavioral scale for rating postoperative pain in children. In: Fields HL, Dubner R, Cervero F, editors.Advances in pain research and therapy. vol. 9. New York: Raven Press; 1985:395-402.
7. Dagher CF, Abboud B, Richa F, et al. Effect of intravenous crystalloid infusion on postoperative nausea and vomiting after thyroidectomy: a prospective, randomized, controlled study. Eur J Anaesthesiol. 2009; 26(3): 188–91.
8. McCaul C, Moran C, O’Cronin D, et al. Intravenous fluid loading with or without supplementary dextrose does not prevent nausea, vomiting and pain after laparoscopy. Can J Anaesth. 2003; 50(5): 440–4.

9. Yogendran S, Asokumar B, Cheng DC, et al. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg. 1995; 80(4): 682–6.
10. Goodarzi M, Matar MM, Shafa M, Townsend JE, Gonzalez I. A prospective randomized blinded study of the effect of intravenous fluid therapy on postoperative nausea and vomiting in children undergoing strabismus surgery. Paediatr Anaesth. 2006; 16(1): 49–53.
11. Bianchetti MG, Bettinelli A. Differential diagnosis and management of fluid, electrolyte, and acid-base disorders. In: Comprehensive Pediatric Nephrology 1st edn. Geary DF, Schaefer F, eds. Philadelphia: Mosby; 2008. 395- 431.
12. Egeli E, Harputluoglu U, Ozturk O, et al. Can post-adenotonsillectomy morbidity be reduced by intravenous 24 h hydration in pediatric patients following adenotonsillectomy?. Int J Pediatr Otorhinolaryngol. 2004; 68(8): 1047–51.
13. Hayes I, Rathore R, Enohumah K, et al. The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery - a prospective randomized trial. BMC Anesthesiol. 2012 31;12:15. doi: 10.1186/1471-2253-12-5.
14. Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg. 1995; 130(4): 423–9.
15. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regi-mens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5): 641–8.
16. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resec-tion: a randomised controlled trial. Lancet 2002;359(9320):1812–8.
17. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid manage-ment on outcome after intraabdominal surgery. Anesthe-siology 2005;103(1):25–32.
18. Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ. 1997 11;315(7113):909-12.
19. Diez L. Assessing the willingness of parents to pay for reducing postoperative emesis in children. Pharmacoeconomics 1998; 13(5 Pt 2): 589–95.