Septoplasti Cerrahi Vakalarında Hacim Kontrollü ve Basınç Kontrollü Venti-lasyonun Serebral Oksijen Satürasyonu, Perfüzyon İndeksi ve Pleth Değişken-lik İndeksi Üzerindeki Etkilerinin Değerlendirilmesi: Gözlemsel Prospektif Çalışma

Öz

Amaç: Bu çalışma, genel anestezi altında septorinoplasti geçiren hastalarda iki ventilasyon stratejisi boyunca plet variabilite indeksi (PVI), perfüzyon indeksi (PI) ve rejyonel serebral oksijen satürasyonu (rSO₂) güvenilirliğini değerlendirmek amacıyla yapılmıştır. Materyal ve Metod: İndüksiyondan sonra, hastalara 20 dakika boyunca hacim kontrollü modda venti-lasyon uygulandı ve bu süre boyunca kalp atım hızı (HR), PI, PVI, periferik oksijen satürasyonu (SpO₂), non-invaziv kan basıncı (NIBP) ve rSO₂ 5 dakikalık aralıklarla kaydedildi. Ardından, ventilasyon 20 daki-ka boyunca basınç kontrollü moda geçirildi ve aynı aralıklarla ölçümler tekrarlandı. Bulgular: Amerikan Anesteziyologlar Derneği (ASA) I-III sınıflandırmasına sahip ve vücut kitle indeksi (BMI) 30'un altında olan 50 hasta çalışmaya dahil edildi. Ameliyat öncesi PI değerleri, her iki ventilas-yon stratejisinde de ameliyat sırasındaki kayıtlara kıyasla anlamlı olarak daha düşüktü (p<0,05). Ameli-yat öncesi PVI, sonraki ölçümlere göre daha yüksekti ve hacim kontrollü ventilasyon (VCV) sırasında 10. dakikada anlamlı olarak yükseldi (p<0,05). Sol taraf rSO₂ değerleri bazal değere göre kademeli bir düşüş gösterirken, sağ taraf rSO₂ değerleri kademeli bir artış gösterdi; ancak dalgalanmalar %10 içinde kaldı. Sonuç: HR, PI, PVI, SpO₂, NIBP ve rSO₂ gibi parametreler iki ventilasyon modu arasında birbirinin yerine kullanılamadı. Genel olarak, VCV'den basınç kontrollü ventilasyona (PCV) geçiş bu değişkenler-de önemli değişikliklere yol açmadı.

Anahtar Kelimeler

• ventilasyon
• plet variabilite indeksi
• perfüzyon indeksi
• rejyonel serebral oksijen satürasyonu

Evaluation of the Effects of Volume-Controlled and Pressure-Controlled Ventilation on Cerebral Oxygen Saturation, Perfusion Index, and Pleth Variability Index in Septoplasty Surgical Cases: An Observational Prospective Study

Öz

Background: This study aimed to assess the reliability of pleth variability index (PVI), perfusion index (PI), and regional cerebral oxygen saturation (rSO₂) across two ventilation strategies in patients un-dergoing septorhinoplasty under general anaesthesia. Materials and Methods: After induction, patients were ventilated with a volume-controlled mode for 20 minutes, during which heart rate (HR), PI, PVI, peripheral oxygen saturation (SpO₂), non-invasive blood pressure (NIBP), and rSO₂ were recorded at 5-minute intervals. Subsequently, ventilation was switched to a pressure-controlled mode for another 20 minutes with repeated measurements at the same intervals. Results: Fifty patients with American Society of Anesthesiologists (ASA) I–III classification and a body mass index (BMI) under 30 were included. Preoperative PI values were significantly lower compared with intraoperative recordings under both ventilation strategies (p<0.05). Preoperative PVI was higher than subsequent measurements, with significantly elevated values during volume-controlled ventilation (VCV) at the 10-minute mark (p<0.05). Left-sided rSO₂ values showed a gradual decrease relative to baseline, whereas right-sided rSO₂ demonstrated progressive increases; however, fluctua-tions remained within 10%. Conclusions: Parameters including HR, PI, PVI, SpO₂, NIBP, and rSO₂ were not interchangeable between the two ventilatory modes. Overall, the transition from VCV to pressure-controlled ventila-tion (PCV) did not yield significant alterations in these variables.

Anahtar Kelimeler

• ventilation mode
• pleth variability index
• perfusion index
• regional cerebral oxygen saturation

Kaynakça

1. 1. Huang HS, Chu CL, Tsai CT, Wu CK, Lai LP, Yeh HM. Perfusion index derived from a pulse oximeter can detect changes in peripheral micro circulation during uretero-renal-scopy Stone manipulation (URS-SM). PLoSOne. 2014;9(12):e115743.
2. 2. Broch O, Bein B, Gruenewald M, Höcker J, Schöttler J, Mey-bohm P, et al. Accuracy of the pleth variability index to pre-dict fluid responsiveness depends on the perfusion index. Ac-ta Anaesthesiol Scand 2011; 55(6): 686-693.
3. 3. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007;11(4):274-281.
4. 4. Forget P, Lois F, de Kock M. Goal Directed fluid management based on the pulse oximeter derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg 2010; 111(4): 910-914.
5. 5. Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesth Analg. 2009;108(2):549-553.
6. 6. Bataille B, Le Moal D, Renault T, Cocquet P, de Selle J, Silva S. Accuracy of pulse pressure variations for fluid responsiveness prediction in mechanically ventilated patients with biphasic positive airway pressure mode. J Clin Monit Comput. 2022;36(5):1479-1487.
7. 7. Monnet X, Guérin L, Jozwiak M, Bataille A, Julien F, Richard C, et al. Pleth variability index is a weak predictor of fluid res-ponsiveness in patients receiving norepinephrine. Br J Ana-esth. 2013;110(2):207-13
8. 8. Ganter MT, Geisen M, Hartnack S, Dzemali O, Hofer CK. Pre-diction of fluid responsiveness in mechanically ventilated cardiac surgical patients: the performance of seven different functional hemodynamic parameters. BMC Anesthesiol. 2018;18(1):55

9. 9. Han J, Hu Y, Liu S, Hu Z, Liu W, Wang H. Volume-controlled ventilation versus pressure-controlled ventilation during spi-ne surgery in the prone position: A meta-analysis. Ann Med Surg (Lond). 2022;78:103878. doi: 10.1016/j.amsu.2022.103878.
10. 10. AulerJúnior JO, Carmona MJ, Silva MH, Silva AM, do Amaral RV. Haemodynamic effects of pressure-controlled ventilation versus volume-controlled ventilation in patients submitted to cardiac surgery. Clin Intensive Care. 1995;6(3):100-6.
11. 11. Guillon A, Espitalier F, Ehrmann S, Masseret E, Laffon M. Influ-ence du mode de ventilation sur la variation respiratoire de la pression pulsée artérielle: étude randomisée [Influence of pressure- and volume-controlled ventilation on pulse pressu-re variations: randomized study]. Ann Fr Anesth Reanim. 2013;32(9):548-53.
12. 12. Godai K, Matsunaga A, Kanmura Y. The effects of hemodyna-mic management using the trend of the perfusion index and pulse pressure variation on tissue perfusion: a randomized pi-lot study. JA Clin Rep. 2019 ;5(1):72.
13. 13. Su L, Zhang R, Zhang Q, Xu Q, Zhou X, Cui N, et al. The Effect of Mechanical Ventilation on Peripheral Perfusion Index and Its Association With the Prognosis of Critically Ill Patients. Crit Care Med. 2019; 47(5):685-90.doi: 10.1097/CCM.0000000000003661.
14. 14. Chu H, Wang Y, Sun Y, Wang G. Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventila-ted patients: a systematic review and metaanalysis. J Clin Monit Comput 2016;30(3):265–74
15. 15. Nilsson LM, Lindenberger DM, Hahn RG. The effect of positive end-expiratory pressure and tripled tidal volume on pleth va-riability index during hypovolaemia in conscious subjects: a volunteer study. Eur J Anaesthesiol. 2013;30(11):671-7
16. 16. Rauch S, Seraglio PM, Dal Cappello T, Roveri G, Falk M, Bock M. Detection of fluid responsiveness by changes of perfusion index and pleth-variability index during passive leg raising in spontaneously breathing post-surgical patients: a prospective interventional study. J Clin Monit Comput. 2025 Apr 7. doi: 10.1007/s10877-025-01292-0. Epub ahead of print. PMID: 40192908.
17. 17. Mahmood SS, Pinsky MR. Heart-lung interactions during mec-hanical ventilation: the basics. Ann Transl Med. 2018;6(18):349. doi: 10.21037/atm.2018.04.29. PMID: 30370276; PMCID: PMC6186561.
18. 18. Wang X, Wang T and Jiang W. Non-Invasive Regional Cerebral Oxygen Saturation (rSO2) and Postoperative Neurological Dys-function. Gerontol Geriatr Res. 2020; 6(1): 1043.
19. 19. Abdallah NM, Elela AHA, Maghawry HH, Alkonaiesy RM. Effect of different mechanical ventilation modes on cerebral blood flow during thoracoscopic surgery in neonates: A randomised controlled trial. Indian J Anaesth. 2022;66(9):651-656.
20. 20. Bugiera M, Szczapa T, Sowińska A, Roehr CC, Szymankiewicz-Bręborowicz M. Cerebral oxygenation and circulatory parame-ters during pressure-controlled vs volume-targeted mechani-cal ventilation in extremely preterm infants. Adv Clin Exp Med. 2020 Nov;29(11):1325-1329.