Preoperatif Uygulanan Sıvı Rejiminin Obezite Cerrahisi Geçirecek Olan Hastalarda Kardiyak Performansa Etkisi

Yıl 2024, Cilt: 26 Sayı: 3, 308 - 313, 24.12.2024

Muhammed Emin Zora , Bahar Öc , İlhan Ece , Hüseyin Yılmaz , Oğuzhan Arun , Ates Duman

Öz

Amaç: Opere edilecek olan hastaların intraoperatif ve postoperatif risklerini en aza indirmek için çabalamamız gerekmektedir. Giderek büyüyen bir sorun haline gelen obezite tedavisinde bariyatrik cerrahi, uygun hastalarda önerilen bir seçenek haline gelmiştir. Bu çalışmada, obez hastalarda kardiyak problemlerin sıklığını göz önünde bulundurarak, olası komplikasyonları preoperatif sıvı tedavisi yardımıyla en aza indirmek amaçlanmıştır.
Gereç ve Yöntemler: Amerikan Anesteziyologlar Derneği Fiziksel Statü Sınıflandırmaları 1-2 grubunda, 18-50 yaş arası, laparoskopik sleeve gastrektomi geçirecek olan, vücut kitle indeksi 30 ve üzeri obez 31 hasta çalışmaya dahil edildi. Hastalar kura yöntemiyle iki gruba ayrıldı. 1. gruba preoperatif dönemde sıvı tedavisi uygulanmadı. 2. gruba ise, preoperatif dönemde 3 saatte tamamlanacak şekilde ideal kilosuna göre saatte 10 ml/kg/saat intravenöz kristaloid sıvı uygulandı. 1. grup ve 2. grup hastalarda intraoperatif olarak belirli zamanlarda kardiyak output, stroke volüm varyasyonu, stroke volüm indeksi ölçümleri yapıldı. Bu parametreler gruplar arasında karşılaştırıldı.
Bulgular: FloTrac™ sensörü ile ölçülen kalp parametreleri arasında sadece ekstübasyon sonrası ölçülen stroke volüm varyasyonu değerlerinde gruplar arasında fark bulundu. Diğer değerler için gruplar arasında istatistiksel olarak anlamlı bir fark bulunmadı.
Sonuç: Preoperatif sıvı tedavisi alan ve almayan hastalar arasında, ameliyatın çeşitli zamanlarında ölçülen kardiyak output, stroke volüm varyasyonu ve stroke volüm indeksi değerleri benzerdir. Bu konuda daha farklı sıvı tedavi modellerine ve daha fazla hasta içeren kapsamlı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Obezite bariatrik cerrahi, kalp debisi, sıvı tedavisi, intraoperatif izlem

THE EFFECT OF PREOPERATIVE FLUID REGIMEN ON CARDIAC PERFORMANCE IN BARIATRIC SURGERY

Öz

Objective: We must strive to minimize the intraoperative and postoperative risks for patients who will undergo surgery. In the treatment of obesity, which is becoming an increasingly pressing issue, bariatric surgery has become a recommended option for suitable patients. This study aimed to minimize potential complications in obese patients by considering the frequency of cardiac problems and using preoperative fluid therapy.
Material and Methods: The study included 31 obese patients with a Body Mass Index of 30 or above, aged 18-50, who were in the American Society of Anesthesiologists Physical Status Classifications 1-2 group and were scheduled to undergo laparoscopic sleeve gastrectomy. Patients were randomly divided into two groups. The first group did not receive fluid therapy during the preoperative period. In the second group, intravenous crystalloid fluid was administered at a rate of 10 ml/kg/hour over 3 hours in the preoperative period, based on their ideal weight. Cardiac output, stroke volume variation, and stroke volume index measurements were taken at specific times intraoperatively in patients from both groups. These parameters were compared between the groups.
Results: Among the cardiac parameters measured with the FloTrac™ sensor, only the stroke volume variation values measured after extubation showed a difference between the groups. There was no statistically significant difference between the groups for the other values.
Conclusion: The cardiac output, stroke volume variation, and stroke volume index values measured at various times during the surgery are similar between patients who received preoperative fluid therapy and those who did not. There is a need for more comprehensive studies that involve different fluid therapy models and more patients in this area.

Anahtar Kelimeler

Obesity, bariatric surgery, cardiac output, fluid therapy, intraoperative monitoring

Kaynakça

• Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991-1998. JAMA. 1999;282(16):1519-1522
• Endokrinoloji T, Metabolizma Derneği. Obezite Tanı ve Tedavi Kılavuzu. 8th ed. Ankara, Miki Matbaacılık; 2019.
• Paeratakul S, Lovejoy JC, Ryan DH, Bray GA. The relation of gender, race, and socioeconomic status to obesity and obesity comorbidities in a sample of US adults. Int J Obes. 2002;26(9):1205-1210.
• Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008;93 (11 Suppl 1): s89-s96.
• Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg. 2005;241(2):219-226.
• Hattori K, Maeda T, Masubuchi T, et al. Accuracy and trending ability of the fourth-generation FloTrac/Vigileo system in patients with low cardiac index. J Cardiothorac Vasc Anesth. 2017;31(1):99-104.
• Ramsingh D, Alexander B, Cannesson M. Clinical review: Does it matter which hemodynamic monitoring system is used?. Critical Care 2013;17(2):208.
• Chamos C, Vele L, Hamilton M, Cecconi M. Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization. Perioper Med (Lond). 2013;2(1):19.
• Pösö T, Kesek D, Aroch R, Winsö O. Rapid weight loss is associated with preoperative hypovolemia in morbidly obese patients. Obes Surg. 2013;23(3):306-313
• Matot I, Paskaleva R, Eid L, et al. Effect of the volume of fluids administered on intraoperative oliguria in laparoscopic bariatric surgery: a randomized controlled trial. Arch Surg. 2012;147(3):228-234
• Nguyen NT, Perez RV, Fleming N, Rivers R, Wolfe BM. Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass. J Am Coll Surg. 2002;195(4):476-483.
• Sakka SG, Reinhart K, Meier-Hellmann A. Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients. Intensive Care Med 1999;25(8):843-846.
• Hofer CK, Senn A, Weibel L, Zollinger A. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac™ and PiCCOplus™ system. Crit Care. 2008;12(3):1-8.
• Huan S, Dai J, Song S, Zhu G, Ji Y, Yin G. Stroke volume variation for predicting responsiveness to fluid therapy in patients undergoing cardiac and thoracic surgery: a systematic review and meta-analysis. BMJ open. 2022;12(5):e051112.
• Takahashi H, Shida D, Tagawa K, Suzuki T. Hemodynamics of mesenteric traction syndrome measured by FloTrac sensor. J Clin Anesth. 2016;30:46-50
• Jain AK, Dutta A. Stroke volume variation as a guide to fluid administration in morbidly obese patients undergoing laparoscopic bariatric surgery. Obes Surg. 2010;20(6):709-715.
• Myrberg T, Lindelöf L, Hultin M. Effect of preoperative fluid therapy on hemodynamic stability during anesthesia induction, a randomized study. Acta Anaesthesiol Scand. 2019;63(9):1129-36.