Tiroidektomi Sırasında Semi-Fowler Pozisyonunun Serebral Oksijenizasyona Etkileri

Yıl 2020, Cilt: 42 Sayı: 6, 645 - 651, 09.11.2020

Ferda Yaman Gülçin Aydın Faruk Pehlivanlı

https://doi.org/10.20515/otd.739333

Öz

Cerrahi prosedürü kolaylaştırmak için hastalara genel anestezi sırasında, Semi-Fowler durumda baş ve boynun hiperektansiyona getirilerek pozisyon verilir. Bu çalışmada tiroidektomi cerrahisi sırasında bu pozisyonda serebral oksijenasyondaki değişiklikleri belirlemeyi amaçladık. 22 hasta prospektif gözlemsel çalışmaya dahil edildi. Serebral oksijenizasyon monitorize edildi, sol ve sağ serebral bölgesel oksijen saturasyonları devamlı ölçüldü. Kalp hızı, ortalama arteriyel basınç, end-tidal karbondioksit değerleri ve başlangıçta, 15., 30., 90. dakikalarda ve ameliyat sonrası düzeltilmiş pozisyonda değerlendirildi. 90 dakika sonra, bazal değer ile karşılaştırıldığında sağ serebral oksijenizasyonda anlamlı düşüş görüldü (p ˂ 0.05). 30. dakika serebral oksijenizasyon değeri, 15. dakikaya göre anlamlı olarak düştü. 30. dakikada sol serebral oksijenizasyon değeri 15 dakikaya göre anlamlı olarak düştü (p < 0.05). 90. dakika sol serebral oksijenizasyon değeri 30. dakikaya göre anlamlı olarak azaldı (p <0.05). Her iki serebral tarafta da serebral oksijen saturasyonunda belirgin azalma, uzamış cerrahi süresi ile ilişkili olarak gösterilmiştir. Tiroidektomi cerrahisi için verilen pozisyon serebral oksijenasyonu etkiler. Yüksek riskli hastalarda pozisyonun etkileri bölgesel serebral oksijen saturasyonu ile belirlenebilir ve serebral iskemi önlenebilir. Yüksek riskli hastalar için önlemler alınmalıdır.

Anahtar Kelimeler

serebral oksijenizasyon, tiroidektomi, semi fowler pozisyon, genel anestezi

Effects of Semi-Fowler Position on Cerebral Oxygenation During Thyroidectomy

Öz

Patients are positioned with hyperextension of head and neck at Semi-Fowler state during general anaesthesia to facilitate the surgical procedure. We aimed to determine the changes of serebral oxygenation in this position during thyroidectomy surgery. 22 patients were recruited prospective observational study. Cerebral oxygenation were monitored, left and right cerebral regional oxygen saturation were measured continuously. Heart rate, mean arterial pressure, end-tidal carbondioxide were measured and evaluated at baseline, after positioning at 15th, 30th, 90th minutes and after surgery at corrected position. After 90 minutes, significant decrease was seen cerebral oxygenization right side compared to the baseline (p ˂ 0.05). 30th minute cerebral oxygenization right value decreased significantly compared to the 15th minute. 30th minute, cerebral oxygenization left value decreased significantly compared to 15 minutes (p ˃ 0.05). 90th minute cerebral oxygenization left value decreased significantly compared to the 30th minute (p < 0.05). Significant decrease in cerebral oxygen saturation in both cerebral sides had been shown in relation to prolonged surgery time. Cerebral oxygenation was effected by the position given for thyroidectomy surgery. High-risk patients can be detected by regional cerebral oxygen saturation and prevent cerebral ischemia. Precautions should be taken for high-risk patients.

Anahtar Kelimeler

Cerebral oxygenation; Thyroidectomy; Semi-Fowler position; General anesthesia

Kaynakça

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