Genitoüriner cerrahide kullanılan povidon iyodürün tiroid hormonları üzerine etkisi var mıdır?

Abstract

Amaç: Povidon iyodür (PI) bir çok cerrahi operasyon öncesinde kullanılan bir antiseptiktir. Iyodun deriden absorbe olabildiği bilinmektedir. Bu çalışmada, skrotal deriyi içeren genitoüriner bölge cerrahisinde antiseptik olarak kullanılan PI’nın tiroid hormonları üzerine etkisini incelemeyi amaçladık. Aynı zamanda diğer bir antiseptik olan klorheksidin glokonat (CHG) ile PI’yı antiseptik özelliği yönünden karşılaştırdık.
Gereç ve Yöntemler: Herhangi bir tiroid patolojisi olmayan 77 hasta çalışmaya dahil edildi. Hastalar rastgele iki gruba bölündü. Grup A deri antiseptiği olarak PI kullandığımız 46 hasta, Grup B de CHG kullandığımız 31 hastadan oluşmakta idi. Hastaların göbek ile diz arası, skrotumu içine alacak şekilde, 50 ml antiseptik ile boyandı. PI grubunda operasyondan bir gün önce, operasyondan bir gün ve on dört gün sonra, serbest T3 (sT3), serbest T4 (sT4) ve tiroid stimulan hormon (TSH) düzeyleri ölçüldü. İki grup, yara yeri antiseptik etkinliği açısından karşılaştırıldı. Bulgular: Grup A da, sT3 düzeyi operasyondan 1 gün sonra anlamlı olarak düştü ( preop: 3.45±0.47 pg/ml vs postop 1. gün: 2.70±0.44 pg/ml, p=0.001). Postoperatif 14 üncü gün bazal değere yaklaştı (3.40±0.3 pg/ml, p=0.05). Buna karşın TSH ve sT4 değerlerinde istatistiksel fark yoktu. Her iki grupta Hastalık Kontrol ve Korunma Merkezi (Centers for Disease Control and Prevention) kriterlerine göre cerrahi alan enfeksiyonu saptanmadı.
Sonuç: Araştırmamızda PI, sT3 düzeylerini anlamlı derecede azaltmıştır. Bu nedenle cerrahi alan temizliğinde PI yerine CHG kullanılması önerilebilir.

Keywords

• Povidone iyodür
• klorheksidin diglukonat
• tiroid hormonları

Are there any effect of povidone iodine used in genitourinary surgery on thyroid hormones?

Abstract

Aim: Povidone-iodine (PI) is a preoperative topical antiseptic used in many surgical operations. It is known that iodine can be absorbed by skin. In this study, we aimed to investigate the effect of PI on thyroid hormones during genitourinary surgery incluiding scrotal skin. We also compared the antiseptic effect of PI and Chlorhexidine glauconate (CHG). 

Material and Methods: Seventy-seven patients without any thyroid disease were included in this study. The patients were divided into two groups by random allocation. Group A included 46 patients that uset PI and group B 31 patients that used CHG for skin disinfection. The operative site from umblicus to knee including scrotum painted with 50 ml of antiseptic solution. Thyroid stimulating hormone (TSH), free T3 (fT3) and free T4 (fT4) hormone levels were measured on the day before the operation and on the 1st and 14th day of postoperative period in the PI group. Two groups were compared for wound antiseptic efficacy. 

Results: One day after the operation,fT3 levels decreased significantly (preop: 3.45±0.47 pg/ml vs postop 1st day: 2.70±0.44 pg/ml, p=0.001) in group A. Post op 14th day, fT3 levels returned to basal value (3.40±0.3 pg/ml, p=0.05). However there was no significant difference in TSH and fT4 levels. In both groups no surgical site infections as defined by the Centers for Disease Control and Prevention (CDC) was developed. 

Conclusion: In our study, PI significantly reduced sT3 levels. For this reason, it may be advisable to use CHG instead of PI for cleaning the surgical field.

Keywords

• Povidone iodine
• chlorhexidine digluconate
• thyroid hormones

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