Laparoskopik kolesistektomilerde düşük ve yüksek akımlı anestezinin postoperatif bulantı-kusma ve titreme üzerine olan etkilerinin karşılaştırılması
Comparison of the effects of the low and high flow anesthesia on nausea-vomiting and shivering in laparoscopic cholecystectomy
Yazar: ÖNDER ÖZEN
Danışman: YRD. DOÇ. DR. RAUF GÜL
Gaziantep Üniversitesi / Tıp Fakültesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2011
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation
Dizin: Anestezi = Anesthesia ; Bulantı = Nausea ; Endoskopi = Endoscopy ; Kolesistektomi = Cholecystectomy ; Kusma = Vomiting ; Postoperatif komplikasyonlar = Postoperative complications ; Titremeler = Tremor

Özet:
Bu çalışmanın amacı laparoskopik yöntemle yapılan cerrahilerde desfluran kullanılarak yapılan yüksek ve düşük gaz akımlı anestezinin postoperatif bulantı kusma ve titreme üzerine olan etkilerini karşılaştırmaktır.ASA I-II risk grubunda 18-70 yaşları arasında 60 hasta çalışmaya dahil edildi. Preoksijenasyon sonrası, anestezi indüksiyonu propofol, fentanil ve vekuronyum ile yapıldı. Entübasyondan sonra, 6?10 L/dk %100 O2 ile denitrojenizasyon yapıldı ve yeterli anestezi derinliğine ulaşıldı. Hastalar rastgele iki gruba ayrılarak taze gaz akımı düşürüldü. Taze gaz akımı Grup D'de; 1 L/dk (0.5 L/dk O2 + 0.5 L/dk Hava + desfluran), Grup Y'de; 4 L/dk (2 L/dk O2 + 2 L/dk Hava + desfluran ) olarak ayarlandı.Hastaların giriş, entübasyon ve entübasyonu takiben 5., 10., 15.,20.,25., 30., 45., 60. dk hemodinamik değerleri (ETCO2 , SpO2, FiO2, KAH, OKB, vücut ısısı değişiklikleri) kaydedildi. Postoperatif ilk 24 saat içerisindeki Postoperatif 0.-30. dk, 30.-60.dk., 60.-120.dk., 2.-4.saat, 4.-6.saat, 6.-12. saat ve 12.-24. saat bulantı, kusma, VAS değerleri kaydedildi. Postoperatif 0-30., 30-45., 45-60. dk titreme oranları, vücut ısısı değerleri kaydedildi.Gruplar arasında demografik veriler açısından istatistiksel farklılık bulunamadı. Gruplar arası intraoperatif vücut ısısı değerleri karşılaştırıldığında 30.dk, 45.dk ve 60.dk'da grup D (düşük akım)'de grup Y (yüksek akım)'ye göre anlamlı olarak yüksekti. Grup içi intraoperatif vücut ısısı her iki gruptada anlamlı düşüktü. Gruplar arası postoperatif bulantı değerleri karşılaştırıldığında 0-30.dk arasında grup Y'de grup D'ye göre anlamlı olarak yüksekti. Gruplar arası postoperatif bulantı değerleri karşılaştırıldığında 0-30.dk arasında grup Y'de grup D'ye göre anlamlı olarak yüksekti. Gruplar arası postoperatif ısı değerleri karşılaştırıldığında 0.-30.dk arasında grup D'de grup Y'ye göre anlamlı olarak yüksekti. Gruplar arası postoperatif titreme oranları karşılaştırıldığında 0.-30.dk arasında grup D'de grup Y'ye göre anlamlı olarak düşüktü.Sonuç olarak, düşük akımlı anestezi grubunda, özellikle erken dönemde POBK'nın daha az görüldüğü sonucuna vardık. Bu durumun düşük akımlı anestezinin özellikle solunumsal ısı kaybını önlemesine bağlı olabileceğini düşünüyoruz. Bu grupda titreminin ve hipoterminin daha az olması bu tezimizi desteklemektedir. Ancak kesin bir yargıya varmak için daha ileri çalışmalara ihtiyaç duyulmaktadır.Anahtar Kelimeler: Desfluran, Düşük Akımlı Anestezi, Postoperatif Bulantı, Kusma, Titreme

Abstract:
The aim of this study is to compare the effects of high and low flow anesthesia in which desfluran is used during laparoscopic surgery, on postoperative nausea and vomiting and shivering.60 patients at ASA I-II group included during the study. Anesthetic induction was achieved by using propofol, fentanyl and vecuronium after preoxigenation. After the intubation, denitrogenation was achieved by using 100% oxygen at 6-10 L/min and adequate anesthetic depth was acquired. The patients were divided into two grups randomly and fresh gas flow was reduced. The fresh gas flow at Group D (low flow) was 1 L/min( oxygen 0.5 L/min, air 0.5 L/min plus desfluran); 4L/min (oxygen 2 L/min, air 2 L/min plus desfluran) at Group Y (high flow).The input and postintubation evaluation of the hemodynamic (ETCO2, SpO2, FiO2, HR, MAP and body temperature) parameters of the patients were obtained at 5, 10, 15, 20, 25, 30, 45, 60 minutes. After the operation, nausea, vomiting and VAS values were recorded during the first 24 hours at 0-30 minutes, 30-60 minutes, 2-4 hours, 6-12 hours and 12-24 hours. Postoperative shivering and body temperatures were recorded at 0-30 minutes, 30-45 minutes and 45-60 minutes.There was no significance between the groups from the aspect of the demographic parameters. Postoperative nausea of 0-30 minutes was significantly higher at Group Y than Group D. Postoperative body temperatures of Goup D at 0-30 minutes were significantly higher than Group Y. Postoperative shivering was significantly lower at Group D than Group Y at 0-30 minutes.As a result, we concluded that low flow anesthesia reduces the POBK at the early postoperative period. This situation may be connected to decreased respiratory heat loss because of low flow anesthesia. It supports our thesis that in the low flow anesthesia group shivering and hypothermia were less than other group. However, further studies are needed to make any definite conclusions.KEYWORDS: Desfluran, Low Flow Anesthesia, Postoperative Nausea, Vomiting and Shivering.IV. ABSTRACTCOMPARISON OF THE EFFECTS OF THE LOW AND HIGH FLOW ANESTHESIA ON NAUSEA-VOMITING AND SHİVERİNG IN LAPAROSCOPIC SURGERYÖnder ÖZEN, MDResidency Thesis; Department of Anesthesiology and ReanimationSupervisor: Assistant Prof. Dr. Rauf GÜL2011, 61 pagesThe aim of this study is to compare the effects of high and low flow anesthesia in which desfluran is used during laparoscopic surgery, on postoperative nausea and vomiting and shivering.60 patients at ASA I-II group included during the study. Anesthetic induction was achieved by using propofol, fentanyl and vecuronium after preoxigenation. After the intubation, denitrogenation was achieved by using 100% oxygen at 6-10 L/min and adequate anesthetic depth was acquired. The patients were divided into two grups randomly and fresh gas flow was reduced. The fresh gas flow at Group D (low flow) was 1 L/min( oxygen 0.5 L/min, air 0.5 L/min plus desfluran); 4L/min (oxygen 2 L/min, air 2 L/min plus desfluran) at Group Y (high flow).The input and postintubation evaluation of the hemodynamic (ETCO2, SpO2, FiO2, HR, MAP and body temperature) parameters of the patients were obtained at 5, 10, 15, 20, 25, 30, 45, 60 minutes. After the operation, nausea, vomiting and VAS values were recorded during the first 24 hours at 0-30 minutes, 30-60 minutes, 2-4 hours, 6-12 hours and 12-24 hours. Postoperative shivering and body temperatures were recorded at 0-30 minutes, 30-45 minutes and 45-60 minutes.There was no significance between the groups from the aspect of the demographic parameters. Postoperative nausea of 0-30 minutes was significantly higher at Group Y than Group D. Postoperative body temperatures of Goup D at 0-30 minutes were significantly higher than Group Y. Postoperative shivering was significantly lower at Group D than Group Y at 0-30 minutes.As a result, we concluded that low flow anesthesia reduces the POBK at the early postoperative period. This situation may be connected to decreased respiratory heat loss because of low flow anesthesia. It supports our thesis that in the low flow anesthesia group shivering and hypothermia were less than other group. However, further studies are needed to make any definite conclusions.KEYWORDS: Desfluran, Low Flow Anesthesia, Postoperative Nausea, Vomiting and Shivering.IV. ABSTRACTCOMPARISON OF THE EFFECTS OF THE LOW AND HIGH FLOW ANESTHESIA ON NAUSEA-VOMITING AND SHİVERİNG IN LAPAROSCOPIC SURGERYÖnder ÖZEN, MDResidency Thesis; Department of Anesthesiology and ReanimationSupervisor: Assistant Prof. Dr. Rauf GÜL2011, 61 pagesThe aim of this study is to compare the effects of high and low flow anesthesia in which desfluran is used during laparoscopic surgery, on postoperative nausea and vomiting and shivering.60 patients at ASA I-II group included during the study. Anesthetic induction was achieved by using propofol, fentanyl and vecuronium after preoxigenation. After the intubation, denitrogenation was achieved by using 100% oxygen at 6-10 L/min and adequate anesthetic depth was acquired. The patients were divided into two grups randomly and fresh gas flow was reduced. The fresh gas flow at Group D (low flow) was 1 L/min( oxygen 0.5 L/min, air 0.5 L/min plus desfluran); 4L/min (oxygen 2 L/min, air 2 L/min plus desfluran) at Group Y (high flow).The input and postintubation evaluation of the hemodynamic (ETCO2, SpO2, FiO2, HR, MAP and body temperature) parameters of the patients were obtained at 5, 10, 15, 20, 25, 30, 45, 60 minutes. After the operation, nausea, vomiting and VAS values were recorded during the first 24 hours at 0-30 minutes, 30-60 minutes, 2-4 hours, 6-12 hours and 12-24 hours. Postoperative shivering and body temperatures were recorded at 0-30 minutes, 30-45 minutes and 45-60 minutes.There was no significance between the groups from the aspect of the demographic parameters. Postoperative nausea of 0-30 minutes was significantly higher at Group Y than Group D. Postoperative body temperatures of Goup D at 0-30 minutes were significantly higher than Group Y. Postoperative shivering was significantly lower at Group D than Group Y at 0-30 minutes.As a result, we concluded that low flow anesthesia reduces the POBK at the early postoperative period. This situation may be connected to decreased respiratory heat loss because of low flow anesthesia. It supports our thesis that in the low flow anesthesia group shivering and hypothermia were less than other group. However, further studies are needed to make any definite conclusions.KEYWORDS: Desfluran, Low Flow Anesthesia, Postoperative Nausea, Vomiting and Shivering.