Yasli hastalarda preoksijenasyon; Uç dakika ve dört derin nefes tekniklerinin karşilaştirilmasi
Preoxygenation in the elderly; Comparison of the three minutes and four deep breath tecniques
Yazar: ASU ÖZGÜLTEKİN
Danışman: PROF. DR. YİLDİZ KOSE
İstanbul Üniversitesi / Cerrahpaşa Tıp Fakültesi / Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 1993
Konu: Anestezi ve Reanimasyon = Anesthesiology and Reanimation ; Anestezi ve Reanimasyon = Anesthesiology and Reanimation

Özet:
Yaşlı hastalarda iki preoksijenasyon yönteminin, üç dakika ve dört derin nefes tekniklerinin karşılaştırılması amacıyla ASA grup I ve II hastalardan oluşan 60 yaş üzeri 15'er kişilik iki grup ile çalışıldı.%100 oksijen, devreli bir anestezi sistemiyle ve yeniden solumayı engelleyecek bir akım hızında uygulandı.Oksijen saturasyonu pulse oksimetre ile takip edildi. Arteriel kan gazı örnekleri alındı.Arter kan basınçları ve nabız ile birlikte ölçümler hava solurken, preoksijenasyon sonrası, entübasyon sonrası, %97, %95, ve %93 saturasyonlarda kaydedildi. %93 saturasyon noktasına ulaşma hızları her iki grupta kaydedildi. 
Preoksijenasyonla ulaşılan pik saturasyonlar benzer olmakla birlikte, dört derin nefes grubunda saturasyonun bütün seviyelerine düşme daha süratli oldu( Üç dakika grubu: Ort:379,73±119,38 dakika; Dört derin nefes grubu: Ort:254±94,95 )(p<0,05)
Yaşlı hastalarda apne ile oluşan hipoksiye karşı korunmada preoksijenasyonda üç dakika %100 oksijen solunmasının dört derin nefes tekniğinden daha etkili olabileceği sonucuna varıldı.

Abstract:
Two preoxygenation tecniques were compared in elderly patients in order to find the superior one in terms of the avoidence of hypoxemia during anaesthesia induction and endotracheal intubation.Patients over 60 years of age were randomly divided into two groups: Group three minutes, n=15 and Group four deep breaths, n=15.Preoxygenation was applied with the anesthesia circuit, and with high flow 100% oxygen  to prevent rebreathing. Pulse oxymeter was used for following periferic oxygen saturation.Arterial blood was taken for blood gas analysis . Blood pressures and heart rates were recorded as well as the other measurements at the time points of air-breathing, after preoxygenation, after intubation, and at the saturations of 97%, 95%, 93%. Time to reach the periferic oxygen saturation of 93% were recorded in both groups.
Although the peak saturation levels reached after the both tecniques were similar in groups, the time to reach the desaturation point of93% was significantly shorter in Group four deep breaths ( Group three minutes: Mean:379,73±119,38 minutes; Group four deep breaths: Mean:254±94,95 )(p<0,05)
In conclusion, for the preoxygenation in  elderly patients to avoid hypoxia, breathing 100% oxygen for three minutes was found to be more effective than four deep breaths.
Preoxygenation in the elderly: Comparison of three minutes and four deep breath tecniques
Asu Özgültekin
University Of Health Sciences, Haydarpaşa Numune Training And Research Hospital, Anaesthesiology And Reanimation Department, Istanbul
INTRODUCTION: Preoxygenation with 100% O2 prior to induction is a standart procedure in anesthesia practice.With preoxygenation, alveolar washout of air mixture in functional residuel volume provides higher alveolar oxygen concentration up to 100% which leads to increased alveolar oxygen reserve, so during apnea, time to desaturation levels are delayed 
We studied two different preoxgenation methods in elderly patients, three minutes and four deep breaths to detect which one is more efficient in this patient group
METHODS: 30 patients over 60 years included in the study. ECG, TA, HR and SpO2 were monitorised.Data were recorded before preoxygenation,after induction,after intubation,and when SpO2 reached to 93%.Blood gas analysis also performed at the same time points.Time to reach to SpO2 levels of 97%,95%,93% were also recorded
In GrI(n=15), patients were asked to breath normally for three minutes, after the mask is tightly applied to the patients face.In GrII(n=15), they asked to take four deep breaths when ordered by the anaesthesist, then breath normally
Preoxygenation, ınduction and intubation were performed.The distal end of the tube was left open, the patients were not ventilated untıl SpO2 levels reach to 93%, then they ventilated with 100% oxygen and the study ended
RESULTS: The study was completed with 29 patients.There were no difference in demographic variables and Htc levels and time to apnea(p>0,05).Mean age was 65,8years(61-76)in GrI and 65,2years (60-74) in Gr II.
The hearth rates were different in two groups at the time points of SpO2 97%, 95%, and 93% and time to reach these desaturation points were significantly different in four deep breath group of patients (p<0,001;p<0,01,p<0,05).
DISCUSSION AND CONCLUSION: The physiological changes effect lung capacities and reserves in elderly patients.
We conclude that, as the effectiveness of vital capacity breaths were decreased in these patients, three minutes of tidal breats should be the method of choice for preoxygenation