65 yaş üzeri genel anestezi ile elektif cerrahi planlanan obez ve obez olmayan hastalarda oksijen rezerv indeksinin (ORİ) değerlendirilmesi
Başlık çevirisi mevcut değil.
- Tez No: 916482
- Danışmanlar: DOÇ. DR. AYŞE LAFÇI
- Tez Türü: Tıpta Uzmanlık
- Konular: Anestezi ve Reanimasyon, Anesthesiology and Reanimation
- Anahtar Kelimeler: Elderly, Hypoxia, Obesity
- Yıl: 2024
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Ankara Bilkent Şehir Hastanesi
- Ana Bilim Dalı: Anesteziyoloji ve Reanimasyon Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 51
Özet
Giriş ve Amaç: Hipoksemi, anestezi uygulanan hastalarda ciddi perioperatif komplikasyonlara neden olabilen bir durumdur. Oksijen rezerv indeksi (ORi) noninvaziv ve sürekli ölçüm yapabilen yeni bir parametredir ve hastalarda desatürasyon durumları için erken uyarı sağladığına dair bilgiler mevcuttur.Bu çalışmada elektif cerrahi planlanan 65 yaş üzeri obez (30 < VKİ < 40 kg/ m²) ve normal vücut kitle indeksine sahip (19 < VKİ < 25 kg/ m² ) hastalarda Oksijen Rezerv İndeksi (ORi)'nin nabız oksimetresine kıyasla yaklaşan desatürasyon için klinik olarak anlamlı şekilde ek uyarı süresi sağlayıp sağlamadığının belirlenmesi ve bu iki hasta grubunda erken uyarı sürelerininin birbiriyle karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışma için etik kurul onayı alındıktan sonra Sağlık Bilimleri Üniversitesi Ankara Şehir Hastanesi Onkoloji Ameliyathanesinde 1 Kasım 2023- 1 Mayıs 2024 tarihleri arasında 90 hastanın değerlendirildiği tek merkezli, prospektif, gözlemsel bir çalışmadır. 90 hasta Normal VKİ'ne sahip olan (19
Özet (Çeviri)
Introduction and Aim: Hypoxemia is a condition that can cause serious perioperative complications in anesthetized patients. Oxygen reserve index (ORi) is a new parameter that can be measured noninvasively and continuously, and there are reports that it provides early warning for desaturation states in patients.The aim of this study was to determine whether the Oxygen Reserve Index (ORi) provides clinically significant additional warning time for impending desaturation compared to pulse oximetry in obese (30 < BMI < 40 kg/m²) and normal body mass index (19 < BMI < 25 kg/m²) patients over 65 years of age scheduled for elective surgery and to compare the early warning times in these two patient groups. Materials and Methods: After obtaining ethics committee approval for the study, it is a single-center, prospective, observational study in which 90 patients were evaluated between November 1, 2023 and May 1, 2024 in the Oncology Operating Room of Health Sciences University Ankara City Hospital. The 90 patients were divided into 2 groups: those with normal BMI (19 < BMI < 25 kg/m² (GROUP 1)) and obese patients (30 < BMI < 40 kg/m² (GROUP 2)).After routine preoperative preparation, volunteer patients over 65 years of age with ASA II-III risk score in both sexes, who were to undergo elective surgery planned for endotracheal intubation under general anesthesia (GAA) were included in the study. Informed consent was obtained from all patients participating in the study. Patients who refused to participate in the study, patients younger than 65 years of age, patients with advanced heart failure and advanced pulmonary disease, patients with uncooperative conditions (e.g. dementia, Alzheimer's disease), patients with anticipated difficult airway were excluded from the study. After the patients completed the 8-hour preoperative fasting period, their age, gender, height, weight, BMI, comorbidities, ASA scores, and the operation to be performed were recorded and the patients were monitored. In addition to standard ASA monitoring (electrocardiogram, noninvasive blood pressure, pulse oximetry), a finger sensor (Rainbow® SET, Masimo Inc., Irvine, Ca., USA) was placed for ORi measurement. Patients received intravenous access via a 20 G cannula in the dorsal hand or forearm. SpO2 and ORi were recorded before preoxygenation. Preoxygenation was performed with FiO2 100% and oxygen from 6 L/min until EtO2 (endtidal oxygen) concentration reached at least 85%. At the end of preoxygenation, SpO2 and ORi were re-recorded when the ORi value plateaued for at least 30 seconds. Induction and mask ventilation were then performed. SpO2 and ORi values were recorded again before laryngoscopy. Patients were then intubated by the study coordinator. After the patients were intubated, the breathing circuit was connected and ventilated once, the location of the tube was verified, and the breathing circuit was disconnected from the endotracheal tube. Patients were allowed to be apneic until SpO2 was 94%. Times were recorded when the ORi alarmed, when SpO2 was 97% and when SpO2 was 94%. Simultaneous ORi value was recorded when SpO2 was 94%. After SpO2 was 94%, ventilation was started with FiO2 100% through the endotracheal tube. Meanwhile, SpO2 and ORi values were monitored, and after ORi remained at the plateau for 30 seconds, SpO2 and ORi were recorded simultaneously. ORi stimulus duration, SpO2 stimulus duration, tolerable apnea duration and additional stimulus duration provided by ORi were recorded. Results: ORi alerted before SpO2 dropped to 97% in all patients. Therefore, with ORi early notification, the ORi alert time was always longer than the SpO2 alert time. ORi provided a significant additional warning time both in patients with normal BMI and in obese patients. The additional warning time provided by ORi was 37.4 ± 20.4 seconds in patients with normal BMI and 44.0 ± 38.3 seconds in obese patients. Although there was no statistically significant difference, the additional warning time provided by ORi was longer in obese patients (p = 0.309). Tolerable apnea duration was shorter in obese patients (p < 0.001). Conclusion: In our study, ORi provided a significant additional warning time before impending desaturation in both normal BMI and obese patients over 65 years of age. Our findings suggest that ORi can function as a valuable adjunct to pulse oximetry and that the additional warning time provided may improve airway management, allowing earlier call for help from other experienced healthcare professionals, thus improving patient safety.
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