Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Laparoskopik ve Açık Abdominal Cerrahide Perioperatif Vücut Sıcaklığı Değişikliklerinin Erken Dönem Etkilerinin Karşılaştırılması; Prospektif Gözlemsel Çalışma
Comparison of Early Effects of Perioperative Body Temperature Changes in Laparoscopic and Open Abdominal Surgery
Demet YÜNCÜa, Süheyla KARADAĞ ERKOÇa, Onat BERMEDEa, Yeşim BATİSLAMa
aAnkara Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon ABD, Ankara, TÜRKİYE
Turkiye Klinikleri J Anest Reanim. 2021;19(1):26-35
doi: 10.5336/anesthe.2021-82434
Article Language: TR
Full Text
ÖZET
 Amaç: Hipotermi anestezi uygulamaları sırasında sık karşılaşılan, morbidite ve mortalitede artma ile ilişkili termoregülatuar bir bozukluktur. Bu çalışmada, açık ya da laparoskopik majör cerrahi uygulanan hastalarda, vücut sıcaklıklarında ve derlenme zamanları arasında farklılık olup olmadığı araştırıldı. Gereç ve Yöntemler: Genel Cerrahi ve Üroloji Ameliyathanelerinde; en az 2 saat süren abdominal cerrahi uygulanan, 18-65 yaş arası, Grup 1: Laparoskopik (n=38) ve Grup 2: Açık (n=34) olmak üzere toplam 72 hasta çalışmaya dâhil edildi. Hastalar, alttan ısıtıcı sirkülasyonlu su sistemi ile 38°C de ısıtıldı. Laparoskopik cerrahilerde karın içi basınçları 12-15 mmHg olacak şekilde standardize edildi. Ameliyat odasının ortam sıcaklığı 20-22 °C arasında standardize edildi. Hastaların vücut sıcaklıkları, perioperatif dönemde timpanik termometre ile ölçüldü. Bulgular: Demografik veriler, peroperatif vücut sıcaklıkları, verilen intravenöz sıvılar, kanama miktarı, analjezik miktarı, premedikasyonda bekleme süreleri, derlenme ünitesinde kalma süreleri, Aldrete skorları bakımından gruplar arasında anlamlı fark bulunmadı (p>0,05). Laparoskopik cerrahi uygulanan hastalarda, vizüel analog skala ağrı skoru anlamlı olarak daha düşüktü ve operasyon süresi daha uzundu (p<0,05). Açık cerrahi süredeki 10 dk'lık artış vücut ısısında ortalama 0,006±0,002 derece düşüşe neden oldu (%95 güven aralığı: 0,002; 0,01; p=0,004). Laparoskopik cerrahi süredeki 10 dk'lık artış vücut ısısında ortalama 0,005±0,002 derece artışa neden oldu (%95 güven aralığı: 0,001; 0,008; p=0,007). Sonuç: Cerrahi süresinin artması, açık cerrahi sırasında vücut sıcaklıklarının düşmesine neden olabilir. Cerrahi öncesinde, vücut sıcaklığının optimizasyonu ve intraoperatif ısıtma sistemlerinin kullanılması, laparoskopik ve açık ameliyatlarda hipotermiyi ve olumsuz sonuçları önlemede etkili yöntemlerdir.

Anahtar Kelimeler: Perioperatif dönem; hipotermi; derlenme odası
ABSTRACT
 Objective: Hypothermia is a thermoregulatory disorder that is frequently encountered during anesthesia and associated with morbidity and mortality. The aim of this study was to investigate the difference between open and laparoscopic major surgeries in terms of body temperature and recovery time. Material and Methods: Seventy- two patients, aged 18-65 years, who underwent open (n=38) or laparoscopic surgery (n=34) lasting longer than 2 hours at the General Surgery or Urology Operation Rooms were included. All patients were heated at 38 °C with a circulating water mattress heating system according to routine procedures. The intraabdominal pressure was maintained at 12-15 mmHg during laparoscopic surgeries. Operation room temperature was set at 20-22°C. Peroperative body temperature of the patients was measured with a tympanic thermometer. Results: Demographic data, peroperative body temperature, iv fluid replacement, amount of blood loss, analgesic usage, time at premedication, time at recovery unite, and Aldrete scores were similar between the groups (p>0.05). Visual analogue scale pain score was significantly lower and the operation time was longer in patients who had laparoscopic surgery (p<0.05). The 10-minute increase in open surgery duration caused an average decrease of 0.006±0.002 degrees in body temperature (95% CI: 0.002; 0.01; p=0.004). The 10-minute increase in laparoscopic surgery duration caused an average increase of 0.005±0.002 degrees in body temperature (95% CI: 0.001; 0.008; p=0.007). Conclusion: Increasing the operation time may cause the body temperature to decrease during open surgery. Preoperative body temperature optimization and the use of intraoperative warming systems are effective methods to prevent hypothermia and adverse consequences in laparoscopic and open surgeries.

Keywords: Perioperative period; hypothermia; recovery room
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