Laparoskopik abdominal cerrahilerde, intraabdominal basınç değişikliklerinin optik sinir kılıf çapı, serebral oksijen saturasyonu ve kognitif fonksiyonlara olan etkilerinin değerlendirilmesi
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Dosyalar
Tarih
2021
Yazarlar
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Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Laparoskopik abdominal cerrahi sırasında oluşturulan iyatrojenik intraabdominal basınç artışının kafa içi basınç, serebral oksijenizasyon ve erken postoperatif kognitif fonksiyon değişimlerine etkilerini inceleyerek; kognitif fonksiyonların normal düzeyde devamlılığı ve güvenli cerrahi uygulamalarına katkı sağlamak amaçlandı. Gereç ve Yöntemler: Genel anestezi altında laparoskopik abdominal cerrahi planlanan 20-60 yaş aralığında 50 hasta çalışmaya katıldı. Operasyon öncesi ve operasyondan 24 saat sonra yatışlarının bulunduğu serviste SMMT uygulandı. Hastalar ameliyat odasına alındıktan sonra standart anestezi monitörizasyonuna ilave olarak NIRS ile sağ ve sol frontal rScO2 monitorizasyonu yapıldı. Operasyon sırasında EtCO2 33-40 mm Hg olacak şekilde ventilatör frekans düzenlemelerine izin verildi. OSKÇ ölçümü, her bir göz için horizontal ve vertikal olmak üzere iki ölçüm yapıldı. Ölçüm zamanları genel anestezi indüksiyonu öncesi (T0), genel anestezi indüksiyonundan 5 dakika sonra (T1), CO2 pnömoperitoneum oluşturulduktan 5 dakika sonra (T2), CO2 pnömoperitoneum oluşturulduktan 30 dakika sonra (T3) ve batın desuflasyonundan 5 dakika sonra (T4) olmak üzere tekrarlanan ölçümlerle kaydedildi. Genel anestezi indüksiyonu sonrasında İAB intravezikal olarak ölçüldü. Sonuçlar: İntraserebral basıncı değerlendirmek için OSKÇ'nin ultrasonografik olarak ölçümleri alındığında pnömoperitoneumun başlangıcından itibaren OSKÇ artışının olduğu, bununla birlikte pnömoperitoneumun sonlanması ile başlangıç değerine geri döndüğü tespit edildi. NIRS ile serebral perfüzyon açısından bu değişim değerlendirildiğinde ise pnömoperitoneumun 5. dk sında serebral oksimetre değerlerinde anlamlı azalma tespit edilirken sonraki dönemlerde artışa geçtiği görüldü. OSKÇ ve rScO2 arasında uyumsuz ve zıt değişim, pnömoperitoneum oluşturulduktan sonra 5. dakikadan itibaren artarak devam ettiği tespit edildi ancak aralarında anlamlı bir korelasyon bulunmadı. Pnömoperitoneumun OSKÇ artışına neden olmakla birlikte serebral perfüzyonun korunduğu ve değişimlerle korele SMMT değişikliği tespit edilmedi. Çıkarımlar: Çalışmamız sonucunda; laparoskopik girişimlerde pnömoperitoneumun uygulamasına bağlı İAB ile eş zamanlı OSKÇ artışına karşın rSO2 değerlerinde azalma beklenirken aksine artış gözlenmiştir. POKD açısından SMMT ile OSKÇ ve İAB parametreleri arasında korelasyon bulunmamıştır.
Objective: It was aimed to contribute to the maintenance of cognitive functions at an optimal level and safe surgical practices through investigating the impacts of iatrogenic intra-abdominal pressure elevation generated during laparoscopic abdominal surgery on intracranial pressure, cerebral oxygenation, and early postoperative cognitive function changes. Material and Methods: Fifty patients aged between 20 and 60 years who were scheduled for laparoscopic abdominal surgery under general anesthesia were included in the study. MMSE test was administered before and 24 hours after the procedure in the ward where the patients were hospitalized. In addition to standard anesthesia monitoring, right and left frontal rScO2 monitoring was performed using NIRS, following the patients were taken to the operating room. The ventilator frequency was set to ensure EtCO2 was 33-40 mm Hg throughout the operation. Two ONSD measurements, horizontal and vertical, were performed for each eye. Measurement times were recorded with repeated measurements before induction of general anesthesia (T0), 5 minutes after induction of general anesthesia (T1), 5 minutes after generation of pneumoperitoneum with CO2 (T2), 30 minutes after generation of pneumoperitoneum with CO2 (T3), and 5 minutes after abdominal desufflation (T4). Following the induction of general anesthesia, IAP was measured noninvasively. Results: When ultrasonographic measurements of the ONSD were obtained to assess the intracerebral pressure, it was found out that there was an elevation in ONSD from the onset of the pneumoperitoneum; however, it returned to the baseline value upon the termination of the pneumoperitoneum. Upon evaluating this change in terms of cerebral perfusion through NIRS, a significant decrease was detected in cerebral oximetry values in the 5th minute of pneumoperitoneum, whereas it increased in the following periods. It was determined that the incompatible and inverse change between rScO2 and ONSD continued to increase from the 5th minute after the pneumoperitoneum was created, but there was no significant correlation between the two variables. Although the pneumoperitoneum led to an increase in ONSD, it was found out that cerebral perfusion was stable and there was no correlative change in MMSE scores. Conclusion: Consequently, a decrease was expected in rSO2 values contrary to the increase in ONSD concurrently with IAP levels due to the application of pneumoperitoneum in laparoscopic interventions; however, an increase was observed in rSO2 values. No correlation was determined between MMSE scores and ONSD as well as IAP parameters in terms of POCD.
Objective: It was aimed to contribute to the maintenance of cognitive functions at an optimal level and safe surgical practices through investigating the impacts of iatrogenic intra-abdominal pressure elevation generated during laparoscopic abdominal surgery on intracranial pressure, cerebral oxygenation, and early postoperative cognitive function changes. Material and Methods: Fifty patients aged between 20 and 60 years who were scheduled for laparoscopic abdominal surgery under general anesthesia were included in the study. MMSE test was administered before and 24 hours after the procedure in the ward where the patients were hospitalized. In addition to standard anesthesia monitoring, right and left frontal rScO2 monitoring was performed using NIRS, following the patients were taken to the operating room. The ventilator frequency was set to ensure EtCO2 was 33-40 mm Hg throughout the operation. Two ONSD measurements, horizontal and vertical, were performed for each eye. Measurement times were recorded with repeated measurements before induction of general anesthesia (T0), 5 minutes after induction of general anesthesia (T1), 5 minutes after generation of pneumoperitoneum with CO2 (T2), 30 minutes after generation of pneumoperitoneum with CO2 (T3), and 5 minutes after abdominal desufflation (T4). Following the induction of general anesthesia, IAP was measured noninvasively. Results: When ultrasonographic measurements of the ONSD were obtained to assess the intracerebral pressure, it was found out that there was an elevation in ONSD from the onset of the pneumoperitoneum; however, it returned to the baseline value upon the termination of the pneumoperitoneum. Upon evaluating this change in terms of cerebral perfusion through NIRS, a significant decrease was detected in cerebral oximetry values in the 5th minute of pneumoperitoneum, whereas it increased in the following periods. It was determined that the incompatible and inverse change between rScO2 and ONSD continued to increase from the 5th minute after the pneumoperitoneum was created, but there was no significant correlation between the two variables. Although the pneumoperitoneum led to an increase in ONSD, it was found out that cerebral perfusion was stable and there was no correlative change in MMSE scores. Conclusion: Consequently, a decrease was expected in rSO2 values contrary to the increase in ONSD concurrently with IAP levels due to the application of pneumoperitoneum in laparoscopic interventions; however, an increase was observed in rSO2 values. No correlation was determined between MMSE scores and ONSD as well as IAP parameters in terms of POCD.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
