Katarakt operasyonlarında cerrahi örtü altında ölçülen end-tidal karbondioksit ve serebral oksimetre değerlerinin COVİD-19 pnömonisi geçirmiş ve geçirmemiş hastalarda karşılaştırılması
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Katarakt nedeniyle lokal anestezi altında, drape adı verilen hava geçirmez steril cerrahi örtü kullanılarak fakoemülsifikasyon operasyonu planlanan, COVID-19 pnömonisi geçirmiş (n=40) ve geçirmemiş (n=40) iki ana grup içinde, 2 lt/dak ve 4 lt/dak oksijen desteği verilen ikişer alt grup oluşturularak; end-tidal karbondioksit düzeylerinin, optik sinir kılıf çapı ölçüm değerlerinin, serebral/rejyonel oksimetre ve hemodinamik parametrelerinin ana ve alt gruplar arasında karşılaştırılması amaçlanmıştır. ASA I, II, III fizyolojik risk grubunda bulunan, 18 yaşından büyük, lokal anestezi altında fakoemülsifikasyon tekniğiyle tek gözünden katarakt cerrahisi geçirecek 80 hasta çalışmamıza dahil edildi. SARS-CoV-2 pnömonisi geçiren ve geçirmeyen 40'ar hasta içeren iki ana grup (Grup A ve Grup B) oluşturuldu. Her ana grup, operasyon süresince 2 lt/dak ve 4 lt/dak nazal oksijen desteği verilmek üzere blok rastgeleleştirme yöntemiyle ikişer alt gruba randomize edildi. Operasyon öncesinde drape örtülmeden ve operasyon bitiminde opere edilmeyecek olan gözün optik sinir kılıf çapı ultrasonografik olarak ölçülerek kaydedildi. Operasyon boyunca SAB, DAB, OAB, KAH; CapnostreamTM20p cihazı üzerinde ETCO2, IPI, SS, SpO2; Masimo O3 Root Monitor® (ABD) serebral/rejyonel oksimetri cihazı üzerinde hastaların sağ ve sol olmak üzere her iki temporofrontal bölgeden alınan rSO2, ?HHbi, ?O2Hbi, ?cHbi, ?Base% değerleri değerleri takip edilerek, 5 dakika ara ile kaydedildi. Ana gruplar arasında hemodinamik veriler incelendiğinde; SAB, DAB, OAB, KAH açısından anlamlı fark bulunmamıştır. Ancak 2 lt/dak oksijen desteği alan alt gruplar arasında DAB açısından anlamlı farklılık bulunmuştur (p=0.002). ETCO2, IPI, SS, SpO2 , rSO2-sağ ve rSO2-sol değerleri açısından hem ana grup hem de alt gruplar arasında istatistiksel olarak anlamlı farklılık gözlenmemiştir. ?HHbi-sağ değeri, Grup A'da Grup B'ye göre 10. dakikada anlamlı olarak daha yüksek bulunmuştur (p=0.002, p*=0.003). 2 lt/dak O2 alan grupların karşılaştırmasında Grup A-2'de Grup B-2'ye göre 35. dakikada daha yüksek ?HHbi-sağ değerleri tespit edilmiştir (p=0.003, p*<0.001). 4 lt/dak O2 alan grupların karşılaştırmasında Grup A-4'te Grup B-4'e göre 10. dakikada daha yüksek ?HHbi-sağ değerleri tespit edilmiştir (p=0.006, p*=0.004). Optik sinir kılıf çapı preoperatif ve postoperatif ölçümleri açısından ana gruplar ve alt gruplar arasında yapılan karşılaştırmalarda herhangi bir istatistiksel olarak anlamlı farklılık saptanmamıştır. Benzer demografik özellikte olan, COVID-19 geçirmiş (geçirilmiş hastalığın ağırlığı açısından benzer) ve geçirmemiş hastalardan oluşan ana gruplar ve 2 lt/dak veya 4 lt/dak oksijen desteği verilen alt gruplar arasında, primer çıktılarımız olan ETCO2 ve optik sinir kılıf çapı açısından istatistiksel ve klinik olarak anlamlı bulunmamıştır. Sekonder çıktılar olan hemodinamik bulgular, solunumsal parametreler ve serebral oksijenasyon parametreleri açısından istatistiksel olarak anlamlı fark gösteren parametreler de dahil olmak üzere, klinik olarak anlamlı farklılığa neden olacak fizyolojik sınırların dışına çıkan bir fark saptanmamıştır. Çalışmamızda operasyon başlangıcı ve sonu arasında belli aralıklarla ölçülen end-tidal karbondioksit değerlerinde her grupta yapılan istatistiksel analizlerde anlamlı fark saptanmasa da gruplar kendi içinde incelendiğinde operasyon boyunca end-tidal karbondioksit düzeyinde artış olduğu görülmüştür. Optik sinir kılıfı çapının ölçümü sonuçlarında da benzer şekilde gruplar arasında istatistiksel olarak fark görülmemekle birlikte, grafik gösterimde de dikkat çektiği üzere her grup için operasyon boyunca optik sinir kılıf çapında artış izlenmektedir. Çalışmamızda beklenen ETCO2 artışı gerçekleşmediğinden dolayı, optik sinir kılıf çapında buna bağlı gelişmesi öngörülen artış da izlenmemiştir. Ancak çalışmamız ile literatür arasındaki bu çelişkinin çalışmamızdaki operasyon sürelerinin her iki ana grupta 36 dakika gibi görece kısa bir süre olmasından kaynaklandığını düşünmekteyiz.
Introduction and purpose: From two main groups who had COVID-19 pneumonia (n=40) and those who did not (n=40) and who, due to cataracts, were planned to undergo a phacoemulsification operation using an airtight sterile surgical cloth called a drape under local anasthesia, two subgroups were formed who were given 2 lt/min and 4 lt/min oxygen support. The aim of this study was to compare end-tidal carbon dioxide levels, optic nerve sheath daimeter measurement values, cerebral/regional oximetry and haemodynamic parametres between main and subgroups. 80 patients in the ASA I, II, III physiological risk group, over 18 years of age, who would undergo cataract surgery on one eye with the phacoemulsification technique under local anesthesia, were included in our the study. Two main groups (Group A and Group B) were created, each containing 40 patients with and without SARS-CoV-2 pneumonia. Each main group was randomised into two subgroups by block randomisation method to receive 2 lt/min and 4 lt/min nasal oxygen support during the operation. Before the operation, the optic nerve sheath diameter of the eye that would not be operated on was measured ultrasonographically before draping and recorded and was measured ultrasonographically and recorded again at the end of the operation. During the operation; systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), end-tidal carbon dioxide (ETCO2), integrated pulmonary index (IPI), respiratory rate (RR), peripheral oxygen saturation (SpO2) were monitored and recorded on CapnostreamTM 20p device; and similarly, tissue oxygen saturation (rSO2), measurement of the relative changes in deoxygenated hemoglobin (?HHbi), measurement of the relative changes in oxygenated hemoglobin (?O2Hbi), measurement of the relative changes in total hemoglobin as a sum of ?O2Hbi and ?HHbi (?cHbi), difference between current rSO2 and user-defined baseline (?Base%) values obtained from both temporofrontal regions of the patients, right and left, were monitored and recorded on Masimo O3 Root Monitor®(USA) cerebral/regional oximetry device, all at 5 minute intervals. When haemodynamic data is examined between the main groups there was no significant difference in terms of SAP, DAP, MAP and HR. However,a significant difference was found in terms of DAP between the subgroups receiving 2 lt/min oxygen support (p=0.002). No statistically significant difference was observed between both the main group and the subgroup in terms of ETCO2, IPI, RR, SpO2, rSO2-right and rSO2-left values. ?HHbi-right value was found to be significantly higher in Group A than in Group B at the 10th minute (p=0.002, p*=0.003). In the comparison of groups receiving 2 lt/min O2, higher ?HHbi-right values were detected at the 35th minute in Group A-2 compared to Group B-2 (p=0.003, p*<0.001). In the comparison of groups receiving 4 lt/min O2, higher ?HHbi-right values were detected at the 10 minute in Group A-4 compared to Group B-4 (p=0.006, p*0.004). No statistically significant difference was found in the comparisons made between the main groups and subgroups in terms of preoperative and postoperative measurements of optic nerve sheath diameter. There were no statistically and clinically significant differences in our primary outcomes, ETCO2 and optic nerve sheath diameter, between the main groups of patients with similar demographic characteristics, with and without COVID-19 (similar in terms of severity of the illness), and between subgroups receiving 2 lt/min or 4 lt/min oxygen supplementation. In terms of secondary outcomes, including haemodynamic findings, respiratory parameters and cerebral oxygenation parameters, there were no statistically significant differences beyond physiological limits that would cause clinically significant differences. In our study, although no significant difference was found in the end-tidal carbon dioxide values measured at certain intervals between beginning and end of the operation in the statistical analysis performed in each group, a nonsignificant increase in the end-tidal carbon dioxide level was observed throughout the operation. Similarly, there was no statistical difference between the groups in the results of optic nerve sheath diameter measurements, but there was an increase in the optic nerve sheath diameter for each group throughout the operation as shown in the graphical representation. Since the expected statistically significant increase in ETCO2 did not occur in our study, the predicted increase in optic nerve sheath diametre was not observed. However, we consider that this contradiction between our study and the literature is due to the relatively short operation time of 36 minutes in both main groups.
Introduction and purpose: From two main groups who had COVID-19 pneumonia (n=40) and those who did not (n=40) and who, due to cataracts, were planned to undergo a phacoemulsification operation using an airtight sterile surgical cloth called a drape under local anasthesia, two subgroups were formed who were given 2 lt/min and 4 lt/min oxygen support. The aim of this study was to compare end-tidal carbon dioxide levels, optic nerve sheath daimeter measurement values, cerebral/regional oximetry and haemodynamic parametres between main and subgroups. 80 patients in the ASA I, II, III physiological risk group, over 18 years of age, who would undergo cataract surgery on one eye with the phacoemulsification technique under local anesthesia, were included in our the study. Two main groups (Group A and Group B) were created, each containing 40 patients with and without SARS-CoV-2 pneumonia. Each main group was randomised into two subgroups by block randomisation method to receive 2 lt/min and 4 lt/min nasal oxygen support during the operation. Before the operation, the optic nerve sheath diameter of the eye that would not be operated on was measured ultrasonographically before draping and recorded and was measured ultrasonographically and recorded again at the end of the operation. During the operation; systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), end-tidal carbon dioxide (ETCO2), integrated pulmonary index (IPI), respiratory rate (RR), peripheral oxygen saturation (SpO2) were monitored and recorded on CapnostreamTM 20p device; and similarly, tissue oxygen saturation (rSO2), measurement of the relative changes in deoxygenated hemoglobin (?HHbi), measurement of the relative changes in oxygenated hemoglobin (?O2Hbi), measurement of the relative changes in total hemoglobin as a sum of ?O2Hbi and ?HHbi (?cHbi), difference between current rSO2 and user-defined baseline (?Base%) values obtained from both temporofrontal regions of the patients, right and left, were monitored and recorded on Masimo O3 Root Monitor®(USA) cerebral/regional oximetry device, all at 5 minute intervals. When haemodynamic data is examined between the main groups there was no significant difference in terms of SAP, DAP, MAP and HR. However,a significant difference was found in terms of DAP between the subgroups receiving 2 lt/min oxygen support (p=0.002). No statistically significant difference was observed between both the main group and the subgroup in terms of ETCO2, IPI, RR, SpO2, rSO2-right and rSO2-left values. ?HHbi-right value was found to be significantly higher in Group A than in Group B at the 10th minute (p=0.002, p*=0.003). In the comparison of groups receiving 2 lt/min O2, higher ?HHbi-right values were detected at the 35th minute in Group A-2 compared to Group B-2 (p=0.003, p*<0.001). In the comparison of groups receiving 4 lt/min O2, higher ?HHbi-right values were detected at the 10 minute in Group A-4 compared to Group B-4 (p=0.006, p*0.004). No statistically significant difference was found in the comparisons made between the main groups and subgroups in terms of preoperative and postoperative measurements of optic nerve sheath diameter. There were no statistically and clinically significant differences in our primary outcomes, ETCO2 and optic nerve sheath diameter, between the main groups of patients with similar demographic characteristics, with and without COVID-19 (similar in terms of severity of the illness), and between subgroups receiving 2 lt/min or 4 lt/min oxygen supplementation. In terms of secondary outcomes, including haemodynamic findings, respiratory parameters and cerebral oxygenation parameters, there were no statistically significant differences beyond physiological limits that would cause clinically significant differences. In our study, although no significant difference was found in the end-tidal carbon dioxide values measured at certain intervals between beginning and end of the operation in the statistical analysis performed in each group, a nonsignificant increase in the end-tidal carbon dioxide level was observed throughout the operation. Similarly, there was no statistical difference between the groups in the results of optic nerve sheath diameter measurements, but there was an increase in the optic nerve sheath diameter for each group throughout the operation as shown in the graphical representation. Since the expected statistically significant increase in ETCO2 did not occur in our study, the predicted increase in optic nerve sheath diametre was not observed. However, we consider that this contradiction between our study and the literature is due to the relatively short operation time of 36 minutes in both main groups.
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
