Obez hastalarda düşük akım ve normal akım anestezisinin etkinlik ve güvenirliliğinin araştırılması: Randomize bir çalışma
Abstract
Amaç: Vücut kitle indeksinin 30 ve üstü değerleri obezite olarak
tanımlanmaktadır. Obezlerde kilo ile beraber vücut yüzey alanı artar, böylece
bazal metabolik hız normal kiloda olanlara kıyasla daha yüksek hale gelir.
Düşük akım anestezisi (DAA), taze gaz akımının (TGA) 1L/dk’nın altında olduğu
anestezi yöntemidir. Literatürde, laparoskopik cerrahi uygulanan obez
hastalarda farklı gaz akımlarının etkilerini karşılaştıran çalışmalar çok
sınırlıdır. Çalışmamızın amacı, düşük akım anestezisinin obez hastalardaki
etkinlik ve güvenilirliğini incelemektir.
Materyal ve
Metod: Bu randomize prospektif
çalışmaya, laparaskopik kolesistektomi uygulanan, 18-65 yaş arası 100 hasta
dâhil edildi. Randomizasyon için kapalı zarf yöntemi kullanıldı. DAA uygulaması
TGA’nın 0.5 L/dk’dan verilmesi olarak tanımlanırken, normal akım anestezi (NAA)
TGA’nın 2 L/dk’dan verilmesi olarak
tanımlandı. 100 hasta randomize olarak 4 gruba ayrıldı. Grup 1: normal kilolu
ve DAA uygulan hastalar, Grup 2: normal kilolu ve NAA uygulanan hastalar, Grup
3: obez olup DAA uygulan hastalar, Grup 4: obez olup NAA uygulan hastalar.
Bulgular: Çalışmaya dâhil edilen hastaların hiçbirinde entübasyon sonrası
inspiratuar oksijen düzeyi (insO2) değeri %35’in altına düşmedi. Dolayısıyla da
hiçbir hastada hipoksi gözlenmedi. Bununla beraber; grup 2 hastalar ile
karşılaştırıldığında, grup 1 hastalarında anestezi süresi anlamlı olarak daha
uzun iken, desflurane tüketimi ise anlamlı olarak daha az idi. Benzer şekilde,
grup 4 hastalar ile karşılaştırıldığında, grup 3 hastalarında anestezi süresi
anlamlı olarak daha uzun iken, desflurane tüketimi ise anlamlı olarak daha az
idi.
Sonuç: Çalışmamızdan elde edilen bulgular DAA uygulamasının normal kilolu
hastalarda olduğu gibi, obez hastalarda da güvenle kullanılabileceğini ve maliyeti
düşürmede etkili bir yöntem olduğunu düşündürmektedir.
Supporting Institution
Yok
Project Number
Yok
Thanks
Yok
References
- 1- Lotia S, Bellamy CM. Anaesthesia and morbid obesity. Contin Educ Anaesth Crit Care Pain 2008;8(5):151-6
- 2- Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological. Can J Anaesth. 2012;59:974-96.
- 3- Tuncalı B, Pekcan YÖ, Ayhan A, Erol V, Yılmaz TH, Kayhan Z. Retrospective Evaluation of Patients who Underwent Laparoscopic Bariatric Surgery. Turk J Anaesthesiol Reanim. 2018;46(4):297-304.
- 4- Baum JA, Aitkenhead AR. Low-flow anaesthesia. Anaesthesia 1995;50:37-44.
- 5- Baum J.Low Flow Anaesthesia: The Theory and Practice of Low Flow, Minimal Flow and Closed System Anaesthesia.2nd ed. Butterworth-Heinemann; Oxford, Boston 2001.
- 6- Kılıç Y. A Reminder to Anesthesiologists: Low-Flow Anesthesia. J Clin Anal Med 2016;7(suppl 2): 183-5.
- 7- Dohrn N, Sommer T, Bisgaard J, Ronholm E, Larsen JF. Difficult Tracheal Intubation in Obese Gastric Bypass patients. Obes Surg. 2016; 26(11):2640-7.
- 8- Ortiz VE, Kwo J. Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiology. 2016;15:97.
- 9- Lo HC, Wang YC, Su LT, Hsieh CH. Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases. Surg Endosc 2012;26(11):3301-6.
- 10- Valenza F, Chevallard G, Fossali T, Salice V, Pizzocri M, Gattinoni L. Management of mechanical ventilation during laparoscopic surgery. Best Pract Res Clin Anaesthesiol. 2010;24(2):227-41.
- 11- Eichenberger A, Proietti S, Wicky S, Frascarolo P, Suter M, Spahn DR, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95(6):1788-92.
- 12- Dupont J, Tavernier B, Ghosez Y, Durinck L, Thevenot A, Moktadir-Chalons N, et al. Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane. Br J Anaesth 1999;82:355-9.
- 13- Juvin P, Vadam C, Malek L, Dupont H, Marmuse JP, Desmonts JM. Postoperative recovery after desflurane, propofol, or isoflurane anaesthesia among morbidly obese patients: a prospective randomized study. Anesth Analg 2000;91:714-9
- 14- Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998; 87: 654-60.
- 15- Duymaz G, Yağar S, Özgök A. Comparison of Effects of Low-Flow Sevoflurane and Low-Flow Desflurane Anaesthesia on Renal Functions Using Cystatin C. Turk J Anaesthesiol Reanim. 2017;45(2):93-7.
- 16- Cherian A, Badhe A. Low-flow anaesthesia at a fixed flow rate. Acta Anaesthesiol Scand 2009; 53: 1348–53.
- 17- Bahar S, Arslan M, Urfalioglu A, Gisi G, Oksuz G, Bilal B, et al. Low-flow anaesthesia with a fixed fresh gas flow rate. J Clin Monit Comput. 2019; 33(1):115-21.
- 18- Kupisiak J, Goch R, Polenceusz W, Szyca R, Leksowski K. Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy - a randomized controlled trial. Wideochir Inne Tech Maloinwazyjne. 2011;6(4):226-30.
- 19- Kazancıoğlu L, Batçık Ş, Erdivanlı B, Şen A, Dursun E. Comparison of the Effects of Minimal and High-Flow Anaesthesia on Cerebral Perfusion During Septorhinoplasty. Turk J Anaesthesiol Reanim. 2019;47(1):12-16.
- 20- Akbas S, Ozkan AS. Comparison of effects of low-flow and normal-flow anesthesia on cerebral oxygenation and bispectral index in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a prospective, randomized clinical trial. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):19-26.
- 21- Golembiewski J. Economic considerations in the use of inhaled anesthetic agents. Am J Health Syst Pharm. 2010;67(8 Suppl 4):S9-12.
- 22- Horwitz M, Jakobsson JG. Desflurane and sevoflurane use during low- and minimal-flow anesthesia at fixed vaporizer settings. Minerva Anestesiol. 2016;82(2):180-5.
- 23- Jeong JS, Yoon SW, Choi SL, Choi SH, Lee BY, Jeong MA. Comparison of emergence times with different fresh gas flow rates following desflurane anaesthesia. J Int Med Res. 2014; 42(6): 1285-93.
- 24- Jose O, Miyoshi E, Claudia RF. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: A comparative study. Anesth Analg 2002; 94:741-8.
- 25- Salvadori A, Fanari P, Fontana M, Buontempi L, Saezza A, Baudo S, et al. Oxygen uptake and cardiac performance in obese and normal subjects during exercise. Respiration. 1999;66(1):25-33.
- 26- de Souza E Silva CG, Franklin BA, de Araújo CG. Influence of central obesity in estimating maximal oxygen uptake. Clinics. 2016; 71(11):629-34.
- 27- Coussa M, Proietti S, Schnyder P, Frascarolo P, Suter M, Spahn DR, et al. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg. 2004;98(5):1491-5.
Investigation of the efficacy and safety of low-flow and normal-flow anesthesia in obese patients: A randomized trial
Abstract
Background: Body mass index values ≥30 are defined as obesity. In obese, body
surface area increases with weight; thus, the basal metabolic rate becomes
higher compared to those at normal weight. Low-flow anesthesia (LFA) is an
anesthetic method where fresh gas flow (FGF) is less than 1L /min. There are
limited studies in the literature comparing the effects of different gas flows
in obese patients undergoing laparoscopic surgery. The aim of this study was to
investigate the efficacy and safety of LFA in obese patients.
Materials and Methods: This randomized prospective study included 100
patients aged between 18-65 years undergoing laparoscopic cholecystectomy.
Sealed envelope method was used for randomization. LFA was defined as the
administration of FGF at 0.5 L/min, while normal flow anesthesia (NFA) was defined
as FGF at 2 L/min. 100 patients were randomly divided into 4 groups. Group 1: normal
patients with weight and LFA, Group 2: normal patients with weight and NFA,
Group 3: obese patients and LFA, Group 4: obese patients with and NFA.
Results: None
of the patients had an inspiratory oxygen level (insO2) value below 35% after
intubation. Therefore, hypoxia was not observed in any patient. However; when
compared to group 2, group 1 had significantly longer anesthesia time and lower
desflurane consumption. Similarly, when compared to group4, group 3 had
significantly longer anesthesia time and lower desflurane consumption.
Conclusion: Our results suggest that LFA can be used safely in obese patients as
well as in normal weight patients and it is an effective method to reduce the
cost.
Project Number
Yok
References
- 1- Lotia S, Bellamy CM. Anaesthesia and morbid obesity. Contin Educ Anaesth Crit Care Pain 2008;8(5):151-6
- 2- Cullen A, Ferguson A. Perioperative management of the severely obese patient: a selective pathophysiological. Can J Anaesth. 2012;59:974-96.
- 3- Tuncalı B, Pekcan YÖ, Ayhan A, Erol V, Yılmaz TH, Kayhan Z. Retrospective Evaluation of Patients who Underwent Laparoscopic Bariatric Surgery. Turk J Anaesthesiol Reanim. 2018;46(4):297-304.
- 4- Baum JA, Aitkenhead AR. Low-flow anaesthesia. Anaesthesia 1995;50:37-44.
- 5- Baum J.Low Flow Anaesthesia: The Theory and Practice of Low Flow, Minimal Flow and Closed System Anaesthesia.2nd ed. Butterworth-Heinemann; Oxford, Boston 2001.
- 6- Kılıç Y. A Reminder to Anesthesiologists: Low-Flow Anesthesia. J Clin Anal Med 2016;7(suppl 2): 183-5.
- 7- Dohrn N, Sommer T, Bisgaard J, Ronholm E, Larsen JF. Difficult Tracheal Intubation in Obese Gastric Bypass patients. Obes Surg. 2016; 26(11):2640-7.
- 8- Ortiz VE, Kwo J. Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiology. 2016;15:97.
- 9- Lo HC, Wang YC, Su LT, Hsieh CH. Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases. Surg Endosc 2012;26(11):3301-6.
- 10- Valenza F, Chevallard G, Fossali T, Salice V, Pizzocri M, Gattinoni L. Management of mechanical ventilation during laparoscopic surgery. Best Pract Res Clin Anaesthesiol. 2010;24(2):227-41.
- 11- Eichenberger A, Proietti S, Wicky S, Frascarolo P, Suter M, Spahn DR, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95(6):1788-92.
- 12- Dupont J, Tavernier B, Ghosez Y, Durinck L, Thevenot A, Moktadir-Chalons N, et al. Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane. Br J Anaesth 1999;82:355-9.
- 13- Juvin P, Vadam C, Malek L, Dupont H, Marmuse JP, Desmonts JM. Postoperative recovery after desflurane, propofol, or isoflurane anaesthesia among morbidly obese patients: a prospective randomized study. Anesth Analg 2000;91:714-9
- 14- Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998; 87: 654-60.
- 15- Duymaz G, Yağar S, Özgök A. Comparison of Effects of Low-Flow Sevoflurane and Low-Flow Desflurane Anaesthesia on Renal Functions Using Cystatin C. Turk J Anaesthesiol Reanim. 2017;45(2):93-7.
- 16- Cherian A, Badhe A. Low-flow anaesthesia at a fixed flow rate. Acta Anaesthesiol Scand 2009; 53: 1348–53.
- 17- Bahar S, Arslan M, Urfalioglu A, Gisi G, Oksuz G, Bilal B, et al. Low-flow anaesthesia with a fixed fresh gas flow rate. J Clin Monit Comput. 2019; 33(1):115-21.
- 18- Kupisiak J, Goch R, Polenceusz W, Szyca R, Leksowski K. Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy - a randomized controlled trial. Wideochir Inne Tech Maloinwazyjne. 2011;6(4):226-30.
- 19- Kazancıoğlu L, Batçık Ş, Erdivanlı B, Şen A, Dursun E. Comparison of the Effects of Minimal and High-Flow Anaesthesia on Cerebral Perfusion During Septorhinoplasty. Turk J Anaesthesiol Reanim. 2019;47(1):12-16.
- 20- Akbas S, Ozkan AS. Comparison of effects of low-flow and normal-flow anesthesia on cerebral oxygenation and bispectral index in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a prospective, randomized clinical trial. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):19-26.
- 21- Golembiewski J. Economic considerations in the use of inhaled anesthetic agents. Am J Health Syst Pharm. 2010;67(8 Suppl 4):S9-12.
- 22- Horwitz M, Jakobsson JG. Desflurane and sevoflurane use during low- and minimal-flow anesthesia at fixed vaporizer settings. Minerva Anestesiol. 2016;82(2):180-5.
- 23- Jeong JS, Yoon SW, Choi SL, Choi SH, Lee BY, Jeong MA. Comparison of emergence times with different fresh gas flow rates following desflurane anaesthesia. J Int Med Res. 2014; 42(6): 1285-93.
- 24- Jose O, Miyoshi E, Claudia RF. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: A comparative study. Anesth Analg 2002; 94:741-8.
- 25- Salvadori A, Fanari P, Fontana M, Buontempi L, Saezza A, Baudo S, et al. Oxygen uptake and cardiac performance in obese and normal subjects during exercise. Respiration. 1999;66(1):25-33.
- 26- de Souza E Silva CG, Franklin BA, de Araújo CG. Influence of central obesity in estimating maximal oxygen uptake. Clinics. 2016; 71(11):629-34.
- 27- Coussa M, Proietti S, Schnyder P, Frascarolo P, Suter M, Spahn DR, et al. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg. 2004;98(5):1491-5.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Project Number | Yok |
| Publication Date | December 25, 2019 |
| Submission Date | September 3, 2019 |
| Acceptance Date | October 25, 2019 |
| Published in Issue | Year 2019 Volume: 16 Issue: 3 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty