AMELİYAT ÖNCESİ GÖĞÜS HASTALIKLARI KLİNİĞİ TARAFINDAN KONSÜLTE EDİLEN HASTALARIN RETROSPEKTİF OLARAK PULMONER RİSK FAKTÖRLERİ AÇISINDAN DEĞERLENDİRİLMESİ

Göğüs hastalıkları kliniğinden konsültasyonu istenen ve değerlendirilen hastalarda hangi risk faktörlerinin daha fazlaanestezi riski konusunda belirleyici olduğunun incelenmesi amaçlanmıştır.Yöntem: Daha önce pulmoner hastalık tanısı, prodüktif öksürük, balgam şikayetleri ve PA akciğer grafisinde patolojik görüntünedeniyle göğüs hastalıkları konsültasyonu istenmiş olan 60 hastanın preoperatif anestezi vizitinde alınan notlar geriye dönükolarak taranmış, anestezi riskine en çok etki eden faktörler açısından incelenmiştir.Bulgular: Anestezi riski üzerinde sırasıyla; yaşın, cinsiyetin, operasyon süresinin, sigara öyküsünün, hışıltılı solunumun, nefesdarlığının, biomass maruziyeti (bitki ve hayvan atıklarından oluşan organik yakıtın açık ocaklarda yakılması) ve yandaş hastalıköyküsünün istatistiksel olarak anlamlı etkisi görülmedi (p>0.05). İstatistiksel olarak yüksek riskli olma ihtimalini anlamlı olarakartıran öksürük, balgam, PA akciğer grafisi ve fizik muayenede patoloji, platelet düzeyi, FEV1 düzeyinin %70 ve daha düşükolması, FEV1/FVC'nin %65 ve daha düşük olması ve periferik oksijen saturasyonu ölçümleri aday risk faktörleri olarak regresyonmodeline dahil edildi. İleriye dönük adımsal elemeli yönteme göre preoperatif pulmoner riskini tahmin etmede en fazla belirleyiciolan risk faktörünün FEV1 düzeyinin %70 ve daha düşük olması ardından ise öksürük şikayeti olduğu gözlemlendi.Sonuç: Preoperatif pulmoner risklerin değerlendirilmesinde, spirometrik testlerin diğer etmenlere göre daha ön planda tutulduğubelirlenmiştir

ASSESSMENT OF PATIENTS WHO HAVE BEEN CONSULTED PREOPERATIVELY BY CHEST DISEASES CLINIC IN TERMS OF PULMONARY RISK FACTORS RETROSPECTIVELY

The aim of this study is to investigate which risk factors are more determinative in anaesthesia risks of patientswho have been requested Chest diseases consultations. Method: The notes taken during the preoperative anaesthesia visits of 60 patients who were previously diagnosed with pulmonarydisease and for whom chest diseases consultations are requested due to productive cough and phlegm compliant and detectedpathology in their PA chest X-rays were reviewed retrospectively, and were examined in terms of the most influencing risk factors.Results: No statistically significant effect of age, gender, duration of surgery, smoking history, wheezing, breath shortness,biomass exposure and associated disease history was seen on the risk of anesthesia (p>0.05). Parameters statistically increasingthe probability of high risk such as cough, phlegm, pathology in PA chest X-ray and physical examination, platelet level, FEV1level being less than 70%, FEV1/FVC being less than 65% and peripheral oxygen saturation measurements were added to theregression model as risk factors. It was observed that according to the forward looking stepwise elimination method, the mostdeterminative risk factor in the estimation of the preoperative pulmonary risk was observed to be FEV1 level being lower than70%; which was followed by the complaints of cough as the second most determinative risk factor.Conclusion: It is concluded that spirometric tests have been prioritised over other risk factors in determining the preoperativepulmonary risks

___

Qaseem A, Snow V, Fitterman N et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 2006 18;144(8):575-580.
Arslan S, Berk S, Bulut G et al. Üniversite hastanesinde yatağında istenen göğüs hastalıkları konsültasyonlarının değerlendirilmesi. Cumhuriyet Tıp Derg 2010; 32: 199-206.
Wiener-Kronish JP, Albert RK. Textbook of Respiratory Medicine. in: Preoperative evaluation. eds: Murray JF. Nadel JA. W.b..Volume 1. Saunders Company. Philadelphia. 2000; 883-894.
Smetana GW. Preoperative pulmonary evaluation: identifying and reducing risks for pulmonary complications. Cleve Clin J Med 2006; 73 (Suppl 1):36-41.
Mİller AM, Maalİe R, Pedersen T. Postoperative intensive care admittance: the role of tobacco smoking. Acta Anaesthesiol Scand 2001; 45(3): 345-348.
Kroenke K, Lawrence VA, Theroux JF et al. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med 1992; 152(5): 967-971.
Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144(8): 581-595.
Bapoje SR, Whitaker JF, Schulz T et al: Preoperative evaluation of the patient with pulmonary disease. Chest 2007; 132(5): 1637- 1645.
Warner DO, Warner MA, Barnes RD et al. Perioperative respiratory complications in patients with asthma. Anesthesiology 1996; 85(3): 460-467.
Khan Ma, Hussain Sf. Pre-Operative Pulmonary Evaluation. J Ayub Med Coll Abbottabad 2005; 17(4): 82-86.
Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999 115 (Suppl 5): 58-63.
Canet J, Gallart L, Gomar C. et al. ARISCAT Group.Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010; 113(6): 1338-1350.
Wong DH, Weber EC, Schell MJ et al. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995; 80(2): 276-284.
Chetta A. Tzani P. Marangio E. Carbognani P. Bobbio A. Olivieri D. Respiratory effects of surgery and pulmonary function testing in the preoperative evaluation. Acta Biomed 2006; 77(2): 69-74.
Hamoui N. Kim K. Anthone G. Crookes PF. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg 2003; 138(8): 891-897.
Archer C. Levy AR. McGregor M. Value of routine preoperative chest x-rays: a meta-analysis. Can J Anaesth 1993; 40(11): 1022- 1027.
Kocabas A. Kara K. Ozgur G. Sonmez H. Burgut R. Value of preoperative spirometry to predict postoperative pulmonary complications. Respir Med 1996; 90(1): 25-33.
Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997; 111(3): 564-571.