Laparoskopik kolesistektomi yapılan hastalarda hiperventilasyonun postoperatif bulantı-kusma üzerine etkisi

Amaç: Laparoskopik kolesistektomi uygulanan hastalarda postoperatif bulantı-kusma (POBK) insidansı yüksek olarak bildirilmektedir (% 46-72). Bu çalışmada intraoperatif dönemde kontrollü mekanik ventilasyonda düşük end-tidal karbondioksit (ETCO2) oluşturulmasının laparoskopik kolesistektomi sonrası gelişebilen bulantı-kusmayı önleme etkisi araştırıldı. Metod: Laparoskopik kolesistektomi planlanan 60 ASA I-II hasta Grup Y (ETCO2 35-45 mmHg) ve Grup D (ETCO2 25-30 mmHg) olmak üzere iki gruba zarf usulü ile randomize edildi. Anestezi indüksiyonu tiyopental ve rokuronyum ile yapıldı. İdamede izoşuran ve O2-N2O inhalasyonu karışımı kullanıldı. Hedeşenen ETCO2 düzeyleri oluşturulacak şekilde ventilatör ayarları yapıldı. İntraoperatif dönemde hemodinamik değişkenler ve ETCO2 değerleri izlendi ve kaydedildi. Bulantı ve kusma, cerrahi sonrası 5., 15., 30., 45. ve 60. dakikalarda ve 2., 6., 12. ve 24. saatlerde kaydedildi. Cerrahi sonrası ilk 24 saatteki antiemetik (ondansetron 4 mg) kullanımı takip edildi. Veriler Mann Whitney U ve Ki-kare testleri ile de¤erlendirildi ve p

The effects of hyperventilation for prexenting nause and vomiting with patients undergoing laparoscopic cholecystectomy

Aim: In patients undergoing laparoscopic cholecystectomy, high incidences of PONV have been reported (46-72 %). The aim of this study was to evaluate the effects of low ETCO2 in prevention of nausea and vomiting after laparoscopic cholecystectomy. Methods: 60 ASA I-II patients undergoing laparoscopic cholecystectomy were randomly allocated to Group Y (ETCO2 35-45 mmHg) or Group D (ETCO2 25-30 mmHg). Anaesthesia induction was performed with thiopental and rocuronium, anaesthesia was further maintained with isoflurane in O2-N2O inhalation. Ventilatory settings were done in both groups to achieve the targeted ETCO2 levels. Hemodynamic variables, blood pressure, heart rate and peripheral oxygen saturation and ETCO2 levels were noted during the intraoperative period. The incidence of nausea and vomiting were assessed at 5, 15, 30, 45 and 60th minutes and 2, 6, 12 and 24th hours after surgery. Total antiemetic consumption (ondansetron 4 mg) was noted at 24 hours after surgery. Mann Whitney U and Chi-Square tests were used and p<0.05 was considered as significant. Results: Patient demographics, operation times and hemodynamic variables were comparable among groups. The area under ETCO2 versus time curve was higher in Group Y (p<0.001). The total ondansetron consumption in postoperative period was higher in Group Y compared to Group D (4mg, 0-8, 0mg, 0-4mg) (p=0.006). The number of patient demonstrating nausea postoperatively was higher in Group Y (n=20 vs n=10) (p=0.01). Number of nausea attacks per patient was higher in Group Y (2, 0-5) compared to Group L (0, 0-1) (p=0.002). Conclusion: The results of this study reveal that, intraoperative low ETCO2 levels may reduce the incidence of nausea and the consumption of antiemetic drugs in laparascopic cholecystectomy cases.

Kaynakça

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