Nurçin GÜLHAŞ, Celaleddin SOYALP, Nureddin YÜZKAT

Major Ortopedik Cerrahilerde Anesteziyolog ve Cerrahın Kan Kaybı Tahminlerindeki Hata Paylarının Karşılaştırılması: Klinik Gözlemsel Çalışma

Amaç: Anesteziyolog ve cerrah intraoperatif dönemde farklı gözlem açılarına sahip olduğundan, klinik gözleme dayalı tahminleri büyük değişkenlikler içermektedir. Bu tahminlerin gerçek kan kaybını ne kadar doğru yansıtabildiği halen tartışılan bir konudur. Bu çalışmada, anesteziyolog ve cerrahın, perioperatif kan kaybı ve transfüzyon gerekliliği hakkındaki klinik gözlemlerinin, labora- tuvar sonuçları ile karşılaştırılması amaçlandı. Yöntem: Major ortopedik cerrahi planlanan, 60 olgu çalışmaya dahil edildi. Aynı anestezi uzma- nından ve aynı cerrahtan kan kaybı miktarını ve kan transfüzyonuna gerek duyulup duyulmadığı- nı perioperatif dönemde tahmin etmeleri istendi. Perioperatif hemoglobin değerleri ve total kan hacmi kullanılarak kan kaybı eşzamanlı hesaplandı. Anesteziyolog ve cerrahın tahminleri ile labo- ratuvara göre hesaplanan kan kaybı istatistiksel olarak karşılaştırıldı. Bulgular: Anesteziyolog ve cerrahın perioperatif ortalama kan kaybı volümü tahminleri, laboratuvar sonuçlarına göre hesaplanan kan kaybı volümünden daha düşük bulundu (p=0.01). Hesaplanan kan kaybı 600 mL’den az olduğunda tahminlerin daha yüksek, 600 mL’den yüksek olduğunda ise tahmin- lerin %20 daha düşük olduğu saptandı (p=0.01). Bulgularımıza göre, perioperatif kan kaybı tahmi- ninde yanılma oranı %28.72 olarak saptandı. Kan kaybı 1000 mL’den fazla olduğunda tahminde yanılma oranı %34.03; 1000 mL’den az olduğunda yanılma oranı %25.18 olarak bulundu. Sonuç: Major ortopedik cerrahilerde kan kaybı 1000 ml’den fazla olduğunda tahminde yanılma oranının arttığı, kan kaybını tahmin etmenin güçleştiği ve anesteziyoloğun cerrahtan daha iyi tahminde bulunduğu düşüncesindeyiz.

Comparison of the Error Rates of an Anesthesiologist and Surgeon in Estimating Perioperative Blood Loss in Major Orthopedic Surgeries: Clinical Observational Study

Objective: Since the anesthesiologist and surgeon have different observation angles in the intra-operative period, their predictions based on clinical observation vary greatly. Whether thesepredictions accurately reflect actual blood loss is still a matter of debate. The aim of this studywas to compare the clinical observations of anesthesiologists and surgeons on perioperativeblood loss and transfusion requirements with laboratory results.Methods: Sixty patients who were scheduled for major orthopedic surgery were included in thestudy. Same anesthesiologist and the same surgeon were asked to estimate the amount of bloodloss , and whether blood transfusion was needed during the perioperative period. The amount ofblood loss was calculated synchronously using the perioperative hemoglobin value and the totalblood volume. The blood loss estimates of the anesthesiologist and the surgeon were compared,with blood loss calculated in the laboratory.Results: The anesthesiologist’s and the surgeon’s estimates of perioperative mean blood lossvolume were found to be lower than the blood volume calculated in the laboratory (p=0.01).When the estimated blood loss was less than 600 mL, it was considered as overestimation, andwhen it was more than 600 mL then it was interpreted as 20% underestimation (p=0.01).According to our findings, the rate of error in the perioperative blood loss estimates was 28.72%.When the blood loss was more than 1000 mL, the error rate of predictions was 34.03%; when itwas less than 1000 mL, the error rate of predictions was 25.18%.Conclusion: We believe that when blood loss is more than 1000 mL in major orthopedic surgeries,the error in the estimation is increased, the amount of blood loss is difficult to predict, and theanesthesiologist makes a better prediction than the surgeon.

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