Murat BAKIŞ, SİNEM SARI ÖZTÜRK, Ayhan Öznur CİLLİMOĞLU, Özgür ÖZBEY, Bakiye UĞUR, MUSTAFA OĞURLU

Major alt ekstremite cerrahisinde anestezi türünün postoperatif komplikasyonlara etkisi

Amaç: Major alt ekstremite cerrahisinde rejyonel anestezi genel anesteziye göre daha fazla tercih edilmektedir. Çalışmamızda rejyonel anestezinin major cerrahilerde genel anesteziye göre komplikasyon insidansı ile ilişkisini araştırmayı amaçladık. Yöntemler: Bu çalışmada 1 Ocak 2009-31 Aralık 2012 tarihleri arasında total diz protezi ve total kalça protezi ge- çiren 372 olgunun dosyaları retrospektif incelendi. Genel anestezi uygulanan hasta sayısı 118, rejyonel anestezi uygulanan hasta sayısı 254 idi. Hasta birden fazla kal- ça veya diz replasmanı geçirdiyse sadece ilk operasyon çalışmaya dahil edildi. Hastaların operasyon sonrası 30 gün süresince olan komplikasyonları araştırıldı. Hastaların yaşı, cinsiyeti, operasyon türü (unilateral, bilateral), ek hastalığı olup olmadığı, postoperatif komplikasyonlar bakıldı. Bulgular: Hastaların yaşı, cinsiyeti, sahip oldukları ek hastalıkları bakımından farklılık yoktu. total kalça protezi hastalarının 92 sine genel anestezi 135 hastaya rejyonel anestezi uygulanırken, total diz protezi yapılmış olan hastaların 26 sına genel anestezi, 119 una rejyonel anestezi uygulandığı görüldü (p=0,001). Postoperatif komplikasyonlar incelendiğinde; kardiyak atak hiçbir hasta grubunda yoktu. Pulmoner emboli ve eksitus genel anestezi uygulanan 7, rejyonel anestezi uygulanan 2 hastada tespit edildi. Cerrahi yeri enfeksiyonu genel anestezi uygulanan 9 hastada, rejyonel anestezi uygulanan 7 hastada saptandı ve bu farklar istatistiksel olarak anlamlı bulundu. Sonuç: Kliniğimizde major alt ekstremite cerrahisi geçiren hastalarda rejyonel ve genel anestezi uygulamalarında postop 1 aylık dönem süresince komplikasyonlar bakımından rejyonel anestezi lehine anlamlı fark bulundu.

The effect of anesthesia type on the postoperative complications of major lower extremity surgery

Objective: Regional anesthesia is preferred more than general anesthesia in major lower extremity surgery. In our study, we aimed to investigate the relationship incidence of complications between regional anesthesia and general anesthesia in major surgery. Methods: A total of 372 patients who underwent total hip or knee replacement from 1 January 2009 to 31 December 2012 were evaluated retrospectively in the study. The number of patients undergoing general anesthesia and regional anesthesia was respectively 118 and 254. If the patient has a history of more than one hip or knee replacements we were included only the first operation in the study. Postoperative complications were investigated over the course of 30 days. Patients age, sex, type of operation (unilateral, bilateral), whether additional disease, postoperative complications were evaluated. Results: There were no difference for patients age, sex and in terms of additional diseases. 92 patients general anesthesia and 135 patients regional anesthesia were performed to the patients who underwent total hip replacement, and 26 general anesthesia and 119 regional anesthesia is applied to patients who underwent total knee replacement (p=0.001). Postoperative complications are examined none of patients had no cardiac attack. Pulmonary embolism and death were found 7 in general anesthesia and 2 in regional anesthesia. Surgical site infection was found in 9 patients undergoing general anesthesia and 7 patients undergoing regional anesthesia and difference was statistically significant. Conclusion: In our clinic, regional and general anesthesia in patients undergoing major lower limb surgery applications observe significant difference in terms of complications during the postoperative period of 1 month.

PDF

___

1. Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int 2010;21:S555-72.
2. Howell SJ, Sear YM, Yeates D, et al. Risk factors for cardiovascular death after elective surgery under general anaesthesia. Br J Anaesth 1998;80:14-19.
3. Higuera CA, Elsharkawy K, Klika AK, et al. 2010 MidAmerica Orthopaedic Association Physician in Training Award: predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res 2011;469:1391-400.
4. Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int 2010;21:S555-572.
5. Hu S, Zhang ZY, Hua YQ, et al. A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 2009;91:935- 942.
6. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493.
7. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth 2000;84:450-455.
8. Atanassoff PG. Effects of regional anesthesia on perioperative outcome. J Clin Anesth 1996;8:446-455.
9. Altıntaş F. Total kalça protezi ve venöz tromboemboli. Turkiye Klinikleri J Surg Med Sci 2007;3:44-49.
10. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006;43:322-30.
11. Klatte TO, OLoughlin PF, Citak M, et al. 1-stage primary arthroplasty of mechanically failed internally fixated of hip fractures with deep wound infection: good outcome in 16 cases. Acta Orthop 2013;84:377-379.
12. Kabon B, Fleischmann E, Treschan T, et al. Thoracic epidural anesthesia increases tissue oxygenation during major abdominal surgery. Anesth Analg 2003;97:1812-1817.
13. Treschan TA, Taguchi A, Ali SZ, et al. The effects of epidural and general anesthesia on tissue oxygenation. Anesth Analg 2003;96:1553-1557,
14. Chang CC, Lin HC, Lin HW, Lin HC. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiology 2010;113:279-284.
15. Pugely AJ, Martin CT, Gao Y, et al. Differences in shortterm complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Joint Surg Am 2013;95:193-199.