Nihal GÖKBULUT ÖZASLAN, Filiz Banu ÇETİNKAYA ETHEMOĞLU

Endoskopik Endonazal Transsfenoidal Hipofiz Cerrahisinde Farklı End Tidal CO2 Değerlerinin Hemodinami ve Cerrahiye Etkileri

Amaç: Endoskopik endonazal transsfenoidal hipofiz cerrahisinde farklı aralıklardaki end tidal CO2 (etCO2) değerlerinin hemodinamiye ve cerrahiye etkisini incelemeyi amaçladık. Gereç ve Yöntem: Retrospektif olarak sellar rezeksiyon anındaki maksimum etCO2 değerlerine göre iki grup değerlendirildi. Grup 1:21hasta, etCO2 =25-37 mmHg ve Grup 2: 21 hasta ,etCO2=38-50 mmHg. Hastaların demografik özellikleri, anestezi indüksiyonu sonrası, sellar eksizyon anı ve ekstübasyon öncesi dönemlerde ortalama arter basıncı (OAB), nabız (KH), etCO2, pCO2 , total kanama miktarı, cerrahinin kolaylığı (iyi-orta-kötü) bilgisayar kayıtlarından, anestezi fişlerinden ve cerrahi raporlarından elde edilmiştir. Bulgular:İki grup arasında demografik veriler, komplikasyon ve kanama açısından fark bulunmamıştır. Sellar eksizyon anındaki arteryal pCO2 arasında ilişki saptanmıştır. Grup1’de 9 hastada, Grup2’de ise 12 hastada cerrahi memnuniyet “iyi”olarak değerlendirilmiştir. Sonuç: Yüksek etCO2 değerleri (38-50 mmHg) kitlenin cerrahi eksizyonunu kolaylaştırmış ve hemodinamiyi etkilememiştir. Cerrahi memnuniyeti artırmıştır. EtCO2 ‘yi normalden biraz daha yüksek tutmak bu vakalarda iyi bir seçim olabilir. İyi kurgulanmış prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

hipofiz cerrahisi, anestezi, etCO2, pCO2

The Effects of Different End Tidal CO2 Values on Hemodynamics and Surgery in Endoscopic Endonasal Transsphenoidal Pituitary Surgery

Objective : We aimed to examine the effect of different intervals of end tidal CO2 ( etCO2 ) values on hemodynamics and surgery in endoscopic endonasal transsphenoidal pituitary surgery. Material and Methods: Two groups were evaluated retrospectively according to the maximum etCO2 values at the time of sellar resection. Group 1: 21 patients, etCO 2 =25-37 mmHg and Group 2: 21 patients, etCO 2=38-50 mmHg. The demographic characteristics, mean arterial pressure (MAP), heart rate (HR), etCO2 , pCO2 at the time of anesthesia induction, sellar excision moment and pre-extubation periods , total amount of bleeding, ease of surgery (good-moderate-bad) obtained from computer records, anesthesia receipts and surgical reports. Results: There was no difference between the two groups in terms of demographic data, complications or bleeding. A relationship was found between arterial pCO2 at the time of sellar excision. Surgical satisfaction was evaluated as "good" in 9 patients in Group 1 and 12 patients in Group 2. Conclusion: High etCO 2 values (38-50 mmHg) facilitated surgical excision of the mass and did not affect hemodynamics. Surgery has increased satisfaction. Keeping EtCO2 slightly higher than normal may be a good choice in these cases. Well-designed prospective studies are needed.

Keywords:

pituitary surgery, anesthesia, etCO2, pCO2,

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