Mehmet TERCAN, Ayşe GÜSÜN HALİTOĞLU, Ahmet KAYA, Tuğba BİNGÖL TANRIVERDİ, Gülçin PATMANO

Obez hastalarda düşük akım ve normal akım anestezisinin etkinlik ve güvenirliliğinin araştırılması: Randomize bir çalışma

Amaç: Vücut kitle indeksinin 30 ve üstü değerleri obezite olarak tanımlanmaktadır. Obezlerde kilo ile beraber vücut yüzey alanı artar, böylece bazal metabolik hız normal kiloda olanlara kıyasla daha yüksek hale gelir. Düşük akım anestezisi (DAA), taze gaz akımının (TGA) 1L/dk’nın altında olduğu anestezi yöntemidir. Literatürde, laparoskopik cerrahi uygulanan obez hastalarda farklı gaz akımlarının etkilerini karşılaştıran çalışmalar çok sınırlıdır. Çalışmamızın amacı, düşük akım anestezisinin obez hastalardaki etkinlik ve güvenilirliğini incelemektir. Materyal ve Metod: Bu randomize prospektif çalışmaya, laparaskopik kolesistektomi uygulanan, 18-65 yaş arası 100 hasta dâhil edildi. Randomizasyon için kapalı zarf yöntemi kullanıldı. DAA uygulaması TGA’nın 0.5 L/dk’dan verilmesi olarak tanımlanırken, normal akım anestezi (NAA) TGA’nın 2 L/dk’dan verilmesi olarak tanımlandı. 100 hasta randomize olarak 4 gruba ayrıldı. Grup 1: normal kilolu ve DAA uygulan hastalar, Grup 2: normal kilolu ve NAA uygulanan hastalar, Grup 3: obez olup DAA uygulan hastalar, Grup 4: obez olup NAA uygulan hastalar.Bulgular: Çalışmaya dâhil edilen hastaların hiçbirinde entübasyon sonrası inspiratuar oksijen düzeyi (insO2) değeri %35’in altına düşmedi. Dolayısıyla da hiçbir hastada hipoksi gözlenmedi. Bununla beraber; grup 2 hastalar ile karşılaştırıldığında, grup 1 hastalarında anestezi süresi anlamlı olarak daha uzun iken, desflurane tüketimi ise anlamlı olarak daha az idi. Benzer şekilde, grup 4 hastalar ile karşılaştırıldığında, grup 3 hastalarında anestezi süresi anlamlı olarak daha uzun iken, desflurane tüketimi ise anlamlı olarak daha az idi. Sonuç: Çalışmamızdan elde edilen bulgular DAA uygulamasının normal kilolu hastalarda olduğu gibi, obez hastalarda da güvenle kullanılabileceğini ve maliyeti düşürmede etkili bir yöntem olduğunu düşündürmektedir.

Anahtar Kelimeler:

Düşük akım anestezi, Laparaskopik kolesistektomi, obezite

Investigation of the efficacy and safety of low-flow and normal-flow anesthesia in obese patients: A randomized trial

Background: Body mass index values ≥30 are defined as obesity. In obese, body surface area increases with weight; thus, the basal metabolic rate becomes higher compared to those at normal weight. Low-flow anesthesia (LFA) is an anesthetic method where fresh gas flow (FGF) is less than 1L /min. There are limited studies in the literature comparing the effects of different gas flows in obese patients undergoing laparoscopic surgery. The aim of this study was to investigate the efficacy and safety of LFA in obese patients.Materials and Methods: This randomized prospective study included 100 patients aged between 18-65 years undergoing laparoscopic cholecystectomy. Sealed envelope method was used for randomization. LFA was defined as the administration of FGF at 0.5 L/min, while normal flow anesthesia (NFA) was defined as FGF at 2 L/min. 100 patients were randomly divided into 4 groups. Group 1: normal patients with weight and LFA, Group 2: normal patients with weight and NFA, Group 3: obese patients and LFA, Group 4: obese patients with and NFA.Results: None of the patients had an inspiratory oxygen level (insO2) value below 35% after intubation. Therefore, hypoxia was not observed in any patient. However; when compared to group 2, group 1 had significantly longer anesthesia time and lower desflurane consumption. Similarly, when compared to group4, group 3 had significantly longer anesthesia time and lower desflurane consumption. Conclusion: Our results suggest that LFA can be used safely in obese patients as well as in normal weight patients and it is an effective method to reduce the cost.

Keywords:

Low flow anesthesia, laparoscopic cholecystectomy, obesity,

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