Kulak burun boğaz cerrahisi geçiren pediatrik hastalarda intraoperatif uygulanan sıvı volümünün postoperatif kusmaya etkisi

Giriş ve Amaç:Çocuklarda postoperatif bulantı ve kusmayı önlemek için, uluslararası kılavuzlarda intravenöz sıvı tedavisi önerilmektedir. Fakat, sıvı tedavisinin uygun miktarı henüz belli değildir. Bu gözlemsel çalışmanın amacı, adenoidektomi, tonsillektomi ve adenotonsillektomi yapılan çocuklarda intraoperatif intravenöz sıvı uygulamasının postoperatif kusma üzerine etkisini değerlendirmektir. Yöntem ve Gereçler: Genel anestezi altında elektif adenoidektomi, tonsillektomi ve adenotonsillektomi yapılacak, 2-10 yaş arası 160 çocuk, intraoperatif infüzyon uygulamasına göre, düşük volümlü (grup 1 = 10 ml/kg/s) veya yüksek volümlü (grup 2 = 20 ml/kg/s)% 0.9 NaCl solüsyonu olarak randomize edildi. Standart bir anestezi protokolü uygulandı. Tüm hastaların kusma ve ağrı skorları değerlendirildi. Bulgular: Anestezi sonrası bakım ünitesinde (PACU) birinci ve 15. dakikadaki kusma sıklığı, kısıtlı sıvı alan grup 1 hastalarda grup 2 hastalardan anlamlı derecede yüksekti. Anestezi sonrası bakım ünitesinde (PACU) 1. ve 15. dakikada çocuk hastanesi doğu ontario ağrı ölçeği (CHEOPS) skorları, grup 2'de grup 1'den anlamlı yüksek bulundu (p = 0.021, p = 0.026). Ancak, iki grup arasında CHEOPS skorlarıyla ilgili daha sonraki zamanlarda anlamlı bir fark bulunmadı. Sonuç: Sonuçlarımız, intraoperatif 20 ml/kg/saat % 0.9 NaCl solüsyonu uygulamasının, adenoidektomi, tonsillektomi ve adenotonsillektomi uygulanan çocuklarda, postoperatif birinci ve 15. dakikalarda hafif kusma şikayetini azaltmada yararlı olabileceğini desteklemektedir.

Anahtar Kelimeler:

postoperatif kusma, çocuklar, intravenöz sıvı

The effect of intraoperative fluid volume on postoperative vomiting in pediatric patients undergoing otorhinolaryngological surgery

Aim:Intravenous fluid therapy is recommended in international guidelines to prevent the postoperative nause and vomiting in children. But the proper amount of fluid therapy is not clear yet. The aim of this observational study is to evaluate the effect of intraoperative intravenous fluid administration on postoperative vomiting in children after adenoidectomy, tonsillectomy and adenotonsillectomy.Material and Methods: 160 children, aged between 2-10 years, undergoing elective adenoidectomy, tonsillectomy and adenotonsillectomy under general anaesthesia were randomized to administration of intraoperative infusions of low-volume (group 1=10 ml/kg/h) or high volume (group 2=20/ml/kg/h) 0.9 % NaCl solution. A standardized anaesthesia protocol was performed. The vomiting and pain scores of all patients were evaluated. Results: The frequency of vomiting in patients who received limited fluid in group 1 was significantly higher than those in group 2 at first and 15th minute in post-anesthesia care unit (PACU). The Children’s Hospital East Ontario Pain Scale (CHEOPS) scores at 1st and 15th minutes of PACU were significantly higher in group 2 than in group 1 (p = 0.021, p = 0.026) However, no significant difference was found between the two groups regarding CHEOPS scores at the further time-points. Conclusion: Our results suggest that intraoperative administration of 0.9% NaCl solution at a rate of 20 ml/kg/h can be useful in reducing mild vomiting complaint in the postoperative first and 15th minutes in children undergoing adenoidectomy, tonsillectomy, and adenotonsillectomy.

Keywords:

postoperative vomiting, children, intravenous fluid,

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