Buket DEMİRCİ, Erdem ÖZKISACIK, Varlik K. EREL, Tugba OZBEK CELIK, Mustafa YILMAZ

Deneysel Rat Modeli: Anestezi İndüksiyonu Öncesi %100 O2 İle Preoksijenizasyon Uygun mu Değil mi?

Preoksijenizasyon anestezide indüksiyon öncesi havayolu endişeleri nedeniyle güvenli zamanı uzatmak adına hala önerilen ve uygulanan bir yöntemdir. Ancak yoğun bakım hastaları ve göğüs hastalıkları açısından hiperokseminin zararları ile ilgili tartışmalar çok uzun zamandır yapılmış ve klavuzlarda oksijen yönetimi ile ilgili hususlar yerini almıştır. Hiperokseminin indüksiyon sırasındaki kısa süreli uygulamasında bile bazı hasarların olacağı hipotezinden yola çıkarak %100 O2 ile preoksijenizasyonun patolojik ve biyokimyasal sonuçlarını saptamak üzere bu çalışmayı planladık. Öncelikle, preoksijenizasyonun hayvan modeli için bir konteyner tasarlandı. Dört-altı aylık sağlıklı 16 erkek rat rastgele iki gruba ayrıldı [Grup 21 (n=8): %21 O2 ve Grup 100 (n=8): %100 O2]. Gruplar 5 dk. istenilen konsantrasyonda kaldıktan sonra ketamin ve xylazin (sırasıyla 50 ve 5 mg/ kg) ile uyutularak sakrifiye edildi. Histopatolojik olarak doku hasarı derecelendirmesi ve biyokimyasal testler için kan, akciğer, kalp, karaciğer, böbrek doku örnekleri alındı. Veriler Mann-Whitney-U testi ile istatistiksel olarak değerlendirildi. Bu çalışma anestezi indüksiyonunda %100 O2 ile preoksijenizasyonun akciğerdeki direkt toksik etkilerini göstermesi açısından anlamlıdır. Ancak hastalarda preoksijenizasyon için ideal olan O2 konsantrasyonunun belirlenmesiyle ilgili olarak daha kapsamlı çalışmalara ihtiyaç vardır.

Experimental Rat Model: Is Preoxygenation with 100% O2 Before Anesthesia Induction Appropriate or Not?

Preoxygenation is recommended method for prolonging safe time due to airway concerns before induction of anesthesia. However, debatesabout the damages of hyperoxemia in intensive care patients and chest diseases have been made for a long time and the issues related to oxygenmanagement have taken place in the guidelines. Our aim was to determine the pathological and biochemical results of preoxygenation with100% O2, based on the hypothesis that some damagescan be seen, even in the short duration of hyperoxia. Firstly, a container for rat model ofpreoxygenation was designed. Four and six month old healthy 16 male rats were randomly divided into two groups [Group21 (n=8): 21% O2 andGroup100 (n=8): 100% O2]. Groups were sacrificed under the ketamine and xylazine (50 and 5 mg/kg, respectively) at the end of 5 min. Blood,lung, heart, liver, and kidney samples were taken for biochemical tests and histopathological grades of tissue damage. The data were analyzedstatistically by Mann-Whitney-U test. This study is significant in terms of the direct toxic effects of preoxygenation with 100% O2 before anesthesiainduction. However, there is a need for further studies on the determination of the ideal O2 concentration for preoxygenation in patients.

PDF

___

Lorrain Smith J: The pathological effects due to increase of oxygen tension in the air breathed. J Physiol (London), 24, 19-35, 1899. DOI: 10.1113/jphysiol.1899.sp000746
Heffner JE: The story of oxygen. Respir Care, 58, 18-31, 2013. DOI: 10.4187/respcare.01831
Sandoval J, Long GR, Skoog C, Wood LD, Oppenheimer L: Independent influence of blood flow rate and mixed venous PO2 on shunt fraction. J ApplPhysiol, 55, 1128-1133, 1983. DOI: 10.1152/ jappl.1983.55.4.1128
Domino KB, Wetstein L, Glasser SA, Lindgren L, Marshall C, Harken A, Marshall BE: Influence of mixed venous oxygen tension (PvO2) on blood flow to atelectatic lung. Anesthesiology, 59, 428-434, 1983.
Kiechle FL, Malinski T: Nitric oxide. Biochemistry, pathophysiology, and detection. Am J Clin Pathol, 1100 (5): 567-575, 1993. DOI: 10.1093/ ajcp/100.5.567
Edmark L, Kostova-Aherdan K, Enlund M, Hedenstierna G: Optimal oxygen concentration during induction of general anesthesia. Anesthesiology, 98 (1): 28-33, 2003. DOI: 10.1097/00000542-200301000- 00008
Pedersen T, Nicholson A, Hovhannisyan K, Møller AM, Smith AF, Lewis SR: Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev, 17 (3): CD002013, DOI: 10.1002/14651858.CD002013. pub3
O’Driscoll BR, Howard LS, Davison AG: British Thoracic Society. BTS guideline for emergency oxygen use in adult patients. Thorax, 6, 68, 2008. DOI: 10.1136/thx.2008.102947
Damiani E, Adrario E, Girardis M, Romano R, Pelaia P, Singer M, Donati A: Arterial hyperoxia and mortality in critically ill patients: A systematic review and meta-analysis. Crit Care, 18 (6): 711, 2014. DOI: 10.1186/s13054-014-0711-x
Sun YI, Oberley LW, Li YA: A simple method for clinical assay of superoxide dismutase. Clin Chem, 34 (3): 497-500, 1988.
Aebi H: Catalase. In, Bergmeyer HU (Ed): Methods of Enzymatic Analysis. 673-677, Academic Press, New York, 1974.
Beutler E, Durgun O, Kelly BM: Improved method for the determination of blood glutathione. J Lab Clin Med, 51, 882-888, 1963.
Navarro-Gonzálvez JA, García-Benayas C, ArenasJ: Semi automated measurement of nitrate in biological fluids. Clin Chem, 44, 679-681, 1998.
Ohkawa H, Ohishi N, Yagi K: Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem, 95, 351-358, 1979. DOI: 10.1016/0003-2697(79)90738-3
Zolali E, Asgharian P, Hamishehkar H, Kouhsoltani M, Khodaii H, Hamishehkar H: Effects of gamma oryzanol on factors of oxidative stres and sepsis-induced lung injury in experimental animal model. Iran J Basic Med Sci, 18 (12): 1257-1263, 2015.
Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O’Sullivan EP, Woodall NM, Ahmad I: Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth, 2115 (6): 827-848, 2015. DOI: 10.1093/bja/aev371
Weingart SD, Levitan RM: Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med, 59 (3): 165-175, 2012. DOI: 10.1016/j.annemergmed.2011.10.002
Turrens JF: Mitochondrial formation of reactive oxygen species. J Physiol, 552 (2): 335-344, 2003. DOI: 10.1113/jphysiol.2003.049478
Jamieson D, Chance B, Cadenas E, Boveris A: The relation of free radical production to hyperoxia. Annu Rev Physiol, 48, 703-719, 1986. DOI: 10.1146/annurev.ph.48.030186.003415
Leverve XM: To cope with oxygen: A long and still tumultuous story for life. Crit Care Med, 36 (2): 637-638, 2008. DOI: 10.1097/CCM. 0B013E31816296AD
Hafner S, Beloncle F, Koch A, Radermacher P, Asfar P: Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update. Ann Intensive Care, 5 (1): 42, 2015. DOI: 10.1186/ s13613-015-0084-6
Doyle AJ, Stolady D, Mariyaselvam M, Wijewardena G, Gent E, Blunt M, Young P: Preoxygenation and apneic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange for emergency intubation. J Crit Care, 36, 8-12, 2016. DOI: 10.1016/j.jcrc.2016.06.011
Baillard C, Depret F, Levy V, Boubaya M, Beloucif S: Incidence and prediction of inadequate preoxygenation before induction of anaesthesia. Ann Fr Anesth Reanim, 33 (4): 55-58, 2014. DOI: 10.1016/j. annfar.2013.12.018