Gulcin Aydin, Faruk Pehlivanli, Ferda Yaman

Tiroidektomi Sırasında Semi Fowler Pozisyonunun Serebral Oksijenizasyona Etkileri

Cerrahi prosedürü kolaylaştırmak için hastalara genel anestezi sırasında, Semi-Fowler durumda baş ve boynun hiperektansiyona getirilerek pozisyon verilir. Bu çalışmada tiroidektomi cerrahisi sırasında bu pozisyonda serebral oksijenasyondaki değişiklikleri belirlemeyi amaçladık. 22 hasta prospektif gözlemsel çalışmaya dahil edildi. Serebral oksijenizasyon monitorize edildi, sol ve sağ serebral bölgesel oksijen saturasyonları devamlı ölçüldü. Kalp hızı, ortalama arteriyel basınç, end-tidal karbondioksit değerleri ve başlangıçta, 15., 30., 90. dakikalarda ve ameliyat sonrası düzeltilmiş pozisyonda değerlendirildi. 90 dakika sonra, bazal değer ile karşılaştırıldığında sağ serebral oksijenizasyonda anlamlı düşüş görüldü (p ˂ 0.05). 30. dakika serebral oksijenizasyon değeri, 15. dakikaya göre anlamlı olarak düştü. 30. dakikada sol serebral oksijenizasyon değeri 15 dakikaya göre anlamlı olarak düştü (p < 0.05). 90. dakika sol serebral oksijenizasyon değeri 30. dakikaya göre anlamlı olarak azaldı (p

Effects of Semi-Fowler Position on Cerebral Oxygenation During Thyroidectomy

Patients are positioned with hyperextension of head and neck at Semi-Fowler state during general anaesthesia to facilitatethe surgical procedure. We aimed to determine the changes of serebral oxygenation in this position during thyroidectomy surgery.22 patients were recruited prospective observational study. Cerebral oxygenation were monitored, left and right cerebral regionaloxygen saturation were measured continuously. Heart rate, mean arterial pressure, end-tidal carbondioxide were measured andevaluated at baseline, after positioning at 15th, 30th, 90th minutes and after surgery at corrected position. After 90 minutes,significant decrease was seen cerebral oxygenization right side compared to the baseline (p ˂ 0.05). 30th minute cerebraloxygenization right value decreased significantly compared to the 15th minute. 30th minute, cerebral oxygenization left valuedecreased significantly compared to 15 minutes (p ˃ 0.05). 90th minute cerebral oxygenization left value decreased significantlycompared to the 30th minute (p < 0.05). Significant decrease in cerebral oxygen saturation in both cerebral sides had been shown inrelation to prolonged surgery time. Cerebral oxygenation was effected by the position given for thyroidectomy surgery. High-riskpatients can be detected by regional cerebral oxygen saturation and prevent cerebral ischemia. Precautions should be taken for highrisk patients.

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1. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103:3-13.
2. Kurihara K, Kikukawa A, Kobayashi A. Cerebral oxygenation monitor during head-up and -down tilt using near-infrared spatially resolved spectroscopy. Clin Physiol Funct Imaging. 2003;23:177-81.
3. Aristokleous N, Seimenis I, Georgiou GC, Nicolaides A, Anayiotos AS. The effect of head rotation on the geometry and hemodynamics of healthy vertebral arteries. Ann Biomed Eng. 2015;43:1287-97.
4. Deschamps A, Hall R, Grocott H, Mazer CD, Choi PT, Turgeon AF et al. Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation during High-risk Cardiac Surgery: A Randomized Controlled Feasibility Trial. Anesthesiology. 2016;124:826-36
5. Salazar DH, Davis WJ, Ziroğlu N, Garbis NG. Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position. J Am Acad Orthop Surg Glob Res Rev. 2019;3:e007.
6. Hou X, Ding H, Teng Y, Zhou C, Tang X, Li S, Ding H. Research on the relationship between brain anoxia at different regional oxygen saturations and brain damage using near-infrared spectroscopy. Physiol Meas. 2007;28:1251-65.
7. Salazar DH, Davis WJ, Ziroğlu N, Garbis NG. Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position. J Am Acad Orthop Surg Glob Res Rev. 2019;3:e007
8. Kim JY, Lee JS, Lee KC, Kim HS, Kim SH, Kwak HJ. The effect of desflurane versus propofol on regional cerebral oxygenation in the sitting position for shoulder arthroscopy. J Clin Monit Comput. 2014;28:371-6.
9. Garnaud T, Muheish M, Cholot M, Austruy T. Cranial nerves VII and XII palsy after shoulder surgery. Anaesth Crit Care Pain Med. 2019;38:281-4.
10. Kocaoglu B, Ozgen SU, Toraman F, Karahan M, Guven O. Foreseeing the danger in the beach chair position: Are standard measurement methods reliable? Knee Surg Sports Traumatol Arthrosc. 2015;23:2639-44.
11. Saraçoğlu A, Altun D, Yavru A, Aksakal N, Sormaz İC, Camcı E. Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy. Turk J Anaesthesiol Reanim. 2016;44:241-6.
12. Smarius BJA, Breugem CC, Boasson MP, Alikhil S, van Norden J, van der Molen ABM, de Graaff JC. Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy. Clin Oral Investig. 2020 Mar 26.
13. Özgök A, Ulus AT, Karadeniz Ü, Demir A,Kazancı D, Özyalçın S, Aydın Y, Ünal U. Does uncontrolled diabetes mellitus affect cerebral hemodynamics in heart surgery? Turk Gogus Kalp Damar Cerrahisi Derg. 2020;28:84-91.