Musa ZENGİN, Gülay ÜLGER, Ramazan BALDEMİR, Hilal SAZAK, Ali ALAGÖZ

Göğüs cerrahisi ameliyatı geçiren torakal epidural kateter takılan hastalarda postoperatif bulantı/kusmayı öngörmedeki parametreler

Amaç: Ameliyat süresinin uzun olması ve volatil anesteziklerin kullanılması gibi birçok faktör göğüs cerrahisinde postoperatif bulantı/kusma (PONV) sıklığını artırabilir. Son çalışmalar, nötrofil lenfosit oranı (NLR) gibi inflamatuar parametrelerin PONV'yi öngörebileceğini düşündürmektedir. Bu çalışmanın amacı, torakotomi ameliyatı olan ve torasik epidural analjezi (TEA) uygulanan hastalarda postoperatif demografik, laboratuvar ve klinik verilerin PONV'yi öngörmedeki rolünü incelemektir. Gereç ve Yöntemler:Mart 2017 - Aralık 2020 tarihleri arasında elektif göğüs cerrahisi geçiren ve TEA uygulanan hastaların verileri taranmıştır. Hastaların demografik verileri, laboratuvar parametreleri, ve Amerikan Anestezistler Birliği (ASA) I-II-III, eritrosit dağılım genişliği (RDW), NLR, postoperatif görsel analog skala (VAS) gibi klinik özellikleri incelenmiştir. PONV gelişen tüm hastalar Grup 1'e dahil edilmiştir. PONV gelişmeyen Grup 2 hastaların seçmek için hastane kayıtları kullanılmıştır. Bulgular: PONV insidansı %14.77 olarak belirlendi. ASA ve 24 saatlik VAS skorları açısından gruplar arasında istatistiksel olarak anlamlı fark vardı (p

Anahtar Kelimeler:

postoperatif bulantı/kusma, POBK, Torasik epidural analjezi, Torasik cerrahi

Demographic, clinical, and laboratory parameters in predicting postoperative nausea/vomiting in patients with thoracic epidural analgesia in thoracic surgery

Aim: In thoracic surgery, many factors; such as long duration of surgery and the use of volatile anesthetics may increase the frequency of postoperative nausea/ vomiting (PONV). Recent studies suggests that inflammatory markers such as neutrophils lymphocytes ratio (NLR) can predict PONV. The aim of this study is to postoperatively examine the role of demographic, laboratory, and clinical data in predicting PONV in patients who underwent thoracotomy and received thoracic epidural analgesia (TEA). Material and Methods:Data were collected for patients who underwent elective thoracic surgery and were administered TEA between March 2017 and December 2020. Patients' demographic data, laboratory parameters, and clinical characteristics; such as American Association of Anesthesiologists (ASA) I-II-III, erythrocyte distribution width (RDW), NLR, postoperative visual analog scale (VAS), were scanned. All patients who developed PONV were included in Group 1. Hospital records were used to select Group 2 patients who did not develop PONV. Results: The incidence of PONV was determined as 14.77%. There was a statistically significant difference between the groups in terms of ASA and 24-hour VAS scores (p

Keywords:

Postoperative nausea/vomiting, PONV, thoracic epidural analgesia, thoracic surgery,

PDF

___

1. Gan TJ, Diemunsch P, Habib AS, et al. Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014; 118: 85-113.
2. Karaca O, Dogan G. Can Neutrophil-to-Lymphocyte or Platelet-to-Lymphocyte Ratio Be Used to Predict Postoperative Nausea and Vomiting in Breast Reduction? Cureus. 2020: 12: 7237.
3. Yildiz Altun A, Demirel İ, Bolat E, et al. The Relationship Between the Preoperative Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Patients Undergoing Septorhinoplasty Surgery. Aesthetic Plast Surg. 2019; 43: 861-5.
4. Apfel CC, Kranke P, Katz MH, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002; 88: 659-8.
5. Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012; 109: 742-53.
6. Korkut AY, Erkalp K, Erden V, et al. Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting. Otolaryngol Head Neck Surg. 2010; 143: 831-6.
7. Watcha MF, White PF. Economics of antiemetics in anesthesia. Curr Opin Anaesthesiol. 2001; 14: 563-7.
8. D'Angelo R, Philip B, Gan TJ, et al. A randomized, double-blind, close-ranging, pilot study of intravenous granisetron in the prevention of postoperative nausea and vomiting in patients abdominal hysterectomy. Eur J Anaesthesiol. 2005; 22: 774-9.
9. Arpaci AH, Işik B, Ilhan E, et al. Association of Postoperative Nausea and Vomiting Incidence With Neutrophil-Lymphocyte Ratio in Ambulatory Maxillofacial Surgery. J Oral Maxillofac Surg. 2017; 75: 1367-1.
10. Tayfur C, Burcu DC, Gulten O, et al. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res. 2017;43: 498-504. .
11. Caglayan EK, Engin-Ustun Y, Gocmen AY, et al. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum? J Perinat Med. 2016; 44: 315-20.
12. Wen Y. High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol. 2010; 15: 37-40.
13. Mohindra R, Mishra U, Mathew R, et al. Red Cell Distribution Width (RDW) Index as a Predictor of Severity of Acute Ischemic Stroke: A Correlation Study. Adv J Emerg Med. 2019; 4: 24.
14. Perlstein TS, Weuve J, Pfeffer MA, et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med. 2009; 169: 588-94.
15. Dabbah S, Hammerman H, Markiewicz W, et al. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010; 105: 312-7.
16. Tonelli M, Sacks F, Arnold M, et al. for the Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation. 2008; 117: 163-8.
17. Oğlak SC, Obut M. The Role of Systemic Inflammatory Markers in the Diagnosis of Hyperemesis Gravidarum. Medical Journal of Mugla Sitki Kocman University 2020; 7: 124-7.
18. Beyazit F, Öztürk FH, Pek E, et al. Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study. Ginekol Pol. 2017; 88: 315-9.
19. Çintesun E, Akar S, Gul A, et al. Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study. J Lab Physicians. 2019;11: 149-53.
20. Özay ÖE, Özay AC. Inflammatory Markers in Hyperemesis Gravidarum. Eur Arch Med Res 2021; 37: 27-31.
21. Wang L, Dong Y, Zhang J, et al. The efficacy of gabapentin in reducing pain intensity and postoperative nausea and vomiting following laparoscopic cholecystectomy: A meta-analysis. Medicine (Baltimore). 2017; 96: 8007.
22. Bayter MJE, Peña PWE, Marquez MAM, et al. Incidence of Postoperative Nausea and Vomiting when Total Intravenous Anaesthesia is the Primary Anaesthetic in the Ambulatory Patient Population. Ambulatory Surgery 24.1, March 2018; 8-11.
23. Cohen MM, Duncan PG, DeBoer DP, et al. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg. 1994; 78: 7-16.
24. Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999; 91: 109-18.
25. Choi DH, Ko JS, Ahn HJ, et al. A korean predictive model for postoperative nausea and vomiting. J Korean Med Sci. 2005; 20: 811-5.
26. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019; 55: 91-115.
27. Shanthanna H, Ladha KS, Kehlet H, et al. Perioperative Opioid Administration. Anesthesiology. 2021; 134: 645-59.
28. Gabriel RA, Swisher MW, Sztain JF, et al. State of the art opioid-sparing strategies for post-operative pain in adult surgical patients. Expert Opin Pharmacother. 2019; 20: 949-61. 29. Guay J, Nishimori M, Kopp S. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016; 7: 001893.