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THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES

Yıl 2023, Cilt: 24 Sayı: 1, 89 - 95, 03.01.2023
https://doi.org/10.18229/kocatepetip.1072254

Öz

OBJECTIVE: Intraoperative high fresh gas flow may cause Inadvertent perioperative hypothermia (IPH). For this reason, low and minimal flow anesthesia methods that improve the anesthesia climate are applied. We aimed to investigate the effects of minimal, low and high flow anesthesia on body temperature and tissue oxygenation in patients undergoing elective nasal surgery.
MATERIAL AND METHODS: Prospective randomized controlled study included 92 patients aged 18-60 years, ASA1-2 operation time 1-4 hours, scheduled for elective nasal surgery under hypotensive anesthesia. The patients were divided into Group 1 (0.5Lmin-1), Group 2 (1Lmin-1) and Group 3 (2 Lmin-1). Demographic and operative data of the patients, preoperative waiting room temperature, intraoperative operating room temperature, intraoperative body temperature, anesthesia breathing circuit humidity and temperature, tissue oxygen saturation, 0th, 15th, 30th, 60th, 90th, 120th, 150thmin and postoperative shivering, Aldrete score, room temperature and body temperatures in the recovery unit were recorded.
RESULTS: Perioperative hypothermia developed in all patients (p=0.001). Tympanic temperatures were similar in all three groups (p>0.05). In the subgroup comparison, it was found that the tissue oxygen saturation (StO2) 60 th min value of Group1 was higher than Group 2 (p=0.046). It was found statistically significant that the StO2 90 th min value of Group1 was higher than that of Group 2 and 3 (p=0.013, p=0.013). It was statistically significant that the StO2 120th min value of Group1 was higher than Group 3 (p=0.008).In Group1, postoperativeAldrete score was found to be significantly higher than the other two groups(p=0.002, p=0.002). A correlation was found between operating room temperature, postoperative recovery room temperature, and body temperature(r=.446, p<0.05;r=.531, p<0.01).
CONCLUSIONS: Inadvertent perioperative hypothermia developed in all patients who underwent elective nasal surgery with hypotensive anesthesia in minimal, low and high flow anesthesia applications. It was observed that body temperatures, humidity and the temperature of the anesthesia period were similar in all groups. Tissue oxygen saturation was higher in the minimal flow anesthesia group and Aldrete score was higher in the postoperative recovery unit. Minimal flow anesthesia applications can be a good alternative to prevent IPH. However, we think that more studies are needed for the effects of low-flow anesthesia techniques at the tissue level.

Kaynakça

  • 1. Bilgin H. Inadverdent Perioperative Hypothermia. Turkish J. Anesth. Reanim. 2017;45(3):124–6.
  • 2. Kleemann PP. Humidity of Anaesthetic Gases with Respect to Low Flow Anaesthesia. Anaesth Intens Care.1994;22(4):380-2.
  • 3. Nunn G. Low-flow anaesthesia. Contin. Educ. Anaesth. Crit. Care Pain.2008;8, 1–4.
  • 4. Hendrickx JFA, De Wolf AM, De Hert S. O2, anybody? Eur J Anaesthesiol. 2015;32(6): 371–3.
  • 5. Lima A, van Genderen ME, Klijn E, Bakke J, van Bommel J. Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy. Intensive Care Med.2012;38(4): 606–11.
  • 6. O’Brien-Lambert A, Driver B, Moore JC, et al. Using Near Infrared Spectroscopy for Tissue Oxygenation Monitoring During Procedural Sedation: The Occurrence of Peripheral Tissue Oxygenation Changes With Respiratory Depression and Supportive Airway Measures. Acad. Emerg Med. 2016;23(1): 98–101.
  • 7. Yi J, Yongjin L, Shiyuan X, et al. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China. National study in China. PloS One. 2017;12(6): 0177221.
  • 8. Sagiroglu G, Ozturk GA, Baysal A, et al. Inadvertent perioperative hypothermia and important risk factors during major abdominal surgeries. Journal of College Physicians Surgeons Pakistan. 2020;30(2):123-8.
  • 9. Aksu C, Kus A, Gurkan Y, et al. Survey on Postoperative Hypothermia Incidence In Operating Theatres of Kocaeli University. Turkish Journal of Anesthesiology Reanimation . 2014; 42(2): 66-70.
  • 10. Wang CS, Chen CL, Huang CJ, et al. Effects of Different Operating Room Temperatures on the Body Temperature Undergoing Live Liver Donor Hepatectomy. Transplantation Proceedings. 2008;40(8): 2463–65.
  • 11. El-Gamal N, Elkassabany N, Frank SM, et al. Age-Related Thermoregulatory Differences in a Warm Operating Room Environment (Approximately 26°C). Anesth Analg. 2000;90(3):694–98.
  • 12. Baum J, Zueckner K, Hölscher UM, et al. Klimatisierung von Narkosegasen bei Einsatz unterschiedlicher Patientenschlauchsysteme. Anaesthesist. 2000; 49(5):402–11.
  • 13. Plotnikow GA, AccoceM, Navarro E, et al. Humidification and heating of inhaled gas in patients with artificial airway. A narrative review. Rev Bras Ter Intensiva. 2018 ;30(1):86-97.
  • 14. Bisinotto FMB, Braz JRC, Martins RHG, et al. Tracheobronchial consequences of the use of heat and moisture exchangers in dogs. Canadian Journal of Anesthesia. 1999 ;46(9): 897-903.
  • 15. Barbet JP, Chauveau M, Labbe S, et al. Breathing dry air causes acute epithelial damage and inflammation of the guinea pig trachea. Journal of Applied Physiology. 1988 ;64(5): 1851-57.
  • 16. Restrepo RD, Walsh BK. Clinical Pratice Guideline. Humidification During Invasive and Noninvasive Mechanical Ventilation: Respiratory Care. 2012;57(5):782-88.
  • 17. Choi YJ, Min SH, Park JJ, et al. Comparison of the temperature and humidity in the anesthetic breathing circuit among different anesthetic workstations. Medicine Baltimore. 2017;96(25):7239.
  • 18. Lafçı A, Öztürk L, But A. Timpanoplasti Operasyonlarında Yüksek Akımlı ve Düşük Akımlı Desfluran Anestezisinin Karşılaştırılması. Türk Tıp Dergisi. 2011 5(1):12-21.
  • 19. Bengston JP, Bengston A, Sonander H, et al. Humidity of the Bain and circle systems reassessed. Anesthesia and Analgesia. 1989;69(1):83-86.
  • 20. Johansson A, Lundberg D, Luttropp HH. The effect of heat and moisture exchanger on humidity and body temperature in a low-flow anaesthesia system. Acta Anaesthesiologica Scandinavica. 2003;47(5):564- 68.
  • 21. Kazancıoğlu L, Batçık Ş, Erdivanlı B, et al. Comparison of the effects of minimal and high-flow anaesthesia on cerebral perfusion during septorhinoplasty. Turk J Anaesthesiol Reanim. 2019;47(1):12-6.
  • 22. Bilgi M, Göksu S, Mızrak A, et al. Comparison of the effects of low-flow and high-flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests. European Journal of Anaesthesiology. 2011;28(4): 279-83.
  • 23. Kalaycı D, Dikmen B, Kaçmaz M, et al. Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates. Revista Brasileira de Anestesiologia. 2014;64(4):292-98.
  • 24. Kim J, Kang D, Lee H, et al. Change of inspired oxygen concentration in low flow anesthesia. Anesth
  • Pain Med. 2020;15(4):434–40.
  • 25. Kazancioglu L, Batcik S, Arpa M, et al. Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties. International Journal of Clinical Practice. 2021;75(11): 14838.
  • 26. Batçık Ş, Kazancıoğlu L, Arpa M et al. The effect of minimal-flow and high-flow hypotensive anesthesia on oxidative stress. Middle Black Sea Journal of Health Science. 2021;7(2):221-29.
  • 27. Kozanhan B, Eğilmez Aİ, Tok Cekmecelioglu B, et al. Novel oxidative stress biomarker in sepsis: dynamic thiol-disulfide homeostasis. Cukurova Medical Journal. 2020;45(1):63-70.
  • 28. Kaufner L, Niggemann P, Baum T, et al. Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: A randomized trial. BMC Anesthesiology. 2019;19(1):1-10.

NAZAL CERRAHİLERDE MİNİMAL, DÜŞÜK VE YÜKSEK AKIMLI ANESTEZİNİN VÜCUT SICAKLIĞI VE DOKU OKSİJENLENMESİ ÜZERİNE ETKİLERİ

Yıl 2023, Cilt: 24 Sayı: 1, 89 - 95, 03.01.2023
https://doi.org/10.18229/kocatepetip.1072254

Öz

AMAÇ: İntraoperatif yüksek taze gaz akışı istemsiz perioperatif hipotermi (İPH) oluşumuna neden olabilir. Bu nedenle anestezi iklimini iyileştiren düşük ve minimal akımlı anestezi yöntemleri uygulanmaktadır. Elektif nazal cerrahi geçiren hastalarda minimal, düşük ve yüksek akımlı anestezinin vücut sıcaklığı ve doku oksijenasyonu üzerine etkisini araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Prospektif randomize kontrollü çalışmaya hipotansif anestezi altında, elektif nazal cerrahi planlanan 18-60 yaş, ASA 1-2, operasyon süresi 1-4 saat olan 92 hasta dahil edildi. Hastalar, Grup1(0.5L dk-1), Grup2(1L dk-1) ve Grup 3(2L dk-1) olarak ayrıldı.Hastaların demografik ve operatif verileri, preoperatif bekleme odası sıcaklığı, intraoperatif ameliyathane sıcaklığı, intraoperatif vücut sıcaklığı, anestezi solunum devresi nemi ve sıcaklığı, doku oksijen satürasyonu, 0.,15.,30.,60.,90.,120.,150. Dakika(dk) ve postoperatif dönemde titreme, Aldrete skoru, derlenme ünitesindeki oda sıcaklığı ve vücut sıcaklıkları kaydedildi
BULGULAR: Hastaların tümünde perioperatif hipotermi gelişti (p=0.001). Her üç gruptada timpanik sıcaklıklar benzerdi(p>0.05). Alt grup karşılaştırmasında Grup 1'in StO2 60. dk değerinin Grup 2'ye göre yüksekti (p=0,046). Grup 1'in doku oksijen düzeyi (StO2) 90.dk değerinin grup 2 ve 3'ten yüksek olduğu istatistiksel olarak anlamlı olduğu belirlendi (p=0.013, p=0.013). Grup 1'in StO2 120.dk değerinin grup 3'ten yüksek olması istatistiksel olarak anlamlıydı (p=0,008 ). Grup 1’de postoperatif Aldrete skoru diğer iki gruba göre anlamlı derecede yüksek bulundu(p=0.002, p=0.002). Vücut sıcaklığı ile ameliyathane oda sıcaklığı,postoperatif derlenme oda sıcaklığı arasında korelasyon saptandı(r=.446, p<0.05; r=.531, p<0.01).
SONUÇ: Minimal, düşük ve yüksek akımlı anestezi uygulamalarında hipotansif anestezi ile elektif nazal cerrahi uygulanan tüm hastalarda istemsiz perioperatif hipotermi gelişti. Tüm gruplarda vücut sıcaklıkları, nem ve anestezi devresinin sıcaklığının benzer olduğu gözlendi. Minimal akımlı anestezi grubunda doku oksijen saturasyonu ve postoperatif derlenme ünitesinde Aldrete skoru daha yüksek bulundu. Minimal akımlı anestezi uygulamaları İPH önlemek için iyi bir alternatif olabilir.Ancak düşük akımlı anestezi tekniklerinin doku düzeyindeki etkileri için daha fazla çalışmaya ihtiyaç olduğunu düşünmekteyiz.

Kaynakça

  • 1. Bilgin H. Inadverdent Perioperative Hypothermia. Turkish J. Anesth. Reanim. 2017;45(3):124–6.
  • 2. Kleemann PP. Humidity of Anaesthetic Gases with Respect to Low Flow Anaesthesia. Anaesth Intens Care.1994;22(4):380-2.
  • 3. Nunn G. Low-flow anaesthesia. Contin. Educ. Anaesth. Crit. Care Pain.2008;8, 1–4.
  • 4. Hendrickx JFA, De Wolf AM, De Hert S. O2, anybody? Eur J Anaesthesiol. 2015;32(6): 371–3.
  • 5. Lima A, van Genderen ME, Klijn E, Bakke J, van Bommel J. Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy. Intensive Care Med.2012;38(4): 606–11.
  • 6. O’Brien-Lambert A, Driver B, Moore JC, et al. Using Near Infrared Spectroscopy for Tissue Oxygenation Monitoring During Procedural Sedation: The Occurrence of Peripheral Tissue Oxygenation Changes With Respiratory Depression and Supportive Airway Measures. Acad. Emerg Med. 2016;23(1): 98–101.
  • 7. Yi J, Yongjin L, Shiyuan X, et al. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China. National study in China. PloS One. 2017;12(6): 0177221.
  • 8. Sagiroglu G, Ozturk GA, Baysal A, et al. Inadvertent perioperative hypothermia and important risk factors during major abdominal surgeries. Journal of College Physicians Surgeons Pakistan. 2020;30(2):123-8.
  • 9. Aksu C, Kus A, Gurkan Y, et al. Survey on Postoperative Hypothermia Incidence In Operating Theatres of Kocaeli University. Turkish Journal of Anesthesiology Reanimation . 2014; 42(2): 66-70.
  • 10. Wang CS, Chen CL, Huang CJ, et al. Effects of Different Operating Room Temperatures on the Body Temperature Undergoing Live Liver Donor Hepatectomy. Transplantation Proceedings. 2008;40(8): 2463–65.
  • 11. El-Gamal N, Elkassabany N, Frank SM, et al. Age-Related Thermoregulatory Differences in a Warm Operating Room Environment (Approximately 26°C). Anesth Analg. 2000;90(3):694–98.
  • 12. Baum J, Zueckner K, Hölscher UM, et al. Klimatisierung von Narkosegasen bei Einsatz unterschiedlicher Patientenschlauchsysteme. Anaesthesist. 2000; 49(5):402–11.
  • 13. Plotnikow GA, AccoceM, Navarro E, et al. Humidification and heating of inhaled gas in patients with artificial airway. A narrative review. Rev Bras Ter Intensiva. 2018 ;30(1):86-97.
  • 14. Bisinotto FMB, Braz JRC, Martins RHG, et al. Tracheobronchial consequences of the use of heat and moisture exchangers in dogs. Canadian Journal of Anesthesia. 1999 ;46(9): 897-903.
  • 15. Barbet JP, Chauveau M, Labbe S, et al. Breathing dry air causes acute epithelial damage and inflammation of the guinea pig trachea. Journal of Applied Physiology. 1988 ;64(5): 1851-57.
  • 16. Restrepo RD, Walsh BK. Clinical Pratice Guideline. Humidification During Invasive and Noninvasive Mechanical Ventilation: Respiratory Care. 2012;57(5):782-88.
  • 17. Choi YJ, Min SH, Park JJ, et al. Comparison of the temperature and humidity in the anesthetic breathing circuit among different anesthetic workstations. Medicine Baltimore. 2017;96(25):7239.
  • 18. Lafçı A, Öztürk L, But A. Timpanoplasti Operasyonlarında Yüksek Akımlı ve Düşük Akımlı Desfluran Anestezisinin Karşılaştırılması. Türk Tıp Dergisi. 2011 5(1):12-21.
  • 19. Bengston JP, Bengston A, Sonander H, et al. Humidity of the Bain and circle systems reassessed. Anesthesia and Analgesia. 1989;69(1):83-86.
  • 20. Johansson A, Lundberg D, Luttropp HH. The effect of heat and moisture exchanger on humidity and body temperature in a low-flow anaesthesia system. Acta Anaesthesiologica Scandinavica. 2003;47(5):564- 68.
  • 21. Kazancıoğlu L, Batçık Ş, Erdivanlı B, et al. Comparison of the effects of minimal and high-flow anaesthesia on cerebral perfusion during septorhinoplasty. Turk J Anaesthesiol Reanim. 2019;47(1):12-6.
  • 22. Bilgi M, Göksu S, Mızrak A, et al. Comparison of the effects of low-flow and high-flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests. European Journal of Anaesthesiology. 2011;28(4): 279-83.
  • 23. Kalaycı D, Dikmen B, Kaçmaz M, et al. Plasma levels of interleukin-10 and nitric oxide in response to two different desflurane anesthesia flow rates. Revista Brasileira de Anestesiologia. 2014;64(4):292-98.
  • 24. Kim J, Kang D, Lee H, et al. Change of inspired oxygen concentration in low flow anesthesia. Anesth
  • Pain Med. 2020;15(4):434–40.
  • 25. Kazancioglu L, Batcik S, Arpa M, et al. Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties. International Journal of Clinical Practice. 2021;75(11): 14838.
  • 26. Batçık Ş, Kazancıoğlu L, Arpa M et al. The effect of minimal-flow and high-flow hypotensive anesthesia on oxidative stress. Middle Black Sea Journal of Health Science. 2021;7(2):221-29.
  • 27. Kozanhan B, Eğilmez Aİ, Tok Cekmecelioglu B, et al. Novel oxidative stress biomarker in sepsis: dynamic thiol-disulfide homeostasis. Cukurova Medical Journal. 2020;45(1):63-70.
  • 28. Kaufner L, Niggemann P, Baum T, et al. Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: A randomized trial. BMC Anesthesiology. 2019;19(1):1-10.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Makaleler-Araştırma Yazıları
Yazarlar

Gül Kesimal Bu kişi benim 0000-0001-5663-4510

Leyla Kazancıoğlu 0000-0002-3833-0692

Hizir Kazdal 0000-0002-0759-4716

Şule Batçık 0000-0003-1110-6786

Tolga Koyuncu Bu kişi benim 0000-0002-0019-9684

Yayımlanma Tarihi 3 Ocak 2023
Kabul Tarihi 28 Mayıs 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 24 Sayı: 1

Kaynak Göster

APA Kesimal, G., Kazancıoğlu, L., Kazdal, H., Batçık, Ş., vd. (2023). THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES. Kocatepe Tıp Dergisi, 24(1), 89-95. https://doi.org/10.18229/kocatepetip.1072254
AMA Kesimal G, Kazancıoğlu L, Kazdal H, Batçık Ş, Koyuncu T. THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES. KTD. Ocak 2023;24(1):89-95. doi:10.18229/kocatepetip.1072254
Chicago Kesimal, Gül, Leyla Kazancıoğlu, Hizir Kazdal, Şule Batçık, ve Tolga Koyuncu. “THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES”. Kocatepe Tıp Dergisi 24, sy. 1 (Ocak 2023): 89-95. https://doi.org/10.18229/kocatepetip.1072254.
EndNote Kesimal G, Kazancıoğlu L, Kazdal H, Batçık Ş, Koyuncu T (01 Ocak 2023) THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES. Kocatepe Tıp Dergisi 24 1 89–95.
IEEE G. Kesimal, L. Kazancıoğlu, H. Kazdal, Ş. Batçık, ve T. Koyuncu, “THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES”, KTD, c. 24, sy. 1, ss. 89–95, 2023, doi: 10.18229/kocatepetip.1072254.
ISNAD Kesimal, Gül vd. “THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES”. Kocatepe Tıp Dergisi 24/1 (Ocak 2023), 89-95. https://doi.org/10.18229/kocatepetip.1072254.
JAMA Kesimal G, Kazancıoğlu L, Kazdal H, Batçık Ş, Koyuncu T. THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES. KTD. 2023;24:89–95.
MLA Kesimal, Gül vd. “THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES”. Kocatepe Tıp Dergisi, c. 24, sy. 1, 2023, ss. 89-95, doi:10.18229/kocatepetip.1072254.
Vancouver Kesimal G, Kazancıoğlu L, Kazdal H, Batçık Ş, Koyuncu T. THE EFFECTS OF MINIMAL, LOW AND HIGH FLOW ANESTHESIA ON BODY TEMPERATURE AND TISSUE OXYGENATION IN NASAL SURGERIES. KTD. 2023;24(1):89-95.

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