Publication: Pron pozisyonda PEEP uygulamasının solunum mekaniği ve arteriyel oksijenizasyon üzerine etkileri
Abstract
Amaç: Çalışmamızın amacı pron pozisyonda cerrahi girişim geçirecek lumber diskopatili hastalarda 10cm H2O ekspirasyon sonu pozitif basınç (positive end-expiratory pressure (PEEP)) uygulamasının arteriyel oksijenizasyon, solunum mekaniği ve dolaşım sistemi üzerindeki etkilerini araştırmaktır. Hastalar ve Yöntem: Pron pozisyonda lumber diskektomi operasyonu geçirecek Amerikan Anesteziyoloji Derneği (The American Society of Anesthesiologists (ASA)) kriterlerine göre I-II sınıf, 40 hasta çalışmaya alındı. Anestezi indüksiyonu ve endotrakeal entübasyondan sonra hastalar aralıklı pozitif basınçlı ventilasyon (intermittent positive pressure ventilation (IPPV)) modunda %60 N2O-%40 O2, akım 4L.dk-1 ve sevoflurane 0.7- 1.0 minimum alveolar konsantrasyon (MAK) olacak şekilde ventile edildi. Hastalar randomize edilerek 2 gruba ayrıldı. PEEP 0 grubunda, PEEP 0 cm H2O, PEEP 10 grubunda, PEEP 10 cm H2O olarak ayarlandı. Solunum sayısı 10 soluk/dk, inspirasyon- ekspirasyon oranı 1:2, tidal volüm 8ml.kg-1 olacak şekilde sabit utuldu. İndüksiyondan 10 dk, pron pozisyona döndükten sonra 15-30-45-60-75-90. dakikalarda kan gazı örnekleri alındı. Vital parametreler, dinamik kompliyans değerleri ve yan etkiler kaydedildi. Bulgular: Ortalama kan basıncı değerleri PEEP 10 grubunda pron dönemde diğer dönemlere göre istatistiksel olarak düşük bulundu (p<0,05). Her iki grupta da pron dönemdeki kalp atım hızı düşüşü diğer dönemdekilere göre istatistiksel olarak anlamlıydı (p<0,05). Pron dönemde PaO2 ve kompliyans, PEEP 10 grubunda, PEEP 0 grubuna göre anlamlı olarak yüksekti (p<0,05). Sonuç: Pron pozisyonda cerrahi girişim geçirecek hastalarda 10 cm H2O PEEP uygulamasının yararlı olacağı sonucuna varılmıştır.
ABSTRACT Objectives: To evaluate the changes in arterial oxygenation and vital parameters by applying 10cm H2O positive end-expiratory pressure (PEEP) to patients undergoing lumbar spine surgery in the prone position. Patients and Method: According to The American Society of Anesthesiologists (ASA) status I-II, 40 patients, scheduled for lumbar discectomy in the prone position were enrolled in the study. During the anesthesia induction and after intubation they were ventilated with intermittent positive pressure ventilation (IPPV) mode, 60%N2O-40%O2, 4L.min-1 flow and 0.7-1.0 minumum alveolar concentration (MAC) sevoflurane. The patients were randomized into 2 groups. PEEP value was set at 0 cm H2O in PEEP 0 group and at 10 cm H2O in PEEP 10 group. Respiratory rate 10/min, inspiration-expiration ratio 1:2 and tidal volume 8ml.kg-1 were kept constant. Blood gas samples were obtained 10 min after induction and 15-30-45-60-75-90 min after prone positioning. Vital parameters, dynamic compliance and side effects were recorded. Results: Mean blood pressure was statistically low in PEEP 10 group at the prone positioning, compared to the other periods (p<0.05). Pulse rate in both groups was significantly low during the prone period compared to other periods (p<0.05). PaO2 and compliance were statistically high in PEEP10 group at the prone position as compared to the PEEP 0 group (p<0.05). Conclusion: In our opinion, applying 10 cm H2O PEEP to patients undergoing spine surgery in the prone position is a beneficial implementation.
ABSTRACT Objectives: To evaluate the changes in arterial oxygenation and vital parameters by applying 10cm H2O positive end-expiratory pressure (PEEP) to patients undergoing lumbar spine surgery in the prone position. Patients and Method: According to The American Society of Anesthesiologists (ASA) status I-II, 40 patients, scheduled for lumbar discectomy in the prone position were enrolled in the study. During the anesthesia induction and after intubation they were ventilated with intermittent positive pressure ventilation (IPPV) mode, 60%N2O-40%O2, 4L.min-1 flow and 0.7-1.0 minumum alveolar concentration (MAC) sevoflurane. The patients were randomized into 2 groups. PEEP value was set at 0 cm H2O in PEEP 0 group and at 10 cm H2O in PEEP 10 group. Respiratory rate 10/min, inspiration-expiration ratio 1:2 and tidal volume 8ml.kg-1 were kept constant. Blood gas samples were obtained 10 min after induction and 15-30-45-60-75-90 min after prone positioning. Vital parameters, dynamic compliance and side effects were recorded. Results: Mean blood pressure was statistically low in PEEP 10 group at the prone positioning, compared to the other periods (p<0.05). Pulse rate in both groups was significantly low during the prone period compared to other periods (p<0.05). PaO2 and compliance were statistically high in PEEP10 group at the prone position as compared to the PEEP 0 group (p<0.05). Conclusion: In our opinion, applying 10 cm H2O PEEP to patients undergoing spine surgery in the prone position is a beneficial implementation.