Publication: Çocuklarda Minimal ve Yüksek Akım İnhalasyon Anestezi Tekniklerinin Sulla 808 V Anestezisi Makinası Kullanılarak Karşılaştırılması
Abstract
ÖZET Bu çalışma, 3-15 yaş grubu çocuklarda Sulla 8O8V anestezi makinası kullanılarak; minimal akım anestezisini (0.5 lt/dk) yüksek akım anestezisiyle (6 lt/dk) klinik ve ekonomik yönden karşılaştırmak ve Sulla 808V anestezi makinasının minimal akım anestezi tekniğine uyumunu değerlendirmek amacıyla yapıldı. Bu amaçla ASA I-II risk grubundan 40 hasta, ameliyathaneye geliş sırasına göre 20'şer kişilik iki gruba ayrıldı. I. Gruba 0.5 lt/dk taze gaz akımlı (25ü ml/dk 02, 250 ml/dk N20, %1.5 vol izofluran) minimal akım anestezisi, II. Gruba 6 lt/dk taze gaz akımlı (2 lt/dk 02, 4 lt/dk N20, %1 vol izofluran) yüksek akım anestezisi uygulandı. Hastaların hepsine EKG, puis oksimetre, otomatik tansiyon ölçümü monitörizasyonu uygulandı. Anestezi indüksiyonunda iv olarak 6-8 mg/kg tiopenton, 0. 1 mg/kg vekuronyum, 0.5 mg/kg meperidin uygulandı. İdamede 02, N20, izofluran gaz karışımı inhalasyonu ve iv vekuronyum kullanıldı. Tüm hastalara nazofarengeal ısı probu yerleştirildi. Respiratuar gazların; İnspiratuar oksijen konsantrasyonu (Fi02), Ekspiryum sonu karbondioksit basıncı (PetC02) ve inspiratuar izofluran konsantrasyonunun monitörizasyonu yapıldı. Sulla 808 V anestezi makinası ile, tidal volüm 8-10 ml/kg, solunum frekansı 10-15 /dk olacak şekilde kontrollü solunum uygulandı. Dakika soluk volümü ve hasta-sistem pik basıncı diğer monitörize parametrelerle birlikte l.,5.,15.,30.,60. dakikalarda ve uygulama süresince kaydedildi. Anesteziden ayılma süreleri ile intraoperatif ve postoperatif komplikasyonlar kaydedildi. Tüketilen izofluran miktarları ölçüldü. Grup l'de 5.,15.,60. dakikalardaki Kalp atım hızları (KAH), Grup IFye göre anlamlı derecede düşük bulundu (p< 0.05). Grup I'deki 30. dakika sistolik arter basıncının Grup Il'deki değere göre yüksek bulunması (p< 0.05) dışında sistolik, diastolik ve ortalama arter basınçları arasında farklılık saptanmadı. Oksijen saturasyonları ve 60 dakikalık süre içerisindeki vücut ışılan arasında farklılık saptanmadı. Yüksek akımdan, minimal akımlı anesteziye geçişte dakika soluk volümünde % 48 oranında düşüş oldu, buna bağlı olarak da hasta-sistem pik basıncında belirgin düşüş oldu. Bu nedenle tidal volümün yeniden ayarlanması gerekti. Minimal akım grubundaki Fi02 değerlerinde % 30'un altına düşüş IIIolmadı. Minimal akım grubundaki PetC02 değerleri yüksek akım grubuna oranla yüksek seyretmesine rağmen normal sınırların üzerine çıkmadı. Minimal akımlı anestezi grubunda anesteziden ayılma daha erken oldu (p< 0.05). Gruplar arasında komplikasyonlar açısından farklılık saptanmadı. Ancak minimal akım grubunda anestezi süresi 3 saati aşan 2 hastada 38°C nin üzerinde vücut ısısı saptandı. Minimal akımlı anestezi grubunda, yüksek akımlı anestezi grubuna oranla % 72 oranında izofluran tasarrufu sağlandı. Sonuç olarak minimal akımlı anestezinin, klinik, ekonomik ve ekolojik yönlerden geleneksel yüksek akımlı anestezi tekniğine üstün olduğunu ve uygun ekipman ile 3-15 yaş grubu çocuklarda rutin olarak kullanılabileceğini düşünmekteyiz. Ancak Sulla 808V anestezi makinasının tidal volümünün ve dolayısıyla dakika volümünün taze gaz akımına bağımlı olması ve buna bağlı olarak taze gaz eksikliğinde dönüşümlü basınç soluması yapması nedeniyle tidal volümü taze gaz akımından bağımsız olan anestezi makinalarının minimal akımlı anestezi uygulaması için daha uygun ve pratik olduğu sonucuna varıldı. Anahtar sözcükler: Minimal akım, yüksek akım, Sulla 808V. IV
ABSTRACT A Comparison of the effects of minimal flow anaesthesia and high flow anaesthesia on children The purpose of this study was to compare the minimal flow anaesthesia where the fresh gas flow of 0.5 L/min was used with high flow technique of 6 L/min in routine and to assess the validity of Sulla 808V anaesthesia ventilator. Forty patients aged between 3-15 years were randomly divided into.two groups. Each group was included 20 patients. Group I was recieved fresh gas flow of 0.5 L/min (250ml/min 02 + 250ml/min N20 + 1.5 % vol isoflurane) (minimal flow technique group), Group 2 was recieved fresh gas flow of 6L/min (2L/min 02 + 4 L/min N2G> + I % vol isoflurane) (high flow anaesthesia technique group). Electrocardiyography, pulse oximeter, automatic arteriel tension monitor were used to record heart rates, arterial oxygen saturations, sistolic and diastolic arterial pressures, mean arterial pressures. 6-8 mg.kg '' tiopentone, 0.1 mg. kg _1 vecuronium and 0.5 mg. kg 'l meperidine were administered for anaesthesia induction. Maintanance of anaesthesia was provided by using the mixture of 02 + N20 + isoflurane. Body temperature was recorded by inserting nasopharegeal termal probe. Fİ02 and Pe+C02 of respiratuar gases and inspiratuar isoflurane gas consantrations were measured. Sulla 808V anaesthesia ventilator was used for maintaining control ventilation with the tidal volume 8-10 ml per kilogram, respiratory rate 10-15 per minute. Breath volume per minute and patient-system peak pressure were recorded at the minutes 1,5, 15, 30 and 60th. The recovery time from anaesthesia, intraoperative and postoperative complications were also recorded. Consumption os isoflurane was calculated. The heart rates at the minutes 5, 15 and 60th were lower in group 1 than in group 2 (p<0.05). Sistolic arterial pressures at the minute 30th was higher in group 1 than in group 2 (p<0,0S), Th@r® were na »tatistieslly difference» between two groups tit the m\mt minutm In sistolic, diastolic and mean arterial pressure values. The saturation of 02 and the body temperatures in minute 60111 were similar in two groups. Breath volume per minute was decreased 48 % by the transition of high flow anaesthesia to minimal flow anaesthesia. By this transition, the decrease in patient system peak pressure was very clear. By this reason tidal volume had to be regulated. The decrease of Fi02 in minimal flow group was not more than 30 %. Pe+C02 values in minimal flow group were higher than in high flow group butthey were in normal ranges. Recovery from anaesthesia was rapid in minimal flow group (p<0.05). The complications were not statistically different between two groups. The body temperatures of two patients were higher than 38 °C, because duration of anaesthesia prolonged more than three hours. The consumption of isoflurane in minimal flow group was less 72 % than in high flow group. We concluded that the minimal flow anaesthesia was superior to conventional high flow technique from clinical, economical and ecological points of wiew, and might be used on children aged between 3-15 routinely, if a special team was ready. For the tidal volume and minute volume of Sulla 808V ventilator were dependent on* fresh gas flow, transformable pressure breathing was used when the fresh gas volume was insufficient. For this reason we suggested that it would be beter to use the ventilators of which tidal volume was not dependent on fresh gas flow for minimal flow anaesthesia. Key Words; Minimal flow, high flow, Sulla 808 V. VI
ABSTRACT A Comparison of the effects of minimal flow anaesthesia and high flow anaesthesia on children The purpose of this study was to compare the minimal flow anaesthesia where the fresh gas flow of 0.5 L/min was used with high flow technique of 6 L/min in routine and to assess the validity of Sulla 808V anaesthesia ventilator. Forty patients aged between 3-15 years were randomly divided into.two groups. Each group was included 20 patients. Group I was recieved fresh gas flow of 0.5 L/min (250ml/min 02 + 250ml/min N20 + 1.5 % vol isoflurane) (minimal flow technique group), Group 2 was recieved fresh gas flow of 6L/min (2L/min 02 + 4 L/min N2G> + I % vol isoflurane) (high flow anaesthesia technique group). Electrocardiyography, pulse oximeter, automatic arteriel tension monitor were used to record heart rates, arterial oxygen saturations, sistolic and diastolic arterial pressures, mean arterial pressures. 6-8 mg.kg '' tiopentone, 0.1 mg. kg _1 vecuronium and 0.5 mg. kg 'l meperidine were administered for anaesthesia induction. Maintanance of anaesthesia was provided by using the mixture of 02 + N20 + isoflurane. Body temperature was recorded by inserting nasopharegeal termal probe. Fİ02 and Pe+C02 of respiratuar gases and inspiratuar isoflurane gas consantrations were measured. Sulla 808V anaesthesia ventilator was used for maintaining control ventilation with the tidal volume 8-10 ml per kilogram, respiratory rate 10-15 per minute. Breath volume per minute and patient-system peak pressure were recorded at the minutes 1,5, 15, 30 and 60th. The recovery time from anaesthesia, intraoperative and postoperative complications were also recorded. Consumption os isoflurane was calculated. The heart rates at the minutes 5, 15 and 60th were lower in group 1 than in group 2 (p<0.05). Sistolic arterial pressures at the minute 30th was higher in group 1 than in group 2 (p<0,0S), Th@r® were na »tatistieslly difference» between two groups tit the m\mt minutm In sistolic, diastolic and mean arterial pressure values. The saturation of 02 and the body temperatures in minute 60111 were similar in two groups. Breath volume per minute was decreased 48 % by the transition of high flow anaesthesia to minimal flow anaesthesia. By this transition, the decrease in patient system peak pressure was very clear. By this reason tidal volume had to be regulated. The decrease of Fi02 in minimal flow group was not more than 30 %. Pe+C02 values in minimal flow group were higher than in high flow group butthey were in normal ranges. Recovery from anaesthesia was rapid in minimal flow group (p<0.05). The complications were not statistically different between two groups. The body temperatures of two patients were higher than 38 °C, because duration of anaesthesia prolonged more than three hours. The consumption of isoflurane in minimal flow group was less 72 % than in high flow group. We concluded that the minimal flow anaesthesia was superior to conventional high flow technique from clinical, economical and ecological points of wiew, and might be used on children aged between 3-15 routinely, if a special team was ready. For the tidal volume and minute volume of Sulla 808V ventilator were dependent on* fresh gas flow, transformable pressure breathing was used when the fresh gas volume was insufficient. For this reason we suggested that it would be beter to use the ventilators of which tidal volume was not dependent on fresh gas flow for minimal flow anaesthesia. Key Words; Minimal flow, high flow, Sulla 808 V. VI
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