Yıl: 2018 Cilt: 46 Sayı: 4 Sayfa Aralığı: 297 - 304 Metin Dili: Türkçe DOI: 10.5152/TJAR.2018.72687 İndeks Tarihi: 24-09-2019

Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi

Öz:
Amaç: Bu çalışmada, laparoskopik obezite cerrahisi uygulanan olgularınpreoperatif özellikleri, intraoperatif ve postoperatif sonuçlarınınretrospektif olarak değerlendirilmesi amaçlanmıştır.Yöntemler: Etik Kurulu onayı alındıktan sonra Ocak 2013 veAralık 2016 arasında laparoskopik obezite cerrahisi uygulananolguların dosyaları incelendi. Demografik özellikler, anestezi veanaljezide kullanılan ilaçlar, derlenme ünitesinde/hastanede kalışsüresi, yoğun bakım/mekanik ventilasyon gereksinimi ve komplikasyonlarkaydedildi.Bulgular: Üç yıllık bir süreçte toplam 329 ASA II-III hasta opereedildi. Anestezi indüksiyonunda tiyopental ve propofol, idamedesevofluran, izofluran ve desfluran, kas gevşetici olarak vekuronyumve rokuronyum kullanıldı. Ortalama derlenme ünitesinde kalış süresi30,80±6,01 dakika ve ortalama hastanede kalış süresi 4,27±1,68gündü. Kullanılan hipnotik ajan, kas gevşetici ya da inhalasyonanesteziğinin derlenme ünitesi ve hastanede kalış süresi üzerine anlamlıbir etkisi bulunmadı. Olguların %5,5’inde maske ventilasyonuve %8,5’inde entübasyon güçlüğü vardı. Obstrüktif uyku apnesendromu varlığı, beden kitle indeksi ve Mallampati skorundakiyüksekliğin zor maske ventilasyonu ve zor entübasyonu anlamlıölçüde artırdığı bulundu. Dört hasta yakın izlem amacıyla yoğunbakıma alındı. İki hastanın tekrar operasyona alındığı, 2 olgudarabdomiyoliz, 1 olguda Wernicke ansefalopatisi, 2 olguda periferiknöropati geliştiği belirlendi. Perioperatif mortalite saptanmadı.Sonuç: Laparoskopik obezite cerrahisi uygulanan olgularda uygunhasta seçimi, iyi tasarlanmış anestezi ve cerrahi protokollerinin uygulanmasının,hasta sonuçlarının, erken ve geç komplikasyonlarınincelenmesinin başarı oranının artırılmasında önemli rol oynayacağıkanısındayız.
Anahtar Kelime:

Konular: Anestezi Acil Tıp Yoğun Bakım, Tıp

Retrospective Evaluation of Patients who Underwent Laparoscopic Bariatric Surgery

Öz:
Objective: In the present study, we aimed to retrospectively evaluate the preoperative characteristics, intraoperative and postoperative results of patients who underwent laparoscopic obesity surgeries. Methods: After obtaining the approval of the Ethics Committee, records of patients who underwent laparoscopic obesity surgery from January 2013 to December 2016 were reviewed. Demographic characteristics, medications used in anaesthesia and analgesia, the duration of recovery unit/hospital stay, intensive care unit/mechanical ventilation requirements and complications were recorded. Results: A total of 329 ASA II-III patients over a 3-year period were operated. Thiopental and propofol were administered at induction, sevoflurane, isoflurane and desflurane were administered for the maintenance, and vecuronium and rocuronium were administered to aid in neuromuscular blockage. The mean durations of recovery unit and hospital stays were 30.80±6.01 minutes and 4.27±1.68 days, respectively. The hypnotic agent, muscle relaxant or inhalation anaesthetics used did not have a significant effect on the duration of recovery unit and hospital stay. Mask ventilation and intubation were noted to be difficult in 5.5% and 8.5% of the cases, respectively. The presence of obstructive sleep apnoea syndrome and high body mass index and Mallampati scores significantly increased difficult mask ventilation and difficult intubation rates. Four patients were transferred to intensive care unit for close monitoring. Two patients were re-operated on, two patients had rhabdomyolysis, one patient had Wernicke's encephalopathy and two patients had peripheral neuropathy. Perioperative mortality did not occur in any patient. Conclusion: We believe that appropriate patient selection, the use of well-designed anaesthesia and surgical protocols play important roles in increasing the success rate of patient outcomes and early and late complications in laparoscopic obesity surgery.
Anahtar Kelime:

Konular: Anestezi Acil Tıp Yoğun Bakım, Tıp
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 201 Lancet 2014; 384: 766-81.
  • 2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systemic review and meta- analysis. JAMA 2004; 292: 1724-37. [CrossRef ]
  • 3. Glance LG, Dick AW, Mukamel DB, Fleming FJ, Zollo RA, Wissler R, et al. Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 2010; 113: 859-72. [CrossRef ]
  • 4. Lindauer B, Steurer MP, Müller MK, Dullenkopf A. Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland. BMC Anesthesiol 2014; 14: 125. [CrossRef ]
  • 5. Yılmaz A, Taşpınar V, Sakçak İ, Özer P, Yılmaz P, Erk G, et al. Bariyatrik cerrahi ve anestezi/retrospektif bir çalışma. Türkiye Klinikleri J Med Sci 2012; 32: 24-31. [CrossRef ]
  • 7. Neligan PJ, Porter S, Max B, Malhotra G, Greenblatt EP, Ochroch EA. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesth Analg 2009; 109: 1182-6. [CrossRef ]
  • 8. Sato S, Hasegawa M, Okuyama M, Okazaki J, Kitamura Y, Sato Y, et al. Mask Ventilation during Induction of General Anesthesia: Influences of Obstructive Sleep Apnea. Anesthesiology 2017; 126: 28-38. [CrossRef ]
  • 9. Siyam MA, Benhamou D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 2002; 95: 1098-102. [CrossRef ]
  • 10. Corso RM, Piraccini E, Calli M, Berger M, Gorini MC, Agnoletti V, et al. Obstructive sleep apnea is a risk factor for difficult endotracheal intubation. Minerva Anestesiol 2011; 77: 99-100.
  • 11. Nishiyama T, Kohno Y, Koishi K. Anesthesia for bariatric surgery. Obes Surg 2012; 22: 213-9. [CrossRef ]
  • 12. Schumann R. Anaesthesia for bariatric surgery. Best Pract Res Clin Anaesthesiol 2011; 25: 83-93. [CrossRef ]
  • 13. Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesth Analg 2002; 95: 1793-805. [CrossRef ]
  • 14. Bagatini A, Trindade RD, Gomes CR, Marcks R. Anesthesia for bariatric surgery. Retrospective evaluation and literature review. Rev Bras Anestesiol 2004; 54: 247-51.
  • 15. Bouvet L, Chassard D. Ultrasound assessment of gastric content in the obese patient: one more step for patient safety. Anesth Analg 2014; 119: 1017-8. [CrossRef ]
  • 16. Turkish Society of Anaesthesiology and Reanimation Practice Guideline for Prevention of Unintentional Perioperative Hypothermia. Turk J Anaesthesiol Reanim 2013; 41: 188-90. [CrossRef ]
  • 17. Nightingale CE, Margarson MP, Shearer E, Margarson MP, Shearer E, Redman JW, et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70: 859-76. [CrossRef ]
  • 18. Siampalioti A, Karavias D, Zotou A, Kalfarentzos F, Filos K. Anesthesia management for the superobese: is sevoflurane superior to propofol as a sole anesthetic agent? A double-blind randomized controlled trial. Eur Rev Med Pharmacol Sci 2015; 19: 2493-500.
  • 19. La Colla L, Albertin A, La Colla G, Manqano A. Faster washout and recovery for desflurane vs sevoflurane in morbidly obese patients when no premedication is used. Br J Anaesth 2007; 99: 353-8. [CrossRef ]
  • 20. Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’Reilly M, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology 2006; 105: 885-91. [CrossRef ]
  • 21. Leoni A, Arlati S, Ghisi D, Verwej M, Lugani D, Ghisi P, et al. Difficult mask ventilation in obese patients: analysis of predictive factors. Minerva Anestesiol 2014; 80: 149-57.
  • 22. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 2005; 103: 429-37. [CrossRef ]
  • 23. Brodsky JB, Lemmens HJM, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tra
  • 24. Dohrn N, Sommer T, Bisgaard J, Rønholm E, Larsen JF. Difficult tracheal intubation in obese gastric bypass patients. Obes Surg 2016; 26: 2640-7. [CrossRef ]
  • 25. Ayhan A, Kaplan Ş, Kayhan Z, Arslan G. Evaluation and management of difficult airway in obesity: a single center retrospective study. Acta Clin Croat 2016; 55: 27-32.
  • 26. Ezri T, Gewurtz G, Sessler DI, Medalion B, Szmuk P, Hagberg C, et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia 2003; 58: 1111-4. [CrossRef ]
  • 27. Sheff SR, May MC, Carlisle SE, Kallies KJ, Mathiason MA, Kothari SN. Predictors of a difficult intubation in the bariatric patient: does preoperative body mass index matter? Surg Obes Relat Dis 2013; 9: 344-9.
  • 28. Karaman S, Doğru S, Karaman T, Tapar H, Sahin A, Arici S, et al. Anesthesia management in laparoscopic bariatric surgery: Perioperative complications and outcomes in the third year of practice. JCEI 2014; 5: 200-5. [CrossRef ]
  • 29. Cadi P, Guenoun T, Journois D, Chevallier JM, Diehl JL, Safran D. Pressure-controlled ventilation improves oxygenation during laparoscopic obesity surgery compared with volume- controlled ventilation. Br J Anaesth 2008; 100: 709-16. [CrossRef ]
  • 30. Hans GA, Preqaldien AA, Kaba A, Sottiaux TM, DeRoover A, Lamy ML, et al. Pressure controlled ventilation does not improve gas exchange in morbidly obese patients undergoing abdominal surgery. Obes Surg 2008; 18: 71-9. [CrossRef ]
  • 31. Hu XY. Effective ventilation strategies for obese patients undergoing bariatric surgery: A literatüre review. AANA J 2016; 84: 35-45.
  • 32. Van Lancker P, Dillemans B, Bogaert T, Mulier JP, De Kock M, Haspeslagh M. Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients. Anaesthesia 2011; 66: 721-5. [CrossRef ]
  • 33. Leykin Y, Pellis T, Del Mestro E, Fanti G, Marzano B. Perioperative management of 195 consecutive bariatric patients. Eur J Anaesthesiol 2008, 25: 168-70.
  • 34. Morgan DJ, Ho KM, Armstrong J, Baker S. Incidence and risk factors for intensive care unit admission after bariatric surgery: a multicentre population-based cohort study. Br J Anaesth 2015; 115: 873-82. [CrossRef ]
  • 35. Karadağ Erkoç S, Yılmaz AA. Bariatrik anestezi, postoperatif bakım ve komplikasyonlar. Anestezi Dergisi 2016; 24: 139-53.
  • 36. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta- analysis. Surgery 2007; 142: 621-32. [CrossRef ]
  • 37. Böckelman C, Hahl T, Victorzon M. Mortality Following Bariatric Surgery Compared to Other Common Operations in Finland During a 5-Year Period (2009-2013). A Nationwide Registry Study. Obes Surg 2017; 27: 2444-51. [CrossRef ]
  • 38. Mittermair RP, Obermüller S, Perathoner A, Sieb M, Aigner F, Margreiter R. Results and complications after Swedish adjustable gastric banding-10 years’ experience. Obes Surg 2009; 19: 1636-41. [CrossRef ]
APA Tuncali B, PEKCAN Y, Ayhan A, Erol V, YILMAZ T, Kayhan Z (2018). Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. , 297 - 304. 10.5152/TJAR.2018.72687
Chicago Tuncali Bahattin,PEKCAN Yonca ÖZVARDAR,Ayhan Asude,Erol Varlık,YILMAZ TUĞBA HAN,Kayhan Zeynep Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. (2018): 297 - 304. 10.5152/TJAR.2018.72687
MLA Tuncali Bahattin,PEKCAN Yonca ÖZVARDAR,Ayhan Asude,Erol Varlık,YILMAZ TUĞBA HAN,Kayhan Zeynep Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. , 2018, ss.297 - 304. 10.5152/TJAR.2018.72687
AMA Tuncali B,PEKCAN Y,Ayhan A,Erol V,YILMAZ T,Kayhan Z Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. . 2018; 297 - 304. 10.5152/TJAR.2018.72687
Vancouver Tuncali B,PEKCAN Y,Ayhan A,Erol V,YILMAZ T,Kayhan Z Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. . 2018; 297 - 304. 10.5152/TJAR.2018.72687
IEEE Tuncali B,PEKCAN Y,Ayhan A,Erol V,YILMAZ T,Kayhan Z "Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi." , ss.297 - 304, 2018. 10.5152/TJAR.2018.72687
ISNAD Tuncali, Bahattin vd. "Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi". (2018), 297-304. https://doi.org/10.5152/TJAR.2018.72687
APA Tuncali B, PEKCAN Y, Ayhan A, Erol V, YILMAZ T, Kayhan Z (2018). Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. Turkish Journal of Anaesthesiology and Reanimation, 46(4), 297 - 304. 10.5152/TJAR.2018.72687
Chicago Tuncali Bahattin,PEKCAN Yonca ÖZVARDAR,Ayhan Asude,Erol Varlık,YILMAZ TUĞBA HAN,Kayhan Zeynep Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. Turkish Journal of Anaesthesiology and Reanimation 46, no.4 (2018): 297 - 304. 10.5152/TJAR.2018.72687
MLA Tuncali Bahattin,PEKCAN Yonca ÖZVARDAR,Ayhan Asude,Erol Varlık,YILMAZ TUĞBA HAN,Kayhan Zeynep Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. Turkish Journal of Anaesthesiology and Reanimation, vol.46, no.4, 2018, ss.297 - 304. 10.5152/TJAR.2018.72687
AMA Tuncali B,PEKCAN Y,Ayhan A,Erol V,YILMAZ T,Kayhan Z Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. Turkish Journal of Anaesthesiology and Reanimation. 2018; 46(4): 297 - 304. 10.5152/TJAR.2018.72687
Vancouver Tuncali B,PEKCAN Y,Ayhan A,Erol V,YILMAZ T,Kayhan Z Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi. Turkish Journal of Anaesthesiology and Reanimation. 2018; 46(4): 297 - 304. 10.5152/TJAR.2018.72687
IEEE Tuncali B,PEKCAN Y,Ayhan A,Erol V,YILMAZ T,Kayhan Z "Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi." Turkish Journal of Anaesthesiology and Reanimation, 46, ss.297 - 304, 2018. 10.5152/TJAR.2018.72687
ISNAD Tuncali, Bahattin vd. "Laparoskopik Obezite Cerrahisi Uygulanan Olguların Retrospektif Olarak Değerlendirilmesi". Turkish Journal of Anaesthesiology and Reanimation 46/4 (2018), 297-304. https://doi.org/10.5152/TJAR.2018.72687