GKD Anest Yoð Bak Dern Derg. 2022; 28(2): 122-128 | DOI: 10.14744/GKDAD.2022.05668

Kalp Cerrahisinde Ýntraoperatif Yakýn Kýzýl Ötesi Spektroskopi Takibi Nörokognitif Disfonksiyonu Önlemede Güvenilir Bir Takip Yöntemi midir?

Nur Ürküt Baz¹, Pýnar Karaca Baysal², Pýnar Yýldýrým özkan³, Ömer Faruk Savluk^2
1Sultanbeyli Devlet Hastanesi, Anestezi ve Reanimasyon Anabilim Dalý, Ýstanbul, Türkiye
²Ýstanbul Kartal Koþuyolu Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi, Anestezi ve Reanimasyon Kliniði, Ýstanbul, Türkiye
³Ýstanbul Ümraniye Eðitim ve Araþtýrma Hastanesi, Anestezi ve Reanimasyon Kliniði, Ýstanbul, Türkiye

Amaç: Calýþmamýzda, kalp kapak cerrahisi sýrasýnda hastalarda, yakýn infrared spektroskopisi kullanýmýyla deðerlendirilen serebral oksimetrideki deðiþikliklerin postoperatif norokognitif disfonksiyonu onlemede guvenilir bir takip yontemi olup olmadýðýnýn araþtýrýlmasý amaclandý.
Yöntem: Mart 2014-Mart 2015 tarihleri arasýnda kalp kapak cerrahisi gecirecek, calýþmayý kabul eden en az ilkokul mezunu 43 hasta (20 erkek, 23 kadýn; yaþ daðýlýmý 18-75 yaþ) calýþmaya dahil edildi. Tum hastalara induksiyon oncesinde ve operasyon suresince yakýn infrared spektroskopisi ile serebral oksimetri takibi yapýldý. En duþuk ve ortalama rSO2 (rejyo-nel hemoglobin oksijen saturasyonu) deðerleri kaydedildi. Yakýn infrared spektroskopisi takibinde rSO2 deðerinde %20 ve uzerinde duþme olup mudahalede bulunan gruba A grubu (n=18), %20’den daha az duþme olan gruba B grubu (n=25) þeklinde isim verildi. Kardiyopulmoner baypas yonetimi ve cerrahi protokolu tum hastalarda ayný þekilde uygulandý. Norokognitif deðerlendirme operasyondan en az iki gun once, operasyondan bir hafta sonra yapýldý. Bu amacla minimental test, gorsel mekansal iþlevler testi ve saat cizim testi uygulandý. Sonuclar istatistiksel olarak deðerlendirildi.
Bulgular: A ve B grubundaki hastalar karþýlaþtýrýlmýþ benzer bulunmuþtur. Gruplar arasýnda ameliyattan bir hafta sonra yapýlan minimental test, gorsel mekansal iþlevler testi ve saat cizim test deðerleri arasýnda anlamý bir farklýlýk bulunmamýþtýr. Bu iki grup icin yoðun bakýmda ve hastanede kalýþ acýsýndan da anlamlý bir fark bulunamamýþtýr.
Sonuç: Kalp kapak cerrahisinde serebral perfuzyon bircok nedenle bozulabilir. Bu durumun yakýn infrared spektroskopisi ile takibi ve gereðinde intraoperatif mudahale postoperatif norokognitif fonksiyonlarý onlemede onemli olabilir duþuncesindeyiz.

Anahtar Kelimeler: Açýk kalp cerrahisi, nörokognitif disfonksiyon, yakýn infrared spektroskopisi

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Can Intraoperative Near-Infrared Spectroscopy Monitoring a Reliable Monitoring Method in Preventing Neurocognitive Dysfunction in Cardiac Surgery? Neurocognitive Monitoring Method in Cardiac Surgery

Nur Ürküt Baz¹, Pýnar Karaca Baysal², Pýnar Yýldýrým özkan³, Ömer Faruk Savluk^2
1Department of Anesthesia and Reanimation, Sultanbeyli State Hospital, Ýstanbul, Türkiye
²Department of Anesthesia and Reanimation, Istanbul Kartal Kosuyolu High Specialization Training and Research Hospital, Ýstanbul, Türkiye
³Department of Anesthesia and Reanimation, Istanbul Umraniye Training and Research Hospital, Ýstanbul, Türkiye

Objectives: Our study aims to investigate whether changes in cerebral oximetry as assessed by the use of near infrared spectroscopy are a reliable monitoring method in preventing post-operative neurocognitive dysfunction in patients undergoing cardiac valvular surgery.
Methods: The study included 43 patients who were to undertake valvular cardiac surgery between March 2014 and March 2015 and agreed to take part in the study. All patients received cerebral oximetry monitoring by near-infrared spectroscopy before induction and during the operation. The group of patients who demonstrated a ≥20% decrease in cerebral oximetry and received intervention were called Group A (n=18), and the group of patients with a <20% reduction in cerebral oximetry was called Group B (n=25). Neurocognitive assessments were performed 2 days before and 1 week after surgery. The minimental test, visual-spatial functions test, and clock-drawing test were utilized for this purpose.
Results: Patients in groups A and B were compared in terms of age, gender, educational status, and additional disease status, and the groups were found to be similar. There was no difference between the two groups in terms of peroperative cardiopulmonary bypass times and cross-clamp times. There was no significant difference between the groups in the minimental test, visual-spatial functions test and clock drawing test values performed one week after the surgery. No significant difference was found in terms of intensive care and hospital stay for these two groups.
Conclusion: We believe that near-infrared spectroscopy monitoring against such a decrease and immediate intraoperative intervention as necessary based on near-infrared spectroscopy monitoring may be important in preventing post-operative neurocognitive dysfunctions.

Keywords: Neurocognitive dysfunction, Near Ýnfrared spectroscopy, open heart surgery

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