GKD Anest Yoð Bak Dern Derg. 2022; 28(4): 326-333 | DOI: 10.14744/GKDAD.2022.49358

Göðüs Cerrahisinde Tek Akciðer Ventilasyonu Uygulanan Diyabetes Mellitus Olgularýnda Serebral Oksijenlenmenin Deðerlendirilmesi: Prospektif, Gözlemsel Bir Çalýþma

Selda Þen¹, Salih Çokpýnar², Imran Kurt Ömürlü³, Sinem Sarý¹, Simge Alkut Kurum¹, Serdar Þen^2
1Aydýn Adnan Menderes Üniversitesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Aydýn, Türkiye
²Aydýn Adnan Menderes Üniversitesi, Göðüs Cerrahisi Anabilim Dalý, Aydýn, Türkiye
³Aydýn Adnan Menderes Üniversitesi, Biyoistatistik Anabilim Dalý, Aydýn, Türkiye

Amaç: Torasik cerrahide tek akciðer ventilasyonu (OLV) sýrasýnda hipoksiye baðlý olarak serebral oksijenasyon azalabilir ve bu durum yakýn kýzýlötesi spektroskopisi (NIRS) ile noninvaziv olarak deðerlendirilebilir. Yapýlan çalýþmalarda diyabetik hastalarda serebral dolaþýmýn etkisine baðlý olarak majör cerrahi sonrasý nörobiliþsel bozukluklarýn olabileceði gösterilmiþtir. Çalýþmamýzda akciðer rezeksiyonu yapýlan diyabetik hastalarda intraoperatif serebral oksijen satürasyonu ve kan gazlarýnýn incelenmesi amaçlandý.
Yöntem: Prospektif, gözlemsel çalýþmamýz akciðer rezeksiyonu uygulanan diyabetik ve diyabetik olmayan hastalarda planlandý. Operasyon sýrasýnda NIRS deðerleri ve hemodinamik parametreler kaydedildi. OLV ve çift lümenli ventilasyon (DLV) sýrasýnda hastalardan santral venöz (ScvO2) ve arteriyel kan gazý örnekleri alýndý. Tüm hastalarda ameliyat öncesi ve sonrasý kreatinin deðerlerine bakýldý.
Bulgular: Çalýþmamýz diyabetik (n=19) ve diyabetik olmayan (n=21) akciðer rezeksiyonu uygulanan hastalarda yapýldý. OLV sýrasýnda NIRS deðerleri her iki grupta da ilk ölçümlere göre 30. dakikada düþerken, bu düþüþ sadece diyabetik grupta operasyon boyunca devam etti. Operasyon boyunca her iki grupta hemodinamik ve ScvO2 deðerleri benzerdi. Diyabetik hastalarda OLV 30. ve 60. dakika rSO2 deðerleri ile postoperatif kreatinin deðerleri arasýnda korelasyon bulundu.
Sonuç: Bu çalýþmada, akciðer cerrahisinde OLV sýrasýnda NIRS ile ölçülen serebral oksijen deðerlerinin diyabetik hastalarda kontrol grubuna göre daha fazla düþtüðü ancak patolojik sýnýrlar içinde olmadýðý gösterildi.

Anahtar Kelimeler: Santral venöz oksijen satürasyonu, kreatinin, diyabetes mellitus, yakýn kýzýlötesi, tek akciðer ventilasyonu, spektroskopi

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Evaluation of Cerebral Oxygenation During One-lung Ventilation in Diabetic Patients Undergoing Lung Resection: A Prospective and Observational Study

Selda Þen¹, Salih Çokpýnar², Imran Kurt Ömürlü³, Sinem Sarý¹, Simge Alkut Kurum¹, Serdar Þen^2
1Department of Anesthesiology and Reanimation, Aydýn Adnan Menderes University, Aydýn, Türkiye
²Department of Thoracic Surgery, Aydýn Adnan Menderes University, Aydýn, Türkiye
³Department of Biostatistics, Aydýn Adnan Menderes University, Aydýn, Türkiye

Objectives: Cerebral oxygenation may decrease due to hypoxia during one lung ventilation (OLV) in thoracic surgery. Diabetic patients are at increased risk of cerebral and renal damage after major surgery due to microangiopathy. The primer aim of our study is to evaluate whether cerebral oxygenation is affected during OLV with near infrared spectroscopy (NIRS) and arterial/central venous oxygen saturation of the central venous blood (ScvO2) blood gases in diabetic patients. The secondary aim of our study is to investigate whether there is a relationship between cerebral oxygenation and changes in renal functions in diabetic patients.
Methods: Diabetic patients underwent lung resection between 2018 and 2021 were included in our prospective, case-controlled study. Regional oxygen saturation (rSO2) and hemodynamic parameters of the cases were recorded every 15 min from the pre-operative period to extubation. Central venous and arterial blood gas samples were taken from the patients during single lung ventilation and double lumen ventilation. They were recorded simultaneously with rSO2 and hemodynamic data. Pre-, post-operative creatinine values were checked.
Results: Fifty-two patients were included in the study. It was completed with 19 diabetic and 22 normal blood sugar patients. rSO2 decreased according to baseline measurements in both groups at 30 min during OLV. While rSO2 values were lower in OLV 60 min and throughout the DLV in diabetic patients, it was around basal values in control group. Hemodynamic data and ScvO2 values were similar. A correlation was observed be-tween rSO2 values and creatinine values during OLV in diabetic patients.
Conclusion: In our study, it was shown that cerebral oxygen values mea-sured by NIRS during OLV in lung surgery decreased more in diabetic patients than control group, but were not within the pathological limits.

Keywords: Central venous oxygen saturation, creatinine, diabetes mellitus, near-infrared, one-lung ventilation, spectroscopy

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