Artertiyovenöz fistül cerrahilerinde lokal anestezi ve rejyonal anestezinin karşılaştırılması
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Date
2015
Authors
Terkanlıoğlu, Serkan
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Publisher
Uludağ Üniversitesi
Abstract
Kronik böbrek yetmezliği (KBY) hastalarında komplikasyon ve maliyetin düşük olması, uzun süre kullanılabilmesi nedeniyle vasküler erişim yolu olarak arteryiovenöz fistül (AVF) tercih edilmektedir. Çalışmamızda AVF cerrahisi için uygulanan lokal ve rejyonal anestezi yöntemlerini, fistül oluşturulan arter ve ven çapı ile kan akımı üzerine etkisini, bloğun oluşma süresini, cerrah ve hasta memnuniyetini, ilk hemodiyaliz seansı sırasındaki AVF performansını değerlendirerek karşılaştırmayı amaçladık. Çalışmamız lokal ve rejyonal anestezi uygulanarak primer AVF formasyonu planlanan 18-85 yaş arası 40 hastada gerçekleştirildi. Hastalar lokal anestezi ve rejyonal anestezi uygulanmasına göre sırasıyla Grup LA (n=20) ve Grup RA (n=20) olmak üzere iki gruba ayrıldılar. Rutin monitorizasyon uygulandıktan sonra kan basıncı, nabız dakika hızı, SpO₂, periferik perfüzyon indeksi(PPİ), vücut ve ortam sıcaklığı kaydedildi. Ultrasonagrafi cihazı ile brakiyal arter ve sefalik veninin çapı aynı şekilde alt aksiller bölgede aksiller ven ve aksiller arter çapı ve pulsatilite indeks(Pİ) bloktan önce, bloktan sonra 20. dakikada ve postoperatif 1. günde ölçüldü. Operasyondan sonra cerrahi ekibin memnuniyeti ve hastanın ağrısı değerlendirildi. İlk hemodiyaliz seansında AVF performansı sorgulandı. Demografik verilerde, cerrahi sürede, vücut ve ortam sıcaklığında anlamlı farklılık görülmedi. Cerrahi memnuniyet Grup RA'da yüksekti(p= 0.005). Grup LA'da operasyon sonunda ve postoperatif 8.saatte Vizüel Analog Skala değeri daha yüksekti (p= 0,0001). Grup RA'da 20. dakikada aksiller arter ve ven çapı, sefalik ven çapı, brakial arter çapı genişti (p= 0,0001). Grup RA'da 20. dakikada Pİ değeri daha düşüktü, PPİ değeri yüksekti (p= 0,0001). Sonuç olarak brakiyal pleksus bloğunun neden olduğu veno-arteriyal dilatasyon ve artmış arteriyal kan akımı ile AVF oluşturulabilmesi için en uygun koşulların sağladığına inanıyoruz.
Arteriovenous fistula(AVF) is preferred as vascular access way because of its long lasting, low cost and complications in Chronic Renal Failure (CRF) patients. We compared local and regional anaesthesia for AVF surgery by investigating the effect on the blood flow and the diameter of arteries and veins creating fistula, time taken to perform the block, contentment of surgeon and patients, the performance of AVF during the first haemodialysis session. Our study was performed in 40 patients aged 18-85 who were scheduled for primary AVF formation under local or regional anaesthesia. Patients were randomized into two groups: Group LA (n=20) and Group RA(n=20) according to administration of local or regional anaesthesia respectively. After routine monitoring, blood pressure, heart rate, SpO₂, peripheral perfusion index (PPI), body and environment temperature were recorded. The diameter of brachial artery, cephalic vein , as well as axillary vein and axillary artery in lower axiallary region and Pulsatile Index (PI) were measured with ultrasonography before the block , 20 minutes after the administration of the block and 1 day after the operation. Contentment of surgeon and patients' pain were evaluated after the operation. Performance of AVF was evaluated during first haemodialysis session. There was no significant difference in demographic data, surgical time and body and environment temperature. Surgeon satisfaction was higher in group RA (p= 0.005). VAS levels at the end of the operation and 8 h after the operation were higher in group LA (p=0,0001). Diameters of axilary artery - vein, cephalic vein and brachial artery were wider 20 minutes after the block in group RA (p= 0,0001). PI levels were lower and PPI levels were higher in group RA 20 minutes after the block (p=0,0001). In conclusion, we believe that brachial plexus block, causing veno-arterial dilation and increased arterial blood flow provides most favourable conditions for creatin of AVF.
Arteriovenous fistula(AVF) is preferred as vascular access way because of its long lasting, low cost and complications in Chronic Renal Failure (CRF) patients. We compared local and regional anaesthesia for AVF surgery by investigating the effect on the blood flow and the diameter of arteries and veins creating fistula, time taken to perform the block, contentment of surgeon and patients, the performance of AVF during the first haemodialysis session. Our study was performed in 40 patients aged 18-85 who were scheduled for primary AVF formation under local or regional anaesthesia. Patients were randomized into two groups: Group LA (n=20) and Group RA(n=20) according to administration of local or regional anaesthesia respectively. After routine monitoring, blood pressure, heart rate, SpO₂, peripheral perfusion index (PPI), body and environment temperature were recorded. The diameter of brachial artery, cephalic vein , as well as axillary vein and axillary artery in lower axiallary region and Pulsatile Index (PI) were measured with ultrasonography before the block , 20 minutes after the administration of the block and 1 day after the operation. Contentment of surgeon and patients' pain were evaluated after the operation. Performance of AVF was evaluated during first haemodialysis session. There was no significant difference in demographic data, surgical time and body and environment temperature. Surgeon satisfaction was higher in group RA (p= 0.005). VAS levels at the end of the operation and 8 h after the operation were higher in group LA (p=0,0001). Diameters of axilary artery - vein, cephalic vein and brachial artery were wider 20 minutes after the block in group RA (p= 0,0001). PI levels were lower and PPI levels were higher in group RA 20 minutes after the block (p=0,0001). In conclusion, we believe that brachial plexus block, causing veno-arterial dilation and increased arterial blood flow provides most favourable conditions for creatin of AVF.
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Keywords
Arteriyovenöz fistül, Brakiyal pleksus bloğu, Damar çapları, Pulsatilite indeksi, Periferik perfüzyon indeksi, Arteriovenous fistula, Brachial plexus block, Vessel diameters, Pulsatility index, Peripheral perfusion index
Citation
Terkanlıoğlu, S. (2015). Artertiyovenöz fistül cerrahilerinde lokal anestezi ve rejyonal anestezinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.