Tiroidektomi Sırasında Semi-Fowler Pozisyonunun Serebral Oksijenizasyona Etkileri

Abstract

Patients are positioned with hyperextension of head and neck at Semi-Fowler state during general anaesthesia to facilitate the surgical procedure. We aimed to determine the changes of serebral oxygenation in this position during thyroidectomy surgery. 22 patients were recruited prospective observational study. Cerebral oxygenation were monitored, left and right cerebral regional oxygen saturation were measured continuously. Heart rate, mean arterial pressure, end-tidal carbondioxide were measured and evaluated at baseline, after positioning at 15th, 30th, 90th minutes and after surgery at corrected position. After 90 minutes, significant decrease was seen cerebral oxygenization right side compared to the baseline (p ˂ 0.05). 30th minute cerebral oxygenization right value decreased significantly compared to the 15th minute. 30th minute, cerebral oxygenization left value decreased significantly compared to 15 minutes (p ˃ 0.05). 90th minute cerebral oxygenization left value decreased significantly compared to the 30th minute (p < 0.05). Significant decrease in cerebral oxygen saturation in both cerebral sides had been shown in relation to prolonged surgery time. Cerebral oxygenation was effected by the position given for thyroidectomy surgery. High-risk patients can be detected by regional cerebral oxygen saturation and prevent cerebral ischemia. Precautions should be taken for highrisk patients.

Nursing Care Related with Surgical Position

“…After induction and intubation, the patient is positioned seated, with the head at the necessary height and with the body at variable degrees of lateralization; in all cases, place the head in the prone position and use metal frames with pegs to support the skull. (26) In neurosurgery, an excellent exposure of the operating field is mandatory and it is necessary to keep the position of the skull fixed for the time required. For this, it is necessary to have the aid of gravity to optimize hemostasis and reduce intracranial pressure without the position having an impact on respiratory and cardiovascular dynamics.…”

“…After induction and intubation, the patient is positioned seated, with the head at the necessary height and with the body at variable degrees of lateralization; in all cases, place the head in the prone position and use metal frames with pegs to support the skull. 26 …”