Ultrasonografi rehberliğinde interskalen brakial pleksus blok uygulamasının solunum fonksiyonları ve arteriyel kan gazı üzerine etkisi
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Tarih
2020
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info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızda ultrason rehberliğinde interskalen brakial pleksus blok uygulamasının solunum fonksiyonları ve arteriyel kan gazı analizi üzerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışma, omuz bölgesi ve üst kol cerrahisi planlanan, ASA I-II, cerrahi süresi 2 saati geçmeyen, pulmoner disfonksiyonu olmayan, toplam 64 hasta ile yapıldı. Cerrahi sırasında anestezi sağlamak amaçlı USG-rehberliğinde interskalen brakial pleksus blok işlemi öncesi baseline (T0) ve blok sonrası 20. dk’ da (T20) kalp hızı, non-invaziv sistolik, diyastolik ve ortalama arter basıncı ölçülerek kaydedildi. Spirometri ve arteriyel kan gazı analizi yapılarak interskalen brakial pleksus blok uygulamasının solunum fonksiyonlarına ve arteriyel kan gazı üzerine etkisi değerlendirildi. Ayrıca blok uygulaması ile ilgili veriler kaydedildi. Bulgular: Blok sonrası 20.dk’ da kalp hızında daha belirgin olmak üzere (p =0,003), sistolik (p =0,375), diyastolik (p =0,608) ve ortalama arteriyel basınçta (p =0,496) baseline (T0) değerlere göre düşme gözlendi. Blok işlemi sonrası 20.dk’ da yapılan ikinci (T20) spirometrik ölçümde, baseline (T0) ile karşılaştırıldığında, vital kapasite (VC) (4,86-3,68, p <0,001), zorlu vital kapasite (FVC), zorlu ekspiratuar volüm 1.sn (FEV1) (4,24-3,40, p <0,018), Sniff PmaxPeak (6,18-5,06) (p <0,001) ve ort. PaO2 (86,40-79,24, p <0,024)’ de önemli oranda azalma gözlendi. Bununla birlikte ortalama PaCO2 (38,62-42,34) (p <0,001) artış anlamlı düzeyde değildi. Blok sonrası, 12 hastada Horner sendrom bulguları, 6 hastada hipotansiyon-bradikardi gözlendi. Dört hastada ise ses kısıklığı gelişti. Sonuç: İnterskalen brakial pleksus bloğu tek taraflı hemidiyafragmatik pareziye neden olarak solunum fonksiyonlarını ve arteriyel oksijen basıncını etkiler ve bu sebeple pulmoner hastalığı veya kardiyak patolojisi olan hastalar için risklidir.
Objective: In this study, we aimed to investigate the effect of ultrasonograpy (USG) guided interscalene brachial plexus block on pulmonary functions and arterial blood gas analysis. Material and Method: The study was carried out with 64 patients who were planned to undergo shoulder and upper arm surgery and had no pulmonary dysfunction with ASA I-II and surgery time not exceeding 2 hours. USG-guided interscalene brachial plexus block procedure (baseline, T0) and 20 minutes after block (T20) was performed to provide anesthesia during surgery. Heart rate, systolic, diastolic and mean arterial pressure was recorded after block procedure. Spirometry and arterial blood gas analysis were performed to evaluate the effect of interschalen block on pulmonary functions and arterial blood gas. In addition, data related to block application were recorded. Results: A decrease in heart rate (p =0.003), systolic (p =0.375), diastolic (p =0.608) and mean arterial pressure (p =0.496) was observed at the 20th min (T20) after the block. In the second (T20) spirometric measurement performed at the 20th minute after block, compared to baseline (T0), vital capacity (VC) (4.86- 3.68, p <0.001), forced vital capacity (FVC), forced expiratory volume 1.sec (FEV1) (4.24-3.40, p <0.018), Sniff PmaxPeak (6.18-5.06, p <0.001) and significant decrease in PaO2 (86.40-79.24, p <0,024) was observed. However, the average PaCO2 (38.62-42.34, p <0.001) increase was not significant. After the block, Horner syndrome findings were observed in 12 patients, and hypotension-bradycardia was observed in 6 patients. Hoarseness developed in 4 patients. Conclusion: Interscalene brachial plexus affects respiratory function and arterial oxygen pressure by causing unilateral hemidiaphragmatic paresis and is therefore risky for patients with pulmonary disease or cardiac pathology
Objective: In this study, we aimed to investigate the effect of ultrasonograpy (USG) guided interscalene brachial plexus block on pulmonary functions and arterial blood gas analysis. Material and Method: The study was carried out with 64 patients who were planned to undergo shoulder and upper arm surgery and had no pulmonary dysfunction with ASA I-II and surgery time not exceeding 2 hours. USG-guided interscalene brachial plexus block procedure (baseline, T0) and 20 minutes after block (T20) was performed to provide anesthesia during surgery. Heart rate, systolic, diastolic and mean arterial pressure was recorded after block procedure. Spirometry and arterial blood gas analysis were performed to evaluate the effect of interschalen block on pulmonary functions and arterial blood gas. In addition, data related to block application were recorded. Results: A decrease in heart rate (p =0.003), systolic (p =0.375), diastolic (p =0.608) and mean arterial pressure (p =0.496) was observed at the 20th min (T20) after the block. In the second (T20) spirometric measurement performed at the 20th minute after block, compared to baseline (T0), vital capacity (VC) (4.86- 3.68, p <0.001), forced vital capacity (FVC), forced expiratory volume 1.sec (FEV1) (4.24-3.40, p <0.018), Sniff PmaxPeak (6.18-5.06, p <0.001) and significant decrease in PaO2 (86.40-79.24, p <0,024) was observed. However, the average PaCO2 (38.62-42.34, p <0.001) increase was not significant. After the block, Horner syndrome findings were observed in 12 patients, and hypotension-bradycardia was observed in 6 patients. Hoarseness developed in 4 patients. Conclusion: Interscalene brachial plexus affects respiratory function and arterial oxygen pressure by causing unilateral hemidiaphragmatic paresis and is therefore risky for patients with pulmonary disease or cardiac pathology
Açıklama
Anahtar Kelimeler
Arteriyel Kan Gazı, İnterskalen Brakial Pleksus Bloğu, Solunum Testleri, Arterial Blood Gase, Breathing Patterns, Interscalene Brachial Plexus Block
Kaynak
Fırat Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
25
Sayı
4
Künye
GENCER M (2020). Ultrasonografi Rehberliğinde İnterskalen Brakial Pleksus Blok
Uygulamasının Solunum Fonksiyonları ve Arteriyel Kan Gazı
Üzerine Etkisi
. Fırat Tıp Dergisi, 25(4), 224 - 229.
