I·ntraoperatı·f ı·ntravenöz ketamı·n ı·nfüzyonunun sağ hepatektomı· uygulanan canlı karacı·ğer verı·cı·lerı·nı·n postoperatı·f depresı·f duygudurumu üzerı·ne etkı·sı·
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kadaeverik karaciğer, karaciğer nakli için bekleme listesine alınan hastalar için önemli organ kaynağı olmuştur. Kadaverik karaciğer yetersizliği, organ bekleme listesindeki artan ölüm oranlarına ve son zamanlarda canlı vericili karaciğer nakli dahil olmak üzere transplantasyonda daha yenilikçi ve riskli yaklaşımların kullanılmasına yol açtı. Organ nakli süreci, doğası gereği stresli bir durumdur, ayrıca alıcılar ve vericiler üzerinde olumsuz psikolojik etkiler yaratabilen birkaç aşamayı kapsamaktadır. Nakil sürecinde de olduğu gibi, donörler üzerinde bağışın psikiyatrik komplikasyonları ve psikolojik sonuçları hakkında çok fazla literatür bulunmamaktadır. Organ bağışından sonra vericilerde en yaygın psikiyatrik bozuklukların depresyon ve anksiyete olduğu bildirilmiştir. Vericilerde intihar gibi ciddi psikiyatrik komplikasyonlara dair artan kanıtlar da vardır. Postoperatif depresyon, hastanın iyileşmesini ve yaşam kalitesini ciddi şekilde etkileyen perioperatif psikolojik bir komplikasyondur. Aşırı durumlarda, intihar davranışına yol açabilir. Kalp dışı cerrahi hastalarının yaklaşık %24'ü ve kalp cerrahisi hastalarının %47'si postoperatif olarak depresif semptomlar yaşamaktadır. Cerrahi popülasyonda, ağrı, koroner arter baypas greftleme, aşırı obezite, bariatrik cerrahi ve doğum sonrası hormon dalgalanmaları gibi perioperatif ve hasta faktörleri psikolojik durumdaki değişikliklere katkıda bulunabilir. Postoperatif depresif semptomların varlığı, artmış enfeksiyon riski ve bilişsel işlev bozukluğu ile ilişkilidir. Ameliyattan sonra depresif semptomları ele almak, cerrahi hastaların bakımının önemli bir yönünü temsil eder, ancak etkili stratejiler henüz belirlenmemiştir. Çok sayıda randomize kontrollü çalışma, ketaminin antidepresan etkilerini göstermiştir. Bu antidepresan etkiler için önerilen mekanizmalar arasında hipokampal nörojenez artışı, glutamat salınımının yeniden dengelenmesi ve stres kaynaklı sinaptik eksikliklerin tersine çevrilmesi yer alır. Bu veriler, ameliyat sonrası depresif semptomların önlenmesi ve hafifletilmesi için perioperatif ortamlarda rutin ketamin kullanımının olası bir rolü olduğunu düşündürmektedir. Güncel literatür eksikliği göz önüne alındığında, donörlerdeki psikiyatrik sonuçların değerlendirilmesine odaklanmanın faydalı olacağını düşünerek bu çalışmayı canlı karaciğer vericilerinde yapmayı planladık. Birincil amacımız düşük doz ketamin infüzyonu uygulanmasının canlı karaciğer vericilerinde depresyon düzeyine etkisini incelemektir. İkincil amacımız da canlı karaciğer vericilerinde preoperatif ve postopertif depresyon görülme sıklığını araştırmaktır. Materyal ve Metot: Sağ hepatektomi operasyonu yapılan, American Society of Anesthesiologists (ASA) skoru I-II ve 18-65 yaş 90 karaciğer nakli vericisi çalışmamıza alındı. Olgular rastgele iki gruba ayrıldı. İntraoperatif ketamin uygulanan olgular, ketamin grubu ve serum fizyolojik uygulanan grup ise kontrol grubu olarak atandı. Olgular operasyon odasına alındıktan sonra standart anestezi ( EKG, periferik oksijen saturasyonu, kan basıncı) ve BİS (Bispektral İndex) monitörizasyonu yapıldı. Anestezi indüksiyonu; propofol ve fentanil ile yapıldı ve kas gevşemesi için roküronyum uygulandı. İdame desfloran ve hava karışımı ile sürdürüldü. BİS değeri 40-60 olacak şekilde desfloran dozu 0,6 ve 1 minimum alveolar concentration (MAC) uygulandı. Ketamin Grubuna; indüksiyondan sonra 0.5 mg/kg ketamin bolusu yapıldı ve anestezi idamensinin başlamasıyla 0.25 mg/kg/saat ketamin infüzyonu başlandı.Kontrol grubu için ise indüksiyondan sonra ve anestezi idamensinin başlamasıyla maskelenmiş bir şekilde serum fizyolojik bolusu ve serum fizyolojik infüzyonu uyguladı. Cerrahi işlemin bitmesiyle her iki gruba da uygulanan infüzyonlar sonlandırıldı. Olgular ekstübasyon sonrası derlenmede 45 dk takip edildi. Olguların depresyon duygu durumu Beck depresyon skalası ile değerlendirildi. Beck deprasyon skalası preoperatif ve postoperatif 7. gün yapıldı. Olguların cinsiyet, eğitim, çalışma, medeni ve akrabalık durumu ile depresyon arasındaki korelasyon incelendi. Bulgular: Gruplar arasında preoperatif ve postoperatif depresyon skorları açısından istatistiksel olarak anlamlı bir farklılık yoktu. Ketamin grubunda; preoperatif depresyon skoruna göre postoperatif dönemde istatistiksel olarak anlamlı bir değişim görülmedi Kontrol grubunda; preoperatif depresyon skoruna göre postoperatif dönemde görülen artış istatistiksel olarak anlamlıydı (p:0.031). Kontrol grubunda kadınlarda hem preoperatif hem de postoperatif depresyon skoru erkeklerden daha yüksekti. Kontrol grubunda çalışmayan kişilerin çalışan kişilere göre depresyon skoru daha yüksekti. Eğitim durumu, medeni durum ve akrabalık durumunun depresyonla ilişkisi görülmedi. Sonuç: Canlı karaciğer vericilerinde intraoperatif süre ile sınırlı düşük doz ketamin infüzyonunun postoperatif depresif ruh hali için geliştirilmiş skorlarda anlamlı bir fark oluşturmadığını gördük. Ancak ketamin alan grupta, postoperatif depresyon skorunda preoperatif dönemdekine göre anlamlı bir değişim görülmezken, Kontrol grubunda; postoperatif depresyon skoru preoperatif döneme göre anlamlı olarak daha yüksekti. Anahtar kelimeler : Ketamin , Depresyon , Canlı karaciğer vericileri
Aim: The cadaveric liver has become an important source of organs for patients on the waiting list for liver transplantation. Cadeveric liver failure has led to increased death rates on the organ waiting list and more recently the use of more innovative and risky approaches to transplantation, including living donor liver transplantation. The organ transplant process is inherently stressful and involves several stages that can have negative psychological effects on recipients and donors. As with the transplant process, there is not much literature on the psychiatric complications and psychological consequences of donation on donors. Depression and anxiety were reported to be the most common psychiatric disorders in donors after organ donation. There is also increasing evidence of serious psychiatric complications, such as suicide, in donors. Postoperative depression is a perioperative psychological complication that seriously affects the patient's recovery and quality of life. In extreme cases, it can lead to suicidal behavior. Approximately 24% of non-cardiac surgery patients and 47% of cardiac surgery patients experience depressive symptoms postoperatively. In the surgical population, perioperative and patient factors such as pain, coronary artery bypass grafting, extreme obesity, bariatric surgery, and postpartum hormone fluctuations may contribute to changes in psychological status. The presence of postoperative depressive symptoms is associated with an increased risk of infection and cognitive dysfunction. Addressing depressive symptoms after surgery represents an important aspect of the care of surgical patients, but effective strategies have yet to be identified. Numerous randomized controlled trials have demonstrated the antidepressant effects of ketamine. Proposed mechanisms for these antidepressant effects include increased hippocampal neurogenesis, rebalancing of glutamate release, and reversal of stress-induced synaptic deficiencies. These data suggest a possible role for routine ketamine use in perioperative settings for the prevention and relief of depressive symptoms after surgery. Considering the lack of current literature, we planned to conduct this study in living liver donors, considering that it would be beneficial to focus on the evaluation of psychiatric outcomes in donors. Our primary aim was to examine the effect of low-dose ketamine infusion on the level of depression in living liver donors. Our secondary aim is to investigate the incidence of preoperative and postoperative depression in living liver donors. Materials and Methods: American Society of Anesthesiologists (ASA) score I-II and 90 liver transplant donors aged 18-65 years who underwent right hepatectomy were included in our study. The cases were randomly divided into two groups. The cases in which ketamine was administered intraoperatively, the ketamine group and the group in which physiological saline was administered were assigned as the control group. After the patients were taken to the operating room, standard anesthesia (ECG, peripheral oxygen saturation, blood pressure) and BIS (Bispectral Index) monitoring were performed. Anesthesia induction; with propofol and fentanyl, and rocuronium for muscle relaxation. Maintenance was continued with a mixture of desflorane and air. Desfloran dose of 0.6 and a minimum alveolar concentration (MAC) of 1 were applied so that the BIS value was 40-60. To the Ketamine Group; After induction, a bolus of 0.5 mg/kg ketamine was administered and 0.25 mg/kg/hour ketamine infusion was initiated with the initiation of anesthesia maintenance. For the control group, they administered a masked saline bolus and saline infusion after induction and with the start of anesthesia maintenance. At the end of the surgical procedure, the infusions administered to both groups were terminated. The patient was followed up for 45 minutes in the recovery after extubation. Depression mood of the cases was evaluated with Beck depression scale. Beck depression scale was performed preoperatively and on the 7th postoperative day. The correlation between the gender, education, employment, marital and kinship status of the cases and depression was examined. Results:There was no statistically significant difference between the groups in terms of preoperative and postoperative depression scores. In the ketamine group; There was no statistically significant change in the postoperative period according to the preoperative depression score. In the control group; The increase in the postoperative period according to the preoperative depression score was statistically significant (p:0.031). In the control group, both preoperative and postoperative depression scores were higher in women than in men. In the control group, people who did not work had a higher depression score than those who worked. Educational status, marital status, and kinship status were not associated with depression. Conclusion: We found that intraoperative time-limited low-dose ketamine infusion in living liver donors did not make a significant difference in improved scores for postoperative depressive mood. However, there was no significant change in the postoperative depression score in the ketamine group compared to the preoperative period, while in the control group; The postoperative depression score was significantly higher than the preoperative period. Keywords: Ketamine, Depression, Live liver donors
Aim: The cadaveric liver has become an important source of organs for patients on the waiting list for liver transplantation. Cadeveric liver failure has led to increased death rates on the organ waiting list and more recently the use of more innovative and risky approaches to transplantation, including living donor liver transplantation. The organ transplant process is inherently stressful and involves several stages that can have negative psychological effects on recipients and donors. As with the transplant process, there is not much literature on the psychiatric complications and psychological consequences of donation on donors. Depression and anxiety were reported to be the most common psychiatric disorders in donors after organ donation. There is also increasing evidence of serious psychiatric complications, such as suicide, in donors. Postoperative depression is a perioperative psychological complication that seriously affects the patient's recovery and quality of life. In extreme cases, it can lead to suicidal behavior. Approximately 24% of non-cardiac surgery patients and 47% of cardiac surgery patients experience depressive symptoms postoperatively. In the surgical population, perioperative and patient factors such as pain, coronary artery bypass grafting, extreme obesity, bariatric surgery, and postpartum hormone fluctuations may contribute to changes in psychological status. The presence of postoperative depressive symptoms is associated with an increased risk of infection and cognitive dysfunction. Addressing depressive symptoms after surgery represents an important aspect of the care of surgical patients, but effective strategies have yet to be identified. Numerous randomized controlled trials have demonstrated the antidepressant effects of ketamine. Proposed mechanisms for these antidepressant effects include increased hippocampal neurogenesis, rebalancing of glutamate release, and reversal of stress-induced synaptic deficiencies. These data suggest a possible role for routine ketamine use in perioperative settings for the prevention and relief of depressive symptoms after surgery. Considering the lack of current literature, we planned to conduct this study in living liver donors, considering that it would be beneficial to focus on the evaluation of psychiatric outcomes in donors. Our primary aim was to examine the effect of low-dose ketamine infusion on the level of depression in living liver donors. Our secondary aim is to investigate the incidence of preoperative and postoperative depression in living liver donors. Materials and Methods: American Society of Anesthesiologists (ASA) score I-II and 90 liver transplant donors aged 18-65 years who underwent right hepatectomy were included in our study. The cases were randomly divided into two groups. The cases in which ketamine was administered intraoperatively, the ketamine group and the group in which physiological saline was administered were assigned as the control group. After the patients were taken to the operating room, standard anesthesia (ECG, peripheral oxygen saturation, blood pressure) and BIS (Bispectral Index) monitoring were performed. Anesthesia induction; with propofol and fentanyl, and rocuronium for muscle relaxation. Maintenance was continued with a mixture of desflorane and air. Desfloran dose of 0.6 and a minimum alveolar concentration (MAC) of 1 were applied so that the BIS value was 40-60. To the Ketamine Group; After induction, a bolus of 0.5 mg/kg ketamine was administered and 0.25 mg/kg/hour ketamine infusion was initiated with the initiation of anesthesia maintenance. For the control group, they administered a masked saline bolus and saline infusion after induction and with the start of anesthesia maintenance. At the end of the surgical procedure, the infusions administered to both groups were terminated. The patient was followed up for 45 minutes in the recovery after extubation. Depression mood of the cases was evaluated with Beck depression scale. Beck depression scale was performed preoperatively and on the 7th postoperative day. The correlation between the gender, education, employment, marital and kinship status of the cases and depression was examined. Results:There was no statistically significant difference between the groups in terms of preoperative and postoperative depression scores. In the ketamine group; There was no statistically significant change in the postoperative period according to the preoperative depression score. In the control group; The increase in the postoperative period according to the preoperative depression score was statistically significant (p:0.031). In the control group, both preoperative and postoperative depression scores were higher in women than in men. In the control group, people who did not work had a higher depression score than those who worked. Educational status, marital status, and kinship status were not associated with depression. Conclusion: We found that intraoperative time-limited low-dose ketamine infusion in living liver donors did not make a significant difference in improved scores for postoperative depressive mood. However, there was no significant change in the postoperative depression score in the ketamine group compared to the preoperative period, while in the control group; The postoperative depression score was significantly higher than the preoperative period. Keywords: Ketamine, Depression, Live liver donors
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
