Thesis Type: Expertise In Medicine
Institution Of The Thesis: Ankara Yildirim Beyazit University, Tıp Fakültesi, Anesteziyoloji Ve Reanimasyon Ana Bilim Dalı, Turkey
Approval Date: 2022
Thesis Language: Turkish
Student: Ezgi UYSAL
Supervisor: SEVAL İZDEŞ
Abstract:Purpose: It was aimed to determine the effects of individualized PEEP ventilation set to the lowest driving pressure on intraoperative hemodynamics, lung mechanics and postoperative pulmonary functions compared to fixed PEEP ventilation in robot-assisted operations performed in the steep Trendelenburg position. Materials and Methods: After approval of the Ethics Committee, the patients who were scheduled for robotic surgery in the steep Trendelenburg position were divided into 2 groups: ventilation with individualized PEEP (Group S) set to the lowest driving pressure and ventilation with fixed PEEP (Group K). After positioning, tidal volume (VT) was set to 6 mL/kg, PEEP to 4 cmH2O, inspiratory pause to 30% in volume-controlled mode in Group K. After pneumoperitoneum, both groups were monitored with, in pressure-controlled mode, routine monitoring parameters and blood gas values taken and the PaO2/FiO2 ratio was calculated. Ppik, Pplato and driving pressures were recorded after intubation, at 5th and 10th minutes after Trendelenburg, and pneumoperitoneum, and then every 15 minutes, pre-extubation. The patients were examined for pulmonary complications at 24th and 48th postoperative hours. The lung areas examined by USG before and after surgery were evaluated with a modified lung ultrasound scoring system (LUS). The Chi-Square test, Kolmogorov-Smirnov test, t-test, Mann-Whitney U test were used for statistical comparison, and p<0.05 was considered significant. Results: While the general characteristics of the groups were similar, the operation-related periods were significantly longer and intraoperative MAP was significantly lower in Group S compared to Group K, (p<0.05), but vasopressor requirement did not occur. In the intraoperative period, at the 5th minute post-pneumoperitoneum and before extubation Pplato was found to be higher in Group K than in Group S (p<0.05). At postoperative 1st hour SpO2 and PaO2 was higher in Group S and LUS values were higher in Group K than in the other Group (p<0.05). However, there was no difference in terms of postoperative pulmonary complications between the groups. Conclusion: It was determined that in robot-assisted laparoscopic operations performed in the steep Trendelenburg position, ventilation with individualized PEEP set to the lowest driving pressure reduces postoperative atelectatic areas and improves perioperative oxygenation without disturbing hemodynamics in the intraoperative period compared to fixed PEEP ventilation.