Majör Cerrahilerde İstenmeyen Perioperatif Hipotermi
Özet
İstenmeyen perioperatif hipotermi, vücut sıcaklığının anestezi öncesinden postoperatif ilk 24 saate kadar olan süreçte 36°C’nin altına düşmesi olarak tanımlanır. Bu durum, cerrahi sonrası morbiditeye yol açan ve önlenebilir faktörlerin başında gelir. Anestezikler, hipotalamustaki termoregülasyon sistemini baskılayarak vücudun ısı dengesini bozar. Özellikle majör cerrahi geçiren hastalarda hipotermi; kalp hızı ve kardiyak çıktının azalması gibi kardiyovasküler sorunlara, doku hipoksisi riskini artıran solunumsal değişikliklere ve insülin duyarlılığının azalması gibi metabolik bozukluklara yol açar. Ayrıca hipotermi, ilaç metabolizmasını yavaşlatarak anesteziden derlenme süresini uzatır, trombosit fonksiyonlarını bozarak cerrahi kanamayı ve enfeksiyon riskini artırır. Majör cerrahilerde yüksek kan kaybı ve geniş yüzey alanlı organların soğuk ameliyathane ortamına maruz kalması ısı kaybını hızlandırır. Bu nedenle, 30 dakikayı aşan tüm operasyonlarda ısı monitörizasyonu kritik öneme sahiptir. Pasif yalıtım ve aktif ısıtma yöntemleri (sıcak hava üflemeli sistemler, mayi ısıtıcılar vb.) kullanılarak normoterminin korunması; sepsis, organ yetmezliği ve mortalite sıklığını önemli ölçüde azaltmaktadır.
Unintended perioperative hypothermia is defined as the body temperature falling below 36°C during the period from the preoperative phase to the first 24 hours after anesthesia. This condition is one of the most significant preventable factors leading to postoperative morbidity. Anesthetics disrupt the body's heat balance by inhibiting the thermoregulation system in the hypothalamus. Especially in patients undergoing major surgery, hypothermia leads to cardiovascular problems such as decreased heart rate and cardiac output, respiratory changes that increase the risk of tissue hypoxia, and metabolic disorders such as decreased insulin sensitivity. Furthermore, hypothermia prolongs the recovery time from anesthesia by slowing down drug metabolism, and increases surgical bleeding and the risk of infection by impairing platelet functions. In major surgeries, high blood loss and the exposure of organs with large surface areas to the cold operating room environment accelerate heat loss. Therefore, temperature monitoring is of critical importance for all operations exceeding 30 minutes. Maintaining normothermia through the use of passive insulation and active warming methods (forced-air warming systems, fluid warmers, etc.) significantly reduces the incidence of sepsis, organ failure, and mortality.
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