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Adenotonsillectomie volgens Sluder onder inhalatieanesthesieHogere incidentie van hypoxemie bij zittende versus liggende operatiehouding

(2018) Verbeek, A.C.M.

Background Sluders’ adenotonsillectomy is one of the most commonly performed operations during childhood in the Netherlands. The intervention can be done with or without endotracheal intubation. In 66% of Dutch hospitals it is performed non-intubated. The adenotonsillectomy is conducted with the patient sitting upright or in supine position, depending on the preference of the surgeon. Little is known about the effects of the different positions.
Aim To investigate the incidence of hypoxemia (SaO₂ < 85% ≥ 60 sec) during non-intubated adenotonsillectomy according to Sluder in sitting versus supine position. Secondary outcomes are the incidence of bradycardia and hemorrhage.
Methods A retrospective database was drawn up with data from all patients in which an Sluders’ adenotonsillectomy was performed under inhalation anesthesia in a peripheral hospital between 01-01-2012 and 01-05-2018. Patients were categorized based on their surgery position: sitting or supine. Patient data on age, sex, height, weight, oxygen saturation, heart rate, need for intubation and hemorrhage were analyzed, using surgical and anesthetic reports.
Results We analyzed the data of 723 patients, 193 in sitting and 530 in supine position. The average age was 4,5 years, the average weight was 18,7 kilograms. There were statistically significant more patients showing hypoxemia in the sitting group, respectively 13 patients (6,7%) versus 13 patients (2,5%) in the supine group. There was no statistical significant difference in bradycardia between the testing groups. No patient with hypoxemia and bradycardia occurring simultaneously existed in the entire study population. In 13 patients, of which 11 were operated lying down, an hemorrhage has occurred.
Conclusion In this retrospective study the incidence of hypoxemia appears higher when performing the adenotonsillectomy according to Sluder in sitting versus supine position.





ID 3973
Moeder ID 3802
Volgorde Verbeek, A.C.M.
Naam VerbeekACM
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2018/VerbeekACM/
Gemaakt op: 2019-07-02 12:29:44
Gemodificeerd op: 2019-07-02 12:29:44
Digitaal ID 5d1b4e3889b28
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel Adenotonsillectomie volgens Sluder onder inhalatieanesthesieHogere incidentie van hypoxemie bij zittende versus liggende operatiehouding
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 27
Publicatiejaar 2018
Taal nl
Engelse samenvatting Background Sluders’ adenotonsillectomy is one of the most commonly performed operations during childhood in the Netherlands. The intervention can be done with or without endotracheal intubation. In 66% of Dutch hospitals it is performed non-intubated. The adenotonsillectomy is conducted with the patient sitting upright or in supine position, depending on the preference of the surgeon. Little is known about the effects of the different positions.
Aim To investigate the incidence of hypoxemia (SaO₂ < 85% ≥ 60 sec) during non-intubated adenotonsillectomy according to Sluder in sitting versus supine position. Secondary outcomes are the incidence of bradycardia and hemorrhage.
Methods A retrospective database was drawn up with data from all patients in which an Sluders’ adenotonsillectomy was performed under inhalation anesthesia in a peripheral hospital between 01-01-2012 and 01-05-2018. Patients were categorized based on their surgery position: sitting or supine. Patient data on age, sex, height, weight, oxygen saturation, heart rate, need for intubation and hemorrhage were analyzed, using surgical and anesthetic reports.
Results We analyzed the data of 723 patients, 193 in sitting and 530 in supine position. The average age was 4,5 years, the average weight was 18,7 kilograms. There were statistically significant more patients showing hypoxemia in the sitting group, respectively 13 patients (6,7%) versus 13 patients (2,5%) in the supine group. There was no statistical significant difference in bradycardia between the testing groups. No patient with hypoxemia and bradycardia occurring simultaneously existed in the entire study population. In 13 patients, of which 11 were operated lying down, an hemorrhage has occurred.
Conclusion In this retrospective study the incidence of hypoxemia appears higher when performing the adenotonsillectomy according to Sluder in sitting versus supine position.
Nederlandse samenvatting Achtergrond Adenotonsillectomie volgens Sluder is in Nederland één van de meest uitgevoerde operaties op de kinderleeftijd. Deze ingreep kan met of zonder endotracheale intubatie plaatsvinden, de ongeïntubeerde techniek wordt in 66% van de Nederlandse ziekenhuizen gebruikt. De operatie wordt uitgevoerd met de patiënt in zittende of liggende houding, naar keuze van de operateur. Er is weinig bekend over de effecten van de verschillende posities.
Doel Onderzoeken wat de incidentie is van hypoxemie (SaO₂ < 85% ≥ 60 sec) tijdens ongeïntubeerde adenotonsillectomie volgens Sluder in zittende versus liggende houding. Secundaire uitkomstmaten zijn het optreden van bradycardie en nabloeding.
Methode Aan de hand van operatie- en anesthesieverslagen werd er een retrospectieve database opgesteld met gegevens over leeftijd, geslacht, lengte, gewicht, zuurstofsaturatie, hartfrequentie, noodzaak tot intubatie en nabloeding van alle patiënten waarbij tussen 01-01-2012 en 01-05-2018 een adenotonsillectomie volgens Sluder onder inhalatieanesthesie is verricht in een perifeer ziekenhuis. Patiënten werden op basis van operatiehouding gecategoriseerd: zittend of liggend.
Resultaten We analyseerden de gegevens van 723 patiënten, 193 in zittende houding en 530 in liggende houding. De gemiddelde leeftijd was 4,5 jaar, het gemiddelde gewicht 18,7 kilogram. Er waren significant meer patiënten met hypoxemie in de zittende groep, respectievelijk 13 patiënten (6,7%) versus 13 patiënten (2,5%) in de liggende groep. Er was geen statistisch significant verschil in optreden van bradycardie tussen de onderzoeksgroepen. In de gehele populatie was geen enkele patiënt met gelijktijdig optreden van hypoxemie én bradycardie. Bij 13 patiënten, waarvan er 11 liggend geopereerd zijn, is een nabloeding opgetreden.
Conclusie In deze retrospectieve studie blijkt de incidentie van hypoxemie hoger bij het uitvoeren van de ongeïntubeerde adenotonsillectomie volgens Sluder in zittende versus liggende houding.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Verbeek, A.C.M.
UMCG begeleider(s) Facultair begeleider; Rinia, drs. A.B.; Afdeling; Keel-, neus- en oorheelkunde; Isala klinieken
Auteur(s) Verbeek, A.C.M.
UMCG begeleider(s) Facultair begeleider; Rinia, drs. A.B.; Afdeling; Keel-, neus- en oorheelkunde; Isala klinieken


 
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