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Elektif sezaryen ameliyatlarında yapılan perioperatif uygulamaların ERAS protokolüne göre değerlendirilmesi

Year 2020, Volume: 45 Issue: 4, 1607 - 1616, 27.12.2020
https://doi.org/10.17826/cumj.745762

Abstract

Amaç: Bu çalışma elektif sezaryen ameliyatlarında perioperatif uygulamaların Cerrahide Hızlı İyileşme Protokolüne (Enhanced Recovery After Surgery – ERAS) göre değerlendirilmesi amacıyla tanımlayıcı ve prospektif olarak yapılmıştır.
Gereç ve Yöntem: Çalışma 01 Ağustos 2016 - 31 Mayıs 2017 tarihleri arasında bir Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’nde yürütülmüştür. Sezaryen ameliyatı planlanan, çalışmaya katılmayı kabul eden 100 kadın araştırma örneklemini oluşturmuştur. Veri toplamak amacı ile kadınların bazı tanıtıcı özellikleri ile ERAS protokolü önerilerini içeren, araştırmacılar tarafından oluşturulan veri toplama formu kullanılmıştır.
Bulgular: Preoperatif katı gıda kısıtlama zamanı 12,17±3,37 saat, preoperatif sıvı kısıtlama zamanı 10,36±2,85 saat olarak hesaplanmıştır. Kadınların %77’sinde spinal anestezi, %23’ünde genel anestezi kullanıldığı, intraoperatif hipoterminin önlenmesi amacı ile bütün hastalarda ameliyat esnasında ısıtıcı alt şiltesi, uyandırma ünitesinde ise havalı battaniyeler kullanıldığı belirlenmiştir. Cerrahi kesi boyutu ortalama 15,83±0,81 cm olarak ölçülmüştür. Postoperatif üriner kateter çıkarılma zamanı 7,99±2,86 saat, gaz çıkış zamanı 15,29±6,36 saat ve katı gıdaya başlama zamanı 16,46±5,85 saat olarak hesaplanmıştır.
Sonuç: Çalışmada elde edilen bulgulara göre çoğu uygulamanın ERAS protokollerine uygun olduğu değerlendirilmiştir. Farklı olan uygulamalarla ilgili; hastaların preoperatif dönemde hem sözel hem de yazılı materyallerle bilgilendirilmesi gerekir.

References

  • 1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Brit J Anaesth. 1997;78:606-617.
  • 2. Kehlet H, Wilmore DW. Fast track surgery. Brit J Surg. 2005;92:3-4.
  • 3. Türkiye Nüfus ve Sağlık Araştırması (TNSA) 2018. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Ankara.
  • 4. OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en. (accessed date: May 2019).
  • 5. Taşkın L. Doğum ve Kadın Sağlığı Hemşireliği. 16. Basım. Ankara, Akademisyen Kitabevi, 2020.
  • 6. NICE Clinical Guideline 132, 2011. https://www.nice.org.uk/guidance/cg132. (accessed May 2017).
  • 7. Long O. Enhanced recovery in obstetric surgery The King’s Experience 2015. www.kssahsn.net (accessed May 2017).
  • 8. Zonca P, Stigler J, Maly T, et al. Do we really apply fast-track surgery? Bratisl Lek Listy. 2008;109:61-65.
  • 9. Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery Society recommendations – Part 1. Gynecol Oncol. 2016;140(2):313-22.
  • 10. Lurie S, Baider C, Glickman H, et al. Are enemas given before cesarean section useful? A prospective randomized controlled study. Eur J Obstet Gynecol Reprod Biol. 2012;163:27-29.
  • 11. T.C Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Riskli Gebelikler Yönetim Rehberi Ankara; 2014. URL: https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/risgebyonreh.pdf (erişim tarihi: Mayıs 2017).
  • 12. Mackeen AD, Packard RE, Ota E, et al. Timing of intraveneous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery, Cochrane Database of Syst Rev 2014, issue 12.
  • 13. Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic / oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part II. Gynecol Oncol. 2016;140(2):323-332.
  • 14. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery. Arch Surgery. 2009;144(10):961-969.
  • 15. Ulubay M, Öztürk M, Fidan U, et al. Skin incision lenghts in caesarean section. Cukurova Med J. 2016;41(1):81-86.
  • 16. Munday J, Hines S, Wallace K, et al. A systematic review of the effectiveness of warming interventions for women undergoing cesarean section. Worldviews Evid Based Nurs. 2014;11(6):383-93.
  • 17. El-Mazny A, El-Sharkawy M, Hassan A. A prospective randomized clinical trial comparing immediate versus delayed removal of urinary catheter following elective cesarean section. Eur J Obstet Gynecol Reprod Biol. 2014;181:111-114.
  • 18. Aluri S, Wrench IJ. Enhanced recovery from obstetric surgery: a UK survey of practice. Int J Obstet Anesth. 2014;23(2):157-60.
  • 19. Parsons B, Yau R. P16 Enhanced recovery in elective caesarean sections: a reduced length of stay and cost savings. Int J Obstet Anesth. 2015;24:18.
  • 20. Göçmen A, Göçmen M, Saraoğlu M. Early postoperative feeding after cesarean delivery. J Int Med Res. 2002;30:506-511.
  • 21. Aydın Y, Altunyurt S, Oge T, Sahin F. Early versus delayed oral feeding after cesarean delivery under different anesthetic methods – A randomised controlled trial anesthesia, feeding in cesarean delivery. Ginekol Pol. 2014;85:815-822.
  • 22. Wrench IJ, Allison A, Galimberti A, et al. Introduction of enhanced recovery for elective caesarean section enabling next day discharge : a tertiary center experience. Int J Obstet Anesth. 2015;24:124-130.
  • 23. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ. 2001;322:473-476.
  • 24. Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia prevention program for the inpatient surgical ward. J Am Coll Surg. 2010;210:491-495.
  • 25. Coates E, Fuller G, Hind D, et al. Enhanced recovery pathway for elective caesarean section. Int J Obstet Anesth. 2016;27:94-5. 26. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;16(2).
  • 27. T.C Sağlık Bakanlığı Doğum Sonu Bakım Yönetim Rehberi Genelgesi 2010/27 URL: http:// www.saglik.gov.tr (erişim tarihi: Mayıs 2017).
  • 28. S. Rhodes, M. Drake, M. Moll, M. Steynor. Adapting Enhanced Recovery for Obstetric Surgery: The National Women’s Experience ePoster presentation 2015. https://www.epostersonline.com/oaa2015/node/115 (accessed: May 2017).
  • 29. Abell D, Pool AW, Sharafudeen S, et al. Enhanced recovery in obstetric surgery (KingsEROS): early results from one of the UKs first programmes. Eur J Anaesthesiol. 2014;31:192.
  • 30. Steenhagen E. Enhanced recovery after surgery: It’s time to change practice! Nutr Clin Pract. 2016;31(1):18-29.

Evaluation of perioperative practices according to ERAS protocol in elective Cesarean surgery

Year 2020, Volume: 45 Issue: 4, 1607 - 1616, 27.12.2020
https://doi.org/10.17826/cumj.745762

Abstract

Purpose: This study was conducted as a descriptive and prospective study to evaluate perioperative practices in elective cesarean operations according to the Enhanced Recovery After Surgery (ERAS) protocol.
Materials and Methods: The research was conducted between 01 August 2016 and 31 May 2017 at an Education and Research Hospital Obstetrics Clinic. The sample consisted of 100 volunteer women that planning elective cesarean surgery. Data collecting form consisted of some descriptive characteristics of women and ERAS protocol proposals.
Results: Mean preoperative solid food restriction time was 12,17±3,37 hours, mean preoperative fluid restriction time was 10,36±2,85 hours. 77% of women was applied spinal anesthesia; 23% of them was applied general anesthesia; in order to prevent intraoperative hypothermia, all women underwent a heating under mattress and air blankets in the wake unit. Surgical incision size was found to be 15,83±0,81 cm. Postoperatively, it was calculated that the time of remove of urinary catheter was an average of 7,99±2,86, the time of release of gas was an average of 15,29±6,36 hours and the time to start solid food was an average of 16,46±5,85 hours.
Conclusion: According to the findings obtained in the study, most of the practices were compatible with the ERAS protocols. About practices that are different; it is recommended that in the preoperative period women may be informed with both verbal and written materials.

References

  • 1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Brit J Anaesth. 1997;78:606-617.
  • 2. Kehlet H, Wilmore DW. Fast track surgery. Brit J Surg. 2005;92:3-4.
  • 3. Türkiye Nüfus ve Sağlık Araştırması (TNSA) 2018. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Ankara.
  • 4. OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en. (accessed date: May 2019).
  • 5. Taşkın L. Doğum ve Kadın Sağlığı Hemşireliği. 16. Basım. Ankara, Akademisyen Kitabevi, 2020.
  • 6. NICE Clinical Guideline 132, 2011. https://www.nice.org.uk/guidance/cg132. (accessed May 2017).
  • 7. Long O. Enhanced recovery in obstetric surgery The King’s Experience 2015. www.kssahsn.net (accessed May 2017).
  • 8. Zonca P, Stigler J, Maly T, et al. Do we really apply fast-track surgery? Bratisl Lek Listy. 2008;109:61-65.
  • 9. Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery Society recommendations – Part 1. Gynecol Oncol. 2016;140(2):313-22.
  • 10. Lurie S, Baider C, Glickman H, et al. Are enemas given before cesarean section useful? A prospective randomized controlled study. Eur J Obstet Gynecol Reprod Biol. 2012;163:27-29.
  • 11. T.C Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Riskli Gebelikler Yönetim Rehberi Ankara; 2014. URL: https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/risgebyonreh.pdf (erişim tarihi: Mayıs 2017).
  • 12. Mackeen AD, Packard RE, Ota E, et al. Timing of intraveneous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery, Cochrane Database of Syst Rev 2014, issue 12.
  • 13. Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic / oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part II. Gynecol Oncol. 2016;140(2):323-332.
  • 14. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery. Arch Surgery. 2009;144(10):961-969.
  • 15. Ulubay M, Öztürk M, Fidan U, et al. Skin incision lenghts in caesarean section. Cukurova Med J. 2016;41(1):81-86.
  • 16. Munday J, Hines S, Wallace K, et al. A systematic review of the effectiveness of warming interventions for women undergoing cesarean section. Worldviews Evid Based Nurs. 2014;11(6):383-93.
  • 17. El-Mazny A, El-Sharkawy M, Hassan A. A prospective randomized clinical trial comparing immediate versus delayed removal of urinary catheter following elective cesarean section. Eur J Obstet Gynecol Reprod Biol. 2014;181:111-114.
  • 18. Aluri S, Wrench IJ. Enhanced recovery from obstetric surgery: a UK survey of practice. Int J Obstet Anesth. 2014;23(2):157-60.
  • 19. Parsons B, Yau R. P16 Enhanced recovery in elective caesarean sections: a reduced length of stay and cost savings. Int J Obstet Anesth. 2015;24:18.
  • 20. Göçmen A, Göçmen M, Saraoğlu M. Early postoperative feeding after cesarean delivery. J Int Med Res. 2002;30:506-511.
  • 21. Aydın Y, Altunyurt S, Oge T, Sahin F. Early versus delayed oral feeding after cesarean delivery under different anesthetic methods – A randomised controlled trial anesthesia, feeding in cesarean delivery. Ginekol Pol. 2014;85:815-822.
  • 22. Wrench IJ, Allison A, Galimberti A, et al. Introduction of enhanced recovery for elective caesarean section enabling next day discharge : a tertiary center experience. Int J Obstet Anesth. 2015;24:124-130.
  • 23. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ. 2001;322:473-476.
  • 24. Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia prevention program for the inpatient surgical ward. J Am Coll Surg. 2010;210:491-495.
  • 25. Coates E, Fuller G, Hind D, et al. Enhanced recovery pathway for elective caesarean section. Int J Obstet Anesth. 2016;27:94-5. 26. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;16(2).
  • 27. T.C Sağlık Bakanlığı Doğum Sonu Bakım Yönetim Rehberi Genelgesi 2010/27 URL: http:// www.saglik.gov.tr (erişim tarihi: Mayıs 2017).
  • 28. S. Rhodes, M. Drake, M. Moll, M. Steynor. Adapting Enhanced Recovery for Obstetric Surgery: The National Women’s Experience ePoster presentation 2015. https://www.epostersonline.com/oaa2015/node/115 (accessed: May 2017).
  • 29. Abell D, Pool AW, Sharafudeen S, et al. Enhanced recovery in obstetric surgery (KingsEROS): early results from one of the UKs first programmes. Eur J Anaesthesiol. 2014;31:192.
  • 30. Steenhagen E. Enhanced recovery after surgery: It’s time to change practice! Nutr Clin Pract. 2016;31(1):18-29.
There are 29 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology, Health Care Administration
Journal Section Research
Authors

Fulden Özkeçeci 0000-0003-3305-7516

Tülay Yavan 0000-0003-3287-1487

Publication Date December 27, 2020
Acceptance Date August 24, 2020
Published in Issue Year 2020 Volume: 45 Issue: 4

Cite

MLA Özkeçeci, Fulden and Tülay Yavan. “Elektif Sezaryen ameliyatlarında yapılan Perioperatif uygulamaların ERAS protokolüne göre değerlendirilmesi”. Cukurova Medical Journal, vol. 45, no. 4, 2020, pp. 1607-16, doi:10.17826/cumj.745762.