Anesthesia techniques in outpatient surgery for procedures due to cervical dysplasia – experiences in Sestre milosrdnice UHC

Autori:

Katarina Kličan-Jaić, Maja Pešić, Sandra Radović-Radovčić, Ivana Stojanović, Ante Vuković

Sažetak
Danas su anestezija i analgezija tako sigurne i učinkovite da se kirurški zahvati kod displazije vrata maternice mogu obavljati unutar jednodnevne kirurgije. Anesteziološke tehnike u jednodnevnoj kirurgiji povezane su sa značajno manje morbiditeta i mortaliteta. Do 2015. godine svi su se kirurški zahvati kod displazije vrata maternice u Kliničkom bolničkom centru Sestre milosrdnice u Zagrebu radili u općoj anesteziji, a prosječni boravak u bolnici trajao je duže od 30, a kraće od 72 sata. U Klinici za ženske bolesti i porodništvo proveli smo retrospektivno istraživanje u periodu od siječnja 2015. do prosinca 2019. godine, budući da su se od tada zahvati konizacije započeli izvoditi u lokalnoj anesteziji. Proučavali smo učestalost opće i regionalne anestezije u odnosu na vrstu konizacije, učestalost vrste anestezije u odnosu na dobnu skupinu i procjenu rizika bolesnica za anesteziju, te duljinu hospitalizacije u odnosu na vrstu kirurškog zahvata. U periodu od 2015. do 2019. godine zabilježen je stalni porast udjela lokalne anestezije u ukupnom broju elektrodijatermijski odstranjenih transformacijskih zona velikom petljom (engl. Large loop excision of the transformation zone) za 36,5% (49/104 zahvata 2015. u odnosu na 112/134 zahvata 2019.). Od listopada 2018., kada je uveden spinalni blok kao metoda anestezije za konizaciju hladnim nožem, do prosinca 2019. godine udio spinalnog bloka u ukupnom broju konizacija hladnim nožem porastao je za 17,3% (2/65 zahvata 2018. u odnosu na 11/54 zahvata 2019.). Istraživanje prikazuje analizu razlike pojavnosti anestezioloških tehnika ovisno o vrsti kirurškog zahvata, procjeni rizika i životnoj dobi bolesnica za anesteziju kod displazije vrata maternice te duljinu hospitalizacije u odnosu na vrstu konizacije.
Summary

Today, anesthesia and analgesia are so safe and effective that surgical procedures for cervical dysplasia can be performed as day surgery. Anesthesia techniques in day surgery are related to significantly less morbidity and mortality. Until 2015, all surgical procedures for cervical dysplasia at the Sestre milosrdnice University Hospital Center in Zagreb were performed under general anesthesia, with the average length of hospital stay longer than 30 hours and shorter than 72 hours. We have conducted retrospective research at the Department of Gynecology and Obstetrics for the period from January 2015 to December 2019, as cone biopsy procedures have been performed under local anesthesia since then. We have studied the frequency of local and regional anesthesia in relation to the type of cone biopsy, frequency of the type of anesthesia in relation to the age group and ris  assessment of the patient undergoing anesthesia, and length of hospital stay in relation to the type of surgical procedure. In the period from 2015 to 2019, there was a steady increase in the share of local anesthesia in the total number of large loop excisions of the transformation zone (LLETZ) by 36.46 % (49/104 procedures in 2015 compared to 112/134 procedures in 2019). From October 2018, when the spinal block was introduced as a method of anesthesia for the cold knife cone biopsy, until December 2019, the share of the spinal block in the total
number of cold knife cone biopsies increased by 17.29 % (2/65 procedures in 2018 compared to 11/54 procedures in 2019). Our research provides an analysis of the difference in the incidence of anesthesia techniques depending on the type of surgical procedure, risk assessment and age of the patient undergoing anesthesia for cervical dysplasia, and length of hospital stay in relation to the type of cone biopsy.

Volumen: 1-2, 2021

Liječ Vjesn 2021;143:25–30

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