Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları

Year 2022, Volume: 5 Issue: 1, 65 - 70, 01.01.2022

Nermin Kılıçarslan Hande Gürbüz Ayşe Neslihan Balkaya Derya Karasu Kaan Demirören Mehmet Gamlı

https://doi.org/10.19127/bshealthscience.1009012

Abstract

Serebral palsili çocuklar sıklıkla var olan nörolojik hasar nedeniyle çiğneme ve yutma güçlüğü yaşamaktadır. Bu nedenle malnütrisyon için önemli bir risk grubunu oluştururlar. Fiziksel malformasyonları ve ek hastalıkları nedeniyle anestezi yönetimi diğer çocuk hastalara göre daha zordur. Çalışmamızda serebral palsili çocuklara yapılan perkütan endoskopik gastrostomi işlemleri sırasında ameliyathane dışı prosedüral sedasyon uygulamalarını değerlendirmeyi amaçladık. Mayıs 2017 ile Haziran 2021 tarihleri arasında ameliyathane dışında endoskopi ünitesinde prosedüral sedasyon ile perkütan endoskopik gastrostomi işlemlerinin gerçekleştirildiği 0-18 yaşları arasındaki hastalar retrospektif olarak değerlendirildi. Toplam 21 serebral palsili hasta ve 30 girişim değerlendirildi. Tüm hastalarda perkütan endoskopik gastrostomi uygulamasının temel endikasyonunu yutma güçlüğü ve malnütrisyon oluşturuyordu. Hastaların %26,6’sı (n=8) ASA skoru 2, %73,3’ü ise (n=22) ASA skoru 3 risk grubu olarak değerlendirildi. Hastaların %73,3’ünün (n=22) vücut ağırlığı <3 persentil idi. İki hastanın trakeostomisi bulunmaktaydı. Hastaların preoperatif laboratuvar değerleri normal sınırlar içindeydi. Hastaların %90,0’ında (n=27) tek başına veya ek hastalıklarına eşlik eden epilepsisi mevcuttu. İşlem sırasında en sık görülen komplikasyon bradikardi idi (n=5). Serebral palsili pediatrik hastaların perkütan endoskopik gastrostomi işlemlerinin, ameliyathane dışı ünitelerde prosedüral sedasyon altında, bu konuda deneyimli merkezler ve ekipler tarafından yapılabileceğini düşünmekteyiz.

Keywords

Serebral palsi, Sedasyon, Anestezi, Malnutrisyon, Perkütan endoskopik gastrostomi

Procedural Sedation Practices during Percutaneous Endoscopic Gastrostomy in Patients with Cerebral Palsy

Abstract

Children with cerebral palsy often have chewing and swallowing difficulties due to the neurological impairment. Therefore, they constitute an important risk group for malnutrition. Anesthesia management in children with cerebral palsy is more difficult than other pediatric patients due to their physical malformations and comorbidities. In our study, we aimed to evaluate non-operating room procedural sedation practices during percutaneous endoscopic gastrostomy procedures performed on children with cerebral palsy. Between May 2017 and June 2021, patients aged 0-18 years who underwent percutaneous endoscopic gastrostomy with procedural sedation in the endoscopy unit outside the operating room were evaluated retrospectively. A total of 21 patients with cerebral palsy and 30 interventions were evaluated. Swallowing difficulties and malnutrition were the main indications for percutaneous endoscopic gastrostomy. Of the patients 26.6% (n=8) were considered as ASA score 2 and 73.3% (n=22) as ASA score 3 risk group. The weight were below the third percentile in 73.3% (n=22) of the patients. Two patients had tracheostomy. Preoperative laboratory values of the patients were within normal limits. 90.0% (n=27) of the patients had epilepsy. The most common complication during the procedure was bradycardia (n=5). We think that percutaneous endoscopic gastrostomy procedures of pediatric patients with cerebral palsy can be performed in non-operating room units under procedural sedation by experienced centers and teams.

Keywords

Cerebral palsy, Procedural sedation, Anesthesia, Malnutrition, Percutaneous endoscopic gastrostomy

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