Çocuklarda rijit bronkoskopide anestezi: tek merkez deneyimi

Year 2018, Volume: 43 Issue: 3, 678 - 684, 30.09.2018

Zehra Hatipoğlu Önder Özden Dilek Özcengiz

https://doi.org/10.17826/cumj.337581

Abstract

Amaç: Rijit bronkoskopi, çocuklarda başta yabancı cisim çıkarılması olmak üzere havayolunun incelenmesi ve örnek alınması için genel anestezi ile uygulanan cerrahi bir girişimdir. Retrospektif yapılan bu çalışmada rijit bronkoskopi uygulanan çocuklarda anestezi yönetimi ve perioperatif komplikasyonlar değerlendirildi.

Gereç ve Yöntem: Ocak 2015 - Mart 2017 tarihleri arasında rijit bronkoskopi için alınan 74 olgu değerlendirmeye alındı. Olgulara ait bilgiler, Nükleus Medikal Bilgi Sistemi ve anestezi kayıt formlarından elde edildi. Bu kayıtlardan, hastaneye başvuru nedenleri, preoperatif özellikleri, anestezi yönetimi, komplikasyonlar ve yatış süreleri değerlendirildi.

Bulgular: Olguların yaş ortancası 24 (3-156) ay, 41’i (%55.4) erkek, 33’ü (%44.6) kız olarak tespit edildi. Olgular yabancı cisim şüphesi (%40.5) ve öksürük (%31.1) şikayetleri nedeniyle hastaneye getirilmişlerdi. Olguların %52.7’sinin akciğer dinleme bulgusunda ve %67.6’sının akciğer grafisinde bir özellik olmadığı belirlendi. Anestezi indüksiyonunda intravenöz ajanlar (%91.8) ve non-depolarizan kas gevşeticilerin (%100) kullanıldığı ve manuel kontrollü ventilasyonun uygulandığı saptandı. Olguların %58.1’inden yabancı cisim çıkarıldığı belirlendi. Nöromusküler blok antagonizması için olguların %46’sında sugammadeks kullanılmıştı. Bir olguda pnömotoraks gelişirken, 5 olgu entübe olarak yoğun bakıma çıkarılmış ve mekanik ventilasyon uygulanmıştır. 

Sonuç: Rijit bronkoskopi, çocuklarda iyi planlanmış anestezi yöntemi ile güvenle uygulanabilir. Preoperatif değerlendirmenin iyi yapılması, intra- ve postoperatif dönemlerdeki yakın takip, olası komplikasyonların önlenmesinde etkilidir. 

Keywords

Bronkoskopi, Anestezi genel

Anesthesia for rigid bronchoscopy in children: single center experience

Abstract

Purpose: Rigid bronchoscopy is performed by general anesthesia because of inspection, taking sample and extraction of foreign body   in airway. In this study, anesthesia methods, perioperative complication and hospitalization time of children performed rigid bronchoscopy was retrospectively noted. 

Materials and Methods: Seventy-four children performed rigid bronchoscopy were included to the study in between Jan/2015- Mar/2017. The data of patients were acquired from Nucleus Medical Information System and anesthesia registration forms. Major complaint, perioperative features, anesthesia managements, and hospitalization time were evaluated. 

Results: Median age was 24 (3-156) months. Forty-one (55.4%) were male and 33 (44.6%) were female. The patients were received for complaint of foreign body aspiration suspicion (40.5%) and cough (31.1%).  52.7% of patients’ lung auscultation and 67.6% of their lung x-ray were found to be normal. Intravenous agents (91.8%) and non-depolarizing neuromuscular blockers (100%) for anesthesia induction and manual controlled ventilation were used. Foreign bodies were found and extracted in 58.1% of the patients. Sugammadex was used for neuromuscular block antagonism in 46% of the patients. There was one pneumothorax, and 5 patients were received to intensive care unit by intubated and supported by mechanical ventilation.   

Conclusion: Rigid bronchoscopy is safely performed by good managed anesthesia. Meticulous evaluation of patients preoperatively and intense follow up of patients intra- and postoperatively are very important for the prevention of potential complications.

Keywords

Bronchoscopy, anesthesia, general; pediatrics

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