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Kalp yetmezliği ve solunum sıkıntısı olup septik şok gelişen bir hastada epidural anestezi altında açık kolesistektomi-Olgu sunumu

Year 2020, Volume: 3 Issue: 2, 59 - 64, 30.06.2020

Abstract

Giriş

Yıllardır, yüksek cerrahi riskli hastalarda semptomatik kolelitiazis tedavisi tartışmalıdır. Kolesistektomi, semptomatik kolelitiazisin tedavisinde tercih edilen bir prosedür olarak kabul edilmektedir. Prosedür genellikle pnömoperitoneum tekniğine bağlı aspirasyon ve solunum sıkıntısını önlemek için genel anestezi ve endotrakeal entübasyonu gerektirir.
Açık kolesistektomi ise genellikle aspirasyon ve solunum sıkıntısını önlemek için genel anestezi ve endotrakeal entübasyonu gerektirir. Biz bu vakada kardiyak yetmezliği olup septik şok ile takip edilen, kaynak kontrolü amaçlı acil açık kolesistektomi planlanan vakanın epidural anestezi ile yönetilmesi ve bu konudaki ön deneyimimizi sunuyoruz.

Vaka

Acil servise karın ağrısı şikayeti ile başvuran 82 yaşında kadın hasta (ağırlık 55 kg, boy 152 cm), genel cerrahi ve enfeksiyon hastalıkları konsültasyonlarından sonra, yüksek enfeksiyon parametreleri ve genel durum bozukluğu nedeniyle yoğun bakım ünitesine kabul edildi (WBC = 17,32). İki yıldır safra kesesinde ultrasonografi ile belgelenen taş ve hipokondriak bölgede sıklıkla ağrı öyküsü olan vakanın kalp yetmezliği mevcuttu. Hastanın sağ lateral dekübitus pozisyonundayken epidural anestezisi, başarıyla gerçekleştirilmiştir.

Sonuç

Bu olgu sunumunda, genel olarak ağır kalp yetmezliği ve septik şok durumu olup epidural anestezi uygulanan acil bir vakanın yönetimini inceledik.

References

  • References
  • 1. Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy: anesthetic implications. Anesthesia and analgesia. 1993;76(5):1120-33. 2. Sinha R, Gurwara A, Gupta S. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2009;19(3):323-7. 3. Gramatica L, Brasesco O, Luna AM, Martinessi V, Panebianco G, Labaque F, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surgical Endoscopy and Other Interventional Techniques. 2002;16(3):472-5. 4. Frazee RC, Roberts JW, Okeson GC, Symmonds RE, Snyder SK, Hendricks JC, et al. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Annals of surgery. 1991;213(6):651. 5. Groeben H. Epidural anesthesia and pulmonary function. Journal of anesthesia. 2006;20(4):290-9. 6. Savas JF, Litwack R, Davis K, Miller TA. Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment. The American journal of surgery. 2004;188(5):603-5. 7. HANSEN G, DRABLOS P, STEINERT R. PULMONARY COMPLICATIONS, VENTILATION AND BLOOD GASES AFTER UPPER ABDOMINAL SURGERY. Survey of Anesthesiology. 1978;22(2):177. 8. Drosatos K, Lymperopoulos A, Kennel PJ, Pollak N, Schulze PC, Goldberg IJ. Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both? Current heart failure reports. 2015;12(2):130-40. 9. Küçük M, Korucuk N, Tosun V, Ertuğrul F, Yıldırım AB. Acute myocardial infarction associated with the induction of general anesthesia. The European Research Journal. 2018;4(4):425-8. 10. Kim W-Y, Hong S-B. Sepsis and acute respiratory distress syndrome: recent update. Tuberculosis and respiratory diseases. 2016;79(2):53-7. 11. Hedenstierna G. 1 Effects of anaesthesia on respiratory function. Baillière's Clinical Anaesthesiology. 1996;10(1):1-16.

Open cholecystectomy under epidural anesthesia in a patient who developed septic shock with heart failure and respiratory distress-A case report

Year 2020, Volume: 3 Issue: 2, 59 - 64, 30.06.2020

Abstract

Introduction
For decades, the management of symptomatic cholelithiasis in high surgical risk patients has remained contentious. Cholecystectomy has become firmly established as a procedure of choice in the management of symptomatic cholelithiasis. The procedure usually necessitates general anesthesia and endotracheal intubation to prevent aspiration and respiratory embarrassment secondary to the induction of pneumoperitoneum
Open cholecystectomy (OC) usually necessitates general anesthesia and endotracheal intubation to prevent aspiration and respiratory embarrassment. We report our preliminary experience with open cholecystectomy using epidural anesthesia in patients with cardiac failure and septic shock.
Case
An 82-year-old woman (weight 55 kg, height 152 cm) with abdominal pain applied to the emergency department. After general surgery and infectious disease consultations, he was admitted to the intensive care unit because of high infection parameters and general condition disorder (WBC =17,32). He had a history of frequent pain at the right hypochondriac region with ultrasonography-documented calculi in the gallbladder for two years and heart failure.
With the patient at the right lateral decubitus position, EA was performed successfully.
Conclusion
In this case report, we wanted to demonstrate the management of an emergency case with epidemic anesthesia, with a general condition of poor heart failure and septic shock.

References

  • References
  • 1. Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy: anesthetic implications. Anesthesia and analgesia. 1993;76(5):1120-33. 2. Sinha R, Gurwara A, Gupta S. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2009;19(3):323-7. 3. Gramatica L, Brasesco O, Luna AM, Martinessi V, Panebianco G, Labaque F, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patients with chronic obstructive pulmonary disease. Surgical Endoscopy and Other Interventional Techniques. 2002;16(3):472-5. 4. Frazee RC, Roberts JW, Okeson GC, Symmonds RE, Snyder SK, Hendricks JC, et al. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Annals of surgery. 1991;213(6):651. 5. Groeben H. Epidural anesthesia and pulmonary function. Journal of anesthesia. 2006;20(4):290-9. 6. Savas JF, Litwack R, Davis K, Miller TA. Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment. The American journal of surgery. 2004;188(5):603-5. 7. HANSEN G, DRABLOS P, STEINERT R. PULMONARY COMPLICATIONS, VENTILATION AND BLOOD GASES AFTER UPPER ABDOMINAL SURGERY. Survey of Anesthesiology. 1978;22(2):177. 8. Drosatos K, Lymperopoulos A, Kennel PJ, Pollak N, Schulze PC, Goldberg IJ. Pathophysiology of sepsis-related cardiac dysfunction: driven by inflammation, energy mismanagement, or both? Current heart failure reports. 2015;12(2):130-40. 9. Küçük M, Korucuk N, Tosun V, Ertuğrul F, Yıldırım AB. Acute myocardial infarction associated with the induction of general anesthesia. The European Research Journal. 2018;4(4):425-8. 10. Kim W-Y, Hong S-B. Sepsis and acute respiratory distress syndrome: recent update. Tuberculosis and respiratory diseases. 2016;79(2):53-7. 11. Hedenstierna G. 1 Effects of anaesthesia on respiratory function. Baillière's Clinical Anaesthesiology. 1996;10(1):1-16.
There are 2 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Betül Afşar This is me 0000-0002-1836-8300

Yasin Tire

Rabia Erkoçak This is me

Emine Çepni Kütahya This is me

Betül Kozanhan

Publication Date June 30, 2020
Published in Issue Year 2020 Volume: 3 Issue: 2

Cite

APA Afşar, B., Tire, Y., Erkoçak, R., Çepni Kütahya, E., et al. (2020). Open cholecystectomy under epidural anesthesia in a patient who developed septic shock with heart failure and respiratory distress-A case report. Dünya Sağlık Ve Tabiat Bilimleri Dergisi, 3(2), 59-64.