Robotik Radikal Prostatektomide Anestezi Deneyimlerimiz

Yıl 2020, Cilt: 15 Sayı: 2, 30 - 34, 08.07.2020

Tuna Şahin , Barış Arslan

https://doi.org/10.17517/ksutfd.677149

Öz

ÖZET
Amaç: Robotik radikal prostatektomi prostat kanser tedavisinde yaygın olarak uygulanmaktadır. Robot yardımlı laparoskopik radikal prostatektomilerde anestezi yönetimi, hasta yaşı ve profili, operasyon pozisyonu ve süresi nedeniyle özelliklidir. Litotomi, derin Trendelenburg pozisyonu, CO2 pnomoperitonyum nedeniyle kardiyovasküler, respiratuar, nörolojik komplikasyonlar gelişebilir. Bu retrospektif çalışmada robot yardımlı laparoskopik radikal prostatektomi uygulanan hastalardaki anestezi deneyimlerimizi incelemeyi , sonuçlarımızı literarür eşliğinde tartışmayı amaçladık.
Yöntem: Etik kurul onayı alındıktan sonra 1Ocak 2018 ve 30 Eylül 2018 tarihleri arasında robot yardımlı laparoskopik radikal prostatektomi uygulanmış 50 hasta değerlendirildi. Hastalara ait demografik veriler, ASA skorlamaları, ek hastalıklar, intraoperatif anestezi ve analjezi yöntemi, gelişen komplikasyonlar, intravenöz verilen sıvı ve kan miktarı, anestezi süresi, cerrahi süresi, yoğun bakımda kalış süresi, hastanede kalış süresi kaydedildi.
Bulgular: Hastaların yaş ortalaması 63.2±6.2 yıl idi. Anestezi idamesinde en sık inhalasyon anestezisi ( sevofluran veya desfluran) ± opioid (remifentanil) kullanıldığı gözlendi.10 (% 20) hastada bradikardi görülürken, 2(%4) hastada hipotansiyon gelişmiş, 2 (% 4) hastada kan ürünlerine ihtiyaç duyulmuştur. Postoperatif analjezi amaçlı kullanılan ilaçlar tramadol, parasetemol, nonsteroidal antienflamatuar ilaç (NSAİİ), meperedin idi.Hastaların tamamı operasyon masasında extübe edilerek yakın takip amaçlı yoğun bakım ünitesine alındı. Hastaların %96 sı bir gece yoğun bakımda takip edilirken ,hastanede kalış süresi 4.02±1.6 gündü.
Sonuç: Robot yardımlı laparoskopik radikal prostatektomilerde anestezi yönetimi özellikli bir süreçtir. Olası komplikasyonlar için gerekli önlemleri almak, uygun anestezik ajan seçimi, akciğer koruyucu ventilasyon uygulamaları, cerrahi ekip ile koordinasyon anestezi açısından elzemdir.
Anahtar Kelimeler: Prostat kanseri, prostatektomi, anestezi
ABSTRACT
Objective:Robotic radical prostatectomy is commonly used in prostat cancer treatment. Anesthesia management in Robot-assisted laparoscopic radical prostatectomies has specialty due to the age and profile of the patient , operation position and operation time. In this retrospective study we aimed to investigate our anesthesia experiences in patients who underwent Robot-assisted laparoscopic .radical prostatectomy and to discuss the current literature.
Methods:After approval of ethical committee 50 patients who underwent Robot-assisted laparoscopic .radical prostatectomy were investigated between 1 January 2018 and 30 September 2018.Demographic data, ASA scores, comorbidities, intraoperative anesthesia and analgesia management, complications, amounts of fluids and bloods given intravenously , anesthesia duration, surgical duration, duration of intensive care unit and hospital stays were recorded.
Results:Average age of patients was 63.2±6.2 years. Inhalation anesthesia ( sevoflurane or desflurane) ± opioid (remifentanil) was the most anesthesia maintenance preffered. 10 (% 20) patient had bradicardia, 2(%4) patient had hypotension, 2 (% 4) patient received blood transfusion.Drugs used for postoperative analgesia were tramadol, paracetamol, nonsteroidal anti-inflammatory drugs (NSAID), meperedine. All of the patients were extubated in the operating room and were admitted to intensive care unit (ICU). 96 % of patients stayed one night in the ICU. Time of hospital stay was 4.02±1.6 days.
Conclusion: In Robot-assisted laparoscopic radical prostatectomies anesthesia management is a special process. Taking precautions for complications, choice of suitable anesthetic agents ,lung protective strategies, being in concordance with surgical team are essential for anesthesia .
Keywords: Prostate cancer, prostatectomy, anesthesia

Anahtar Kelimeler

prostat kanseri, prostatektomi, anestezi

Kaynakça

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