MAO-B İnhibitörü Kullanan Progresif Supranükleer Palsi’li Hastada Spinal Anestezi Deneyimi

Öz

Progresif supranükleer palsi (PSP), postural instabilite ve hafif demans ile karakterize nadir bir klinik sendromdur. PSP’nin klasik klinik tablosunda şiddetli yürüme ve denge bozukluğu, genel bradikinezi, frontal demans, görme bozuklukları, dizartri ve disfaji vardır. Bu hastalarda disfajinin neden olduğu aspirasyon pnömonisi başlıca ölüm nedenidir.
MAO-B inhibitörü kullanan 72 yaşındaki PSP hastasındaki spinal anestezi deneyimlerimizi sunmayı amaçladık. PSP’li hastalarda disfaji nedeniyle aspirasyon riskinin yüksek olması, ilaç etkileşimi yüksek olan çeşitli medikal tedaviler kullanıyor olmalarının göz önünde bulundurulmasını ve anestezi tercihinin rejyonel anesteziden yana yapılmasını önermekteyiz. Aynı zamanda MAO-B inhibitörü kullanan hastalarda eğer ilaç kesilemiyor ise genel ve rejyonel anestezi sırasında opioidlerin dikkatli kullanılmasını önermekteyiz.

Anahtar Kelimeler

• progresif supranükleer palsi
• MAO-B inhibitörü
• anestezi

Spinal anaesthesia experience in a patient with progressive supranuclear palsy using MAO-B inhibitor

Abstract

Progressive supranuclear palsy (PSP) is a rare clinical syndrome characterized by postural instability and mild dementia. The classical clinical picture of PSP includes severe gait and balance disorder, general bradykinesia, frontal dementia, visual disorders, dysarthria and dysphagia. Aspiration pneumonia is the leading cause of death in advanced PSP. We aimed to present our experiences in a 72-year-old patient with PSP using MAO-B inhibitor as an update for anaesthesiologists. We recommend that it should be taken into consideration that patients with PSP have a high risk of aspiration due to dysphagia and use of various medical treatments with high drug interaction and regional anaesthesia should be preferred. At the same time, we recommend the careful use of opioids during general or regional anaesthesia if the drug cannot be discontinued in patients using MAO-B inhibitor.

Keywords

• progressive supranuclear palsy
• MAO-B inhibitor
• anaesthesia

References

1. Golbe LI. Progressive supranuclear palsy. Semin Neurol 2014;34(2):151-9.
2. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth 2017;118:317–34.
3. Tonan M, Egi M, Furushima N, et al. A case of spinal anesthesia in a patient with progressive supranuclear palsy. JA clinical reports 2018;4:1-3.
4. Lamb R, Rohrer JD, Lees AJ, et al. Progressive supranuclear palsy and corticobasal degeneration: pathophysiology and treatment options. Current treatment options in neurology 2016;18:1-18.
5. Ng KP, Therriault J, Kang MS, et al. Rasagiline, a monoamine oxidase B inhibitor, reduces in vivo [18F] THK5351 uptake in progressive supranuclear palsy. Neuroimage Clin 2019;24:102091.
6. Öztürk T, Çıkrıkcı C, Yıldırım F, et al. Kardiyak Cerrahi Geçiren ve Monoamin Oksidaz İnhibitörü Kullanan Parkinson Hastasında Fentanil Reaksiyonu. GKDA Derg 2014;20:232-5.
7. Nakayama H, Matayoshi H. Management of Preoperative Drugs: Psychotropic Drugs. Masui. The Japanese journal of anesthesiology 2016;65:1135-43.
8. Krings-Ernst I, Ulrich S, Adli M. Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: a review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine. Int J Clin Pharmacol Ther 2013;51;763-70.

9. Sakai K, Sumikawa K. Anesthetic management of a patient with progressive supranuclear palsy. Journal of anesthesia 2006;20:312-3.
10. Maggi G, Schiraldi R, Brogly N, et al. Successful airway management of a patient with progressive supranuclear palsy during the induction of anesthesia. Acta Anaesthesiologica Taiwanica 2012;2:87-8.