Derin Beyin Stimulatörü Uygulanan Hastalarda Skalp Bloğu ve İnfiltrasyon Anestezisinde Methemoglobinemi Riski

Year 2021, Volume: 43 Issue: 2, 157 - 163, 30.03.2021

Meryem Onay Mehmet Ali Harbelioğlu Murat Vural Serdar Ekemen

https://doi.org/10.20515/otd.776960

Abstract

Skalp bloğu gibi kanlanması yüksek olan bölgelerde lokal anesteziklerin uygulanması, emilim hızının ve intravasküler enjeksiyon riskinin yüksekliği nedeniyle methemoglobinemi gibi lokal anesteziklerin sistemik etkilerine karşı daha hassastır. Çalışmamızda, özellikle Parkinson olmak üzere nörolojik hastalıklara bağlı derin beyin stimülatörü (DBS) yerleştirilen hastalarda skalp bloğu sonrası methemoglobin değerlerini retrospektif inceleyerek methemoglobinemi riskini değerlendirmeyi amaçladık.Çalışmaya DBS için Ocak 2017 ve Aralık 2018 tarihleri arasında başvuran, 18 yaş üstü ve rejyonel anestezi uygulanan 41 hasta dahil edildi. Hastalara skalp bloğu (n: 10) ve infiltrasyon anestezisi (n: 31) uygulandı. Hastaların yaş, Amerikan Anesteziyologlar Derneği fiziksel sınıflaması (ASA), cinsiyet, DBS endikasyonu, skalp bloğu / infiltrasyon anestezisi, arteriyel kan gazında pH, pO2, Spo2, en yüksek methemoglobin düzeyleri ve klinik semptomlar istatistiksel olarak analiz edildi.DBS endikasyonları 29 hastada Parkinson hastalığı, diğerleri hiper-reaktivite, distoni ve titremeydi. Ayrıca 33 hasta ASA Sınıf II olarak sınıflandırıldı. Skalp bloğu yapılan 2 hastada ve infiltrasyon anestezisi uygulanan 6 hastada MeHb düzeyi% 2'nin üzerindeydi. Ancak skalp bloğu ve infiltrasyon anestezisi arasında methemoglobin düzeylerinde istatiksel olarak anlamlı bir fark gözlenmedi.Skalp gibi kanlanmanın yüksek olduğu bölgelerde klinik bulgu olmadan, lokal anestezi uygulamalarında methemoglobinemia gelişme riski nedeniyle dikkatli olunmalıdır.

Keywords

Derin beyin stimulatörü, methemoglobinemi, skalp blok, infiltrasyon anestezisi

Supporting Institution

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Project Number

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Risk of Methemoglobinemia in Scalp Block and İnfiltration Anesthesia in Patients Undergoing Deep Brain Stimulation

Abstract

The application of local anesthetics in areas with a high blood supply, such as scalp block, is more susceptible to systemic effects of local anesthetics such as methemoglobinemia because of the high absorption rate and the risk of intravascular injection. In this study, we aimed to evaluate the risk of methemoglobinemia by reviewing methemoglobin values after scalp block in patients with a deep brain stimulation (DBS) due to neurological diseases, especially Parkinson’s.The study included 41 patients aged >18 years who were admitted between January 2017 and December 2018 for DBS and underwent regional anesthesia (n = 41). Patients were administered scalp block (n = 10) and infiltration anesthesia (n = 31). Using data from the patients’ medical records, we statistically analyzed the patients’ age, American Society of Anesthesiologists (ASA) status, gender, DBS indication, scalp block/infiltration anesthesia, highest methemoglobin level in arterial blood gas, pH, pO2, SpO2, and clinical symptoms.The indications for DBS were Parkinson’s disease in 29 patients hyperreactivity, dystonia and tremor in the remaining patients. Furthermore, 33 patients were classified as ASA class II. The methemoglobinemia level was >2% in two patients who underwent scalp block and six patients who underwent infiltration anesthesia. However, there was no statistically significant difference in methemoglobin levels between scalp and infiltration anesthesia.In areas with high blood flow, such as the scalp, caution should be exercised in administering local anesthesia because of the patient’s risk of developing methemoglobinemia, although there are no clinical findings on this topic.

Keywords

Deep brain stimulation, methaemoglobinemia, scalp block, infiltration anaesthesia

Project Number

yok

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