SPİNAL ANESTEZİ VE DEKSMEDETOMİDİN SEDASYONU ALTINDA HEMOROİD CERRAHİSİ YAPILAN HASTADA AYILMA ODASINDA KARDİYAK ARREST GELİŞİMİ

Year 2023, Volume: 2 Issue: 3, 117 - 122, 26.12.2023

Gizem Dağhan Muhammed Enes Kardaş Filiz Üzümcügil

Abstract

Spinal anestezi çok çeşitli cerrahilerde kullanılabilen, oldukça sık tercih edilen bir nöroaksiyel anestezi yöntemidir. Fakat nadir de olsa kardiyak arreste (KA) kadar ilerleyebilen komplikasyonlarla karşılaşılmaktadır. Bu vaka raporunda, regüle hipertansiyon dışında sistemik hastalığı bulunmayan hastamızın hemoroid cerrahisi sonrası ayılma ünitesinde bradikardi ile başlayan kardiyak arrest gelişimi ve müdahelesi anlatılmış, başta deksmedetomidin olmak üzere zemin hazırlayan etkenlerin tartışılması amaçlanmıştır.

Vakamızdan yola çıkarak spinal anestezinin kardiyovasküler sistem üzerindeki etkilerini de düşündüğümüzde uygulama sırasında oluşabilen sempatik blokajın şiddetini arttırabilecek, özellikle vagal tonus artışı olan, bazal kalp atım hızı (KH) 60 dk-1 altındaki ASA I genç bireylerde ve özellikle kardiyak hastalığı bulunan hastalarda deksmedetomidin oldukça dikkatli kullanılmalı ve spinal anestezi sırasında ortaya çıkabilecek komplikasyonlar unutulmamalıdır.

Keywords

Spinal anestezi, deksmedetomidin, Resüsitasyon

CARDIAC ARREST IN THE RECOVERY ROOM AFTER HAEMORRHOIDECTOMY UNDER SPINAL ANAESTHESIA COMBINED WITH DEXMEDETOMIDINE SEDATION

Abstract

Spinal anaesthesia is a frequently preferred neuraxial anaesthesia method that can be used in various surgeries. However, although rare, complications that can progress to cardiac arrest (CA) are encountered. We aimed to present the development and subsequent management of a cardiac arrest, which started with bradycardia, in the recovery unit after haemorrhoid surgery. Our patient had no systemic disease other than regulated hypertension.

The predisposing factors, especially dexmedetomidine sedation combined with spinal anaesthesia are discussed. We concluded that dexmedetomidine should be used very carefully, especially in young ASA I patients with a basal heart rate (HR) below 60 bpm, as well as in patients with cardiac disease, due to the increased risk of the severe sympathetic blockade caused by spinal anaesthesia.

Keywords

spinal anaesthesia, dexmedetomidine, resuscitation

References

• Mordecai MM, Brull SJ. Spinal anesthesia. Current Opinion in Anesthesiology. 2005;18(5):527-33.
• Løvstad R, Granhus G, Hetland S. Bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases. Acta Anaesthesiologica Scandinavica. 2000;44(1):48-52.
• Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. The Journal of the American Society of Anesthesiologists. 2002;97(5):1274-80.
• Thoren T, Holmström B, Rawal N, Schollin J, Lindeberg S, Skeppner G. Sequential combined spinal epidural block versus spinal block for cesarean section: effects on maternal hypotension and neurobehavioral function of the newborn. Anesthesia & Analgesia. 1994;78(6):1087-92.
• Dogru S, Ziya K, Dogru HY. Spinal anestezi komplikasyonları. Çağdaş Tıp Dergisi. 2012;2(2):127-34.
• Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. The Journal of the American Society of Anesthesiologists. 1997;87(3):479-86.
• Tarkkila PJ, Kaukinen S. Complications during spinal anesthesia: a prospective study. Regional Anesthesia and Pain Medicine. 1991;16(2):101-6.
• Pollard JB. Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention. Anesthesia & Analgesia. 2001;92(1):252-6.
• Limongi JAG, Lins RSAdM. Cardiopulmonary arrest in spinal anesthesia. Revista brasileira de anestesiologia. 2011;61:115-20.
• Kopp SL, Horlocker TT, Warner ME, et al. Cardiac arrest during neuraxial anesthesia: frequency and predisposing factors associated with survival. Anesthesia & Analgesia. 2005;100(3):855-65.
• Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76(6):906-16.
• Jordi E-M, Marsch SC, Strebel S. Third degree heart block and asystole associated with spinal anesthesia. The Journal of the American Society of Anesthesiologists. 1998;89(1):257-60.
• Kaya FN, Yavaşçaoğlu B, Türker G,et al. Intravenous dexmedetomidine, but not midazolam, prolongs bupivacaine spinal anesthesia. 2010.
• Niu XY, Ding XB, Guo T, Chen MH, Fu SK, Li Q. Effects of Intravenous and Intrathecal Dexmedetomidine in Spinal Anesthesia: A Meta‐Analysis. CNS neuroscience & therapeutics. 2013;19(11):897-904.
• Hammer GB, Drover DR, Cao H, et al. The effects of dexmedetomidine on cardiac electrophysiology in children. Anesthesia & Analgesia. 2008;106(1):79-83.