Abstract
Anesthesiologists frequently confront endocrinologic disorders during their practice. One of them is Cushing syndrome. It is a complex of symptoms resulting from excessive and in- appropriate secretion of glucocorticoids. Treatment choice is surgery in adrenal adenoma and carcinoma. Generally it is associated with metabolic problems and it may cause various problems during anaesthesia. In this case report, Cushing syndrome was diagnosed with clinical and laboratorial findings. Adrenectomy operation had been planned.The patient was in ASA III status. Premedication was given. She was monitorized in operation room. Subcutaneous heparin was given for thromboemboli profilaxis. Rapid sequence induction of anaesthesia was performed with i.v. 6 mg/kg-1 tiyopenthal, 1 µg/kg-1 remifentanil, atracurium 0.6 mg/kg-1. The patient was intubated without any problem. Anesthesia was maintained 50% O2/air, 2% sevofluran and remifentanil 0.25 µg/kg-1/dk-1. The operation duration was 90 minute. Vital functions were stable during operation. Hydrocortisone infusion was begun. Cortisone therapy was continued in intensive care unit by following up cortisone levels She was extubated and observed in intensive care unite and then in surgery department. The patient was discharged postoperative 3. day without any problem. In this case report, we aimed to present and to review anaesthesia management in a patient with Cushing syndrome in the light of literature. Key words: Cushing Syndrome; Anesthesia, General; Intraoperative Complications.
References
- Kurt E, Ayaz Y. Adrenal system and anesthesia. Turkiye Klinikleri J Anest Reanim-Special Topics 2008; 1:53-67.
- Börüban MC, Kılıç G. Cushing syndrome and adrenal insufficiency. Turkiye Klinikleri J Surg Med Sci 2006; 2:58-62.
- Tasch MD. Corticosteroids and anesthesia. Curr Opin Anaesthesiol 2002; 15:377-81.
- Tuzuner F. Endokrin ve metabolik hastalıklarda anestezi. In: Anestezi Yoğun Bakım Ağrı. Tuzuner F (ed). Ankara, MN Medikal&Nobel Yayıncılık 2010,453-78.
- Gomez-Sanchez CE. Cushing’s syndrome and hypertension. Hypertension 1986; 8:258-64.
- Sacerdote A, Weiss K, Tran T, Rokeya Noor B, McFarlane SI. Hypertension in patients with Cushing’s disease: pathophysiology, diagnosis, and management. Curr Hypertens Rep 2005;7:212-8.
- Huiku M, Uutela K, van Gils M, et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth 2007;98:447-55.
- Ledowski T, Bein B, Hanss R, et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia. Anesth Analg 2005; 101:1700-5.
- Bovill JG. Intravenous anesthesia for the patient with left ventricular dysfunction. Semin Cardiothorac Vasc Anesth 2006; 10:43-8.
- Shalet A, Mukherjee A. Hiperkortizolizmin farmakolojik tedavisi. Current Opinion in Endocrinology, Diabetes & Obesity, Türkçe Baskı 2008;3:71-6.
Abstract
Anestezistler uygulamaları sırasında sıklıkla endokrin hastalıklarla karşılaşmaktadırlar. Bu hastalıklardan biri Cushing sendromudur. Bu sendrom çeşitli nedenlerle glukokortikoidlerin aşırı ve uygunsuz salınımı sonucu ortaya çıkar. Sendromun sebebi adrenal adenom veya karsinom ise tedavisi cerrahidir. Hastalar genellikle metabolik problemlerle birliktedir ve anestezi sırasında çeşitli sorunlara neden olabilir. Olgu sunumumuzdaki hastamıza klinik ve laboratuvar bulgularıyla Cushing sendromu tanısı konmuş ve sürrenalektomi operasyonu planlanmıştı. Hastaya ASA III risk verildi, premedikasyonu sağlandı, ameliyat odasına alındı ve monitörize edildi. Tromboemboli proflaksisi için subkutan heparin uygulandı. Hızlı sıra indüksiyon i.v. 6 mg/kg-1 tiyopental, 1 µg/kg1 remifentanil ve 0.6 mg/kg-1 atraküryum ile yapıldı. Entübasyon sorunsuz gerçekleştirildi. İdamede %50 O2/hava, %2 sevofluran karışımı ve 0.25 µg/kg-1/dk-1 remifentanil kullanıldı. İntraoperatif hidrokortizon infüzyonu başlandı. Kortizon düzeyleri takibiyle yoğun bakımda tedavisine devam edildi. Vital bulguları operasyon süresince stabil olan hasta ekstübe edilerek yoğun bakımda ve serviste takip edildi. Postoperatif 3. gün sorunsuz olarak taburcu oldu. Bu olgu sunumunda Cushing sendromunda anestezi yöntemlerini literatürler ışığında hatırlatmayı, uyguladığımız anestezi yöntemini sunmayı amaçladık. Anahtar kelimeler: Cushing Sendromu; Anestezi, Genel; İntraoperatif Komplikasyonlar.
References
- Kurt E, Ayaz Y. Adrenal system and anesthesia. Turkiye Klinikleri J Anest Reanim-Special Topics 2008; 1:53-67.
- Börüban MC, Kılıç G. Cushing syndrome and adrenal insufficiency. Turkiye Klinikleri J Surg Med Sci 2006; 2:58-62.
- Tasch MD. Corticosteroids and anesthesia. Curr Opin Anaesthesiol 2002; 15:377-81.
- Tuzuner F. Endokrin ve metabolik hastalıklarda anestezi. In: Anestezi Yoğun Bakım Ağrı. Tuzuner F (ed). Ankara, MN Medikal&Nobel Yayıncılık 2010,453-78.
- Gomez-Sanchez CE. Cushing’s syndrome and hypertension. Hypertension 1986; 8:258-64.
- Sacerdote A, Weiss K, Tran T, Rokeya Noor B, McFarlane SI. Hypertension in patients with Cushing’s disease: pathophysiology, diagnosis, and management. Curr Hypertens Rep 2005;7:212-8.
- Huiku M, Uutela K, van Gils M, et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth 2007;98:447-55.
- Ledowski T, Bein B, Hanss R, et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia. Anesth Analg 2005; 101:1700-5.
- Bovill JG. Intravenous anesthesia for the patient with left ventricular dysfunction. Semin Cardiothorac Vasc Anesth 2006; 10:43-8.
- Shalet A, Mukherjee A. Hiperkortizolizmin farmakolojik tedavisi. Current Opinion in Endocrinology, Diabetes & Obesity, Türkçe Baskı 2008;3:71-6.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | August 1, 2010 |
| Published in Issue | Year 2010 Volume: 17 Issue: 4 |