Kemoterapi Sonrası Retroperitoneal Lenf Nodu Diseksiyonunda Anestezi Deneyimimiz

Öz

Amaç: Genel olarak 35 yaş altı erkeklerde görülen testis tümörlerinin %95’i germ hücreli olup solid tümörlerdir. Öncelikle orşiektomi ile tedavi edilen testis tümörlerinde kemoterapiyi takiben retroperitoneal lenf nodu diseksiyonu (RPLND) önemli bir cerrahi uygulamadır. Çalışmamızda, RPLND operasyonlarındaki anestezi yönetimimizi güncel literatür ile tartışarak deneyimlerimizi paylaşmak istedik. Gereç ve Yöntemler: Çalışmada bir eğitim araştırma hastanesinde 2017-2023 yılları arasında gerçekleştirilen kemoterapi sonrası RPLND olguları incelendi. Etik kurulundan (No: 2023/305) onay alındıktan sonra, hastaların yaşı, operasyon süresi, peroperatif kan gazı ve işlem esnasında verilen sıvı miktarı hastaların eve taburculuk durumu, hasta dosyalarından ve anestezi takip formlarından retrospektif olarak incelendi. Bilgileri eksik olan hastalar çalışmaya dahil edilmedi. Anestezi indüksiyonundan hemen sonra alınan kan gazı örnekleri, yoğun bakım ünitesine kabul sırasında alınan örneklerle karşılaştırıldı. Kliniğimizde RPLND vakalarında rutin olarak peroperatif alınan havanın oksijen yüzdesi (FiO2) değeri %40 ve altında tutulmakta olup preoperatif multidisipliner değerlendirme yapılmaktadır. Bulgular: Çalışmamıza altı yıllık bir süre boyunca yürütülen kemoterapi sonrası 37 RPLND vakasından verileri eksiksiz olan preoperatif multidisipliner ekip tarafından değerlendirilen 34 hasta çalışmaya dahil edildi. ASA III hasta %35 (n:12), ASA II hasta %65(n:22) olup ortalama yaşları 28 (en az 17-en fazla 47)’idi. Hastaların ameliyathaneye giriş anından yoğun bakım ünitesine yatış süresine kadar geçen süre ortalama 340,7 dakika, yoğun bakım ünitesine yatıştan itibaren ortalama ekstübasyon süresi 125,6 dakika olarak kaydedildi. Hastaların kan gazlarında ortalama pH, pO2 ve pCO2 değerlerinde anlamlı bir değişiklik olmazken, laktat seviyelerinde anlamlı bir artış gözlendi. Peroperatif FiO2 %40'ın ve kristaloid sıvı ilk 2 saate 4 mL-1 kg-1 saat 'in altında tutulmaya çalışıldığı görüldü. Peroperatif ve postoperatif kardiyak pulmoner majör komplikasyon gelişmeyen hastalar eve taburcu edildiler. Sonuç: RPLND multidisipliner bir yaklaşım gerektirir. Perioperatif hipoksi ve hiperoksiye karşı alınan önlemler ve sıvı yönetimi, hem intraoperatif hem de postoperatif dönemde ortaya çıkabilecek majör komplikasyonların önlenmesinde önemli olabilir.

Anahtar Kelimeler

• Germ hücre tümörü
• Hiperoksi
• Multidisipliner yaklaşım
• Pulmoner toksisite
• Retroperitoneal lenf nodu diseksiyonu

Anesthetic Management in Post-Chemotherapy Retroperitoneal Lymph Node Dissection: Insights from Our Clinical Experience

Abstract

Objective: Testicular tumors, of which 95% are germ cell tumors, are generally solid tumors seen in men under the age of 35. Testicular tumors are primarily treated with orchiectomy. Following orchiectomy and chemotherapy, retroperitoneal lymph node dissection (RPLND) is an important surgical procedure in uro-oncology. In our study, we aimed to share our experiences by discussing our anesthesia management in RPLND operations conducted after chemotherapy at our hospital in light of current literature. Material and Methods: This study investigates cases of Retroperitoneal Lymph Node Dissection (RPLND) performed after chemotherapy at a tertiary education and research hospital between 2017 and 2023. After obtaining approval from the Ethics Committee (No: 2023/305), data including patients' ages, operation durations, perioperative blood gas and fraction of inspired oxygen (FiO₂) values, and the amount of fluid administered during the procedure were retrospectively reviewed from patient records and anesthesia monitoring forms. Patients with incomplete information were excluded from the study. Blood gas samples obtained immediately after anesthesia induction were compared with those taken upon admission to the intensive care unit. In our clinic, routine consultations with chest diseases and medical oncology are obtained prior to this procedure. Results: In our study, data from 34 out of 37 RPLND cases conducted over a four-year period were included. ASA III patients constituted 35% (n=12), while ASA II patients made up 65% (n=22), with an average age of 28 years (range: 17 to 47).The average anesthesia duration from the time patients entered the operating room to their admission to the ICU was recorded as 340.7 minutes, and the average extubation time from ICU admission was 125.6 minutes. While there were no significant changes in the average pH, pO₂, and pCO₂ values in blood gases of patients a significant increase in lactate levels was observed. It was noted that the perioperative (FiO₂) was maintained below 40% and the crystalloids administered in the first 2 hours were kept below 4 mL/kg/hour. All patients were discharged home after the operation. Conclusion: RPLND requires a multidisciplinary approach. Measures taken against perioperative hypoxia and hyperoxia, as well as fluid management, may be crucial in preventing major complications that can arise during both the intraoperative and postoperative periods.

Keywords

• Germcell tumors
• Hiperoksi
• Multidisciplinary approach
• Pulmonary toxicity
• Retroperitoneal Lymph Node Dissection

Kaynakça

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