Endoskopik Transsfenoidal Cerrahi Uygulanan Akromegalik Hastalarda Anestezi Yönetiminin Retrospektif Analizi

Öz

Amaç: Endoskopik transsfenoidal cerrahi ile tümör rezeksiyonu uygulanan akromegalik hastaların anestezi yönetimi eşlik eden endokrinolojik ve anatomik anamoliler sebebiyle özel dikkat ve yaklaşım gerektirmektedir. Bu retrospektif çalışma ile akromegali tanısı alarak transsfenoidal hipofiz cerrahisi geçiren hastalardaki anestezi yönetimine ve perioperatif bakıma değinilmek istenmiştir.

Materyal ve Metot: Üniversitemiz Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan etik kurul onayı alındıktan sonra Ocak 2017 ile Aralık 2018 tarihleri arasında endoskopik transsfenoidal cerrahi ile hipofizer tümör eksizyonu uygulanan 25 akromegalik hastanın yazılı ve dijital dosyaları ile anestezi kayıt formları incelenerek retrospektif analizi yapılmıştır.

Bulgular: Hastaların çoğunluğunun geliş şikayeti tümörün aşırı hormon salgılamasının etkileriyle ilişkiliydi. Yaygın semptomlar somatik dismorfiklik, baş ağrısı ve görme alanı defektleri idi. Hastalardan 3’ünde zor maske ventilasyonu 2’sinde zor entübasyon gelişmişti. Zor entübasyon olgularının birinde uyanık fiberoptik bronkoskop ile entübasyon sağlanırken diğer olguda videolaringoskop kullanılmıştı.

Sonuç: Akromegalik hastaların cerrahisi birçok hava yolu sorunu, kalp ve metabolik risk faktörleri dolayısıyla pek çok anestezik zorluğu barındırabilir. Anestezistler, hipofiz hastalığının çeşitli sunumlarını ve hastanın perioperatif durumu üzerine etkilerini iyi bilmelidir.

Anahtar Kelimeler

• Akromegali,anestezi yönetimi

A Retrospective Analysis of Anesthesia Management of Acromegalic Patients Undergoing Endoscopic Transsphenoidal Surgery

Abstract

Aim: Anesthesia management of acromegalic patients undergoing tumor resection with endoscopic transsphenoidal surgery requires special attention and approach due to the accompanying endocrinological and anatomical anamolies. In this retrospective study, we aimed to address anesthesia management and perioperative care in patients undergoing transsphenoidal pituitary surgery with the diagnosis of acromegaly.

Material and Methods: After obtaining approval from the Institutional Investigation and Ethics Committee of our university, between January 2017 and December 2018, 25 acromegalic patients with endoscopic transsphenoidal surgery underwent pituitary tumor excision were retrospectively analyzed by using written and online files and anesthesia records.

Results: The majority of patients presented with complaints of excessive hormone secretion. Common symptoms were somatic dysmorphicity, headache and visual field defects. Difficult mask ventilation was developed in 3 patients and difficult intubation in 2 patients. One of the difficult intubation case was intubated with awake fiberoptic bronchoscope and the other patient was with videolaryngoscope.

Conclusion: Surgery of acromegalic patients may involve several anesthetic difficulties due to many airway problems, heart and metabolic risk factors. Anesthesiologists should be familiar with the various presentations of pituitary disease and its effects on the perioperative status of the patient.

Keywords

• Acromegaly,anesthesia management

Kaynakça

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