Endoskopik Transsfenoidal Cerrahi Uygulanan Akromegalik Hastalarda Anestezi Yönetiminin Retrospektif Analizi

Yıl 2019, Cilt: 2 Sayı: 2, 169 - 179, 31.08.2019

Murat Türkeün Ilgınel , Demet Laflı Tunay

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

Öz

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.

Anahtar Kelimeler

Acromegaly, anesthesia management

Kaynakça

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