KARDİYAK AÇIDAN YÜKSEK RİSKLİ 17 HASTADA KONTİNYU SPİNAL ANESTEZİ DENEYİMLERİMİZ

Yıl 2016, Cilt: 8 Sayı: 1, 1 - 7, 22.03.2016

Aysenur Dostbil

Öz

Amaç: Kontinyu spinal anestezi, spinal anestezi sağlamak amacıyla düşük dozlarda lokal anesteziğin subaraknoid aralığa, bir kateter yoluyla aralıklı olarak verilerek spinal anestezinin sürdürülmesi yöntemidir. Bu çalışmadaki amacımız, kontinyu spinal anestezi uygulanan kardiak olarak yüksek riskli 17 hastadaki deneyimlerimizi sunmaktır.

Materyal ve Metot: Otuz ile 100 yaşları arasında kardiak olarak yüksek riskli 17 hastaya sezaryen, kolon cerrahisi, prostatektomi, kalça protezi, femur fraktürü ve diz artroplasisi anestezi yöntemi için kontinyu spinal anestezi planlandı. Hastalara oturur pozisyonda aseptik şartlar sağlandıktan sonra L3-L4 veya L4-L5 intervertebral aralıktan spinal kateter takıldı. Daha sonra kateterden % 0.5’lik izobarik bupivaka-inden 1 mİ yapıldı. Operasyonun tipine göre, istenilen sensoryal blok seviyesine ulaşılıncaya kadar aynı konsantrasyonda lokal anestezikten 0.5 ml’lik dozlar halinde tekrarlandı. Kan basıncı, nabız ve sensoryal blok seviyesi kaydedildi.

Bulgular: Tüm hastalarda spinal kateterler başarıyla takıldı. Şiddetli hipotansiyon ve bradikardi atakları görülmedi. İki hastada hipotansiyon meydana geldi. Sensoryal blok seviyesi sezaryenda T7, kolon cerrahisinde T5, prostatektomide T6-T7, kalça protezi, femur fraktürü ve diz artroplastisnde T9-T11 ’e ulaştı Hastaların hiçbirinde intraoperatif olarak genel anesteziye geçilmedi. Postoperatif mortalite gözlemlenmedi.

Sonuç: Kontinyu spinal anestezi hemodinamik olarak stabil olmayan kardiak olarak yüksek riskli hastalarda güvenli bir anestezik teknik olduğunu düşünüyoruz.

Dr. Ayşenur DOSTBİL
Dr. Mine ÇELÎK
Dr. Hacı Ahmet ALICI
Dr. Ali Fuat ERDEM
Dr. İlker İNCE
Dr. Ali AHISKALIOĞLU
Dr. Mehmet CESUR
Dr. Mehmet AKSOY

Anahtar Kelimeler

Kontinyu spinal anestezi, yüksek kardiyak riskli hasta, anestezi yönetimi

CONTINUOUS SPINAL ANESTHESIA: OUR EXPERIENCES IN 17 PATIENTS WITH HIGH CARDIAC RISK

Öz

Objectives: Continuous spinal anesthesia is a method for maintaining spinal anesthesia with small doses of local anesthesia injected intermittently in the subarachnoid space through indwelling catheter. In this study our aim is to present our experiences in 17 patients with high cardiac risk who were performed continuous spinal anesthesia.

Materials and Methods: Seventeen patients aged 30 to 100 ages with high cardiac risk were scheduled for continuous spinal anesthesia for caesarean section, colon surgery, prostatectomy, hip replacement, femoral fracture treatment and knee arthroplasty. Following administration of subcutaneous anaesthesia in the sitting position under aseptic conditions, a spinal catheter was inserted through the intervertebral space between the L3-L4, L4-L5 vertebrae. Then, 1 ml 0.5% isobaric bupivacaine was injected through the catheter. According to the type of the operation, 0.5 ml 0.5% isobaric bupivacain was repeated until the desired level of sensory block was achieved. Blood pressure, pulse, sensory block level of patients were all recorded.

Results: Spinal catheters were inserted succesfully in all patients. None of the patients required sedation. Severe hypotension and bradycardia were not observed. Hypotension occured in 2 patients. Sensory block level raised to T7 in caesarean, toT5 in colon surgery, to T6-T7 in prostatectomy, to T9-T11 in hip replacement, femur fracture treatment and knee arthroplasty. None of the patients were not converted to general anesthesia intraoperatively. Postoperative mortality was not observed.

Conclusion: We think that continuous spinal anesthesia is a safe anesthetic technique for high-risk cardiac patients with unstable hemodynamic status.

Anahtar Kelimeler

Continuous spinal anesthesia, high cardiac risk patient, anesthetic management

Kaynakça

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