Mesut ERBAŞ, Tuncer ŞİMŞEK, M TURGUT, Alper ÖZKAN, Hasan ŞAHİN, Hüseyin TOMAN, Hasan Ali KİRAZ, Ali Ümit YENER, Tuğba DOĞU

Mini Doz Hipobarik Unilateral Spinal Anestezi İle Endovenöz Radyofrekans Tedavisi

AMAÇ: Bu çalışma ile alt ekstremite yüzeyel venöz yetmezlik ve buna bağlı gelişen varislerin RFA radyofrekans ablasyon ile tedavisinde unilateral spinal anestezi sırasında kullanılan mini doz hipobarik bupivakainin günübirlik cerrahideki etkinliğini araştırmayı hedefledik.YÖNTEMLER: Bu çalışma 2012-2013 yılları arasında Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi Hastanesi Anesteziyoloji ve Reanimasyon Anabilim Dalı bünyesinde Kalp ve Damar Cerrahisi ameliyathanesinde elektif endovenöz radyofrekans ablasyon yöntemi ile tek taraflı varis tedavisi yapılan hastaların dosya bilgilerinin retrospektif olarak incelenmesi ile gerçekleştirildi. Çalışmaya ASA I-II risk grubundaki 18-55 yaş aralığında 40 hasta dahil edildi. Çalışmaya alınan hastalara 1,5 mL %1 izobarik bupivakain “Marcaine® %0,5 flakon, Eczacıbaşı” + 3,5 mL distile su karışınımın 3 mL’si 4,5 mg olarak intratekal verildi. Bu dozdaki ilacın son hali 37 °C’de hipobarik olduğu 1 literatür bilgileri ile doğrulandı. Spinal anestezinin duyusal blok seviyesi, motor blok derecesi ve hemodinamik göstergelerden olan kalp atım hızı KAH , ortalama arter basıncı OAB ve SpO2 değerleri spinal anestezi yapıldıktan sonra 15 dk boyunca her 2,5 dk’da bir, daha sonra ameliyat bitimine kadar her 5 dk’da bir kaydedildi. Hastalar ameliyat süresince hipotansiyon, bradikardi, bulantı, kusma, ağrı, titreme, huzursuzluk, solunum depresyonu gibi yan etkiler bakımından izlendi ve oluşan komplikasyonlar kaydedildi.BULGULAR: Çalışmamıza 18’ierkek 22’si kadın olmak üzere 40 hasta dahil edildi. Hastaların 2’sinde bulantı/kusma, 2’sinde de bradikardi gözlemledik. Maksimum duyusal blok oluşma süresi 9,18 dk iken maksimum motor blok oluşma süresi 11,3 dk olarak gözlendi.SONUÇ: Sonuç olarak elektif endovenöz radyofrekans ablasyon yöntemi ile tek taraflı varis tedavisi yapılan hastalarda unilateral spinal anestezinin etkin bir anestezinin yanında minimal düzeyde yan etki oluşturup ve hasta memnuniyetini artırarak erken taburculuk süresi sağlar.

Anahtar Kelimeler:

Hipobarik, düşük doz, spinal anestezi

Low Dose Hypobaric Bupivacaine In Unilateral Spinal Anesthesia For Endovenous Radiofrequency Ablation

OBJECTIVE: We aimed to investigate the effects of low dose hypobaric bupivacaine usage in unilateral spinal anesthesia for the treatment of varicose veins with RFA radiofrequency ablation .METHODS: This retrospective study was performed by Çanakkale 18 Mart Medical Faculty Department of Anesthesiology and Reanimation with the method of elective endovenous radiofrequency catheter ablation, scanning the file information of patients retrospecively. 40 patients in the 18-55 year old range and who are in the ASA I-II risk group were included in the study. Patients intrathecally received 4,5 mg 3 ml hypobaric bupivacaine 0.5% plain bupivacaine 1.5mL+3.5 ml of distilled water . This final dose of bupivacaine at 37°C 1 was confirmed as hypobaric by literature. Motor blockade, sensorial blockade and hemodynamic parameters were assessed every 2.5 minutes during the first 15 minutes after spinal injection and then every 5 minutes until the end of operation The side effects during the operation time, such as hypotension, bradycardia, nausea, vomiting, pain, respiratory depression were also documented. The operative time was recorded.RESULTS: Of the patients included in our study were 18 male and 22 were females. We were observed in 2 patients bradycardia and in 2 patients nausea / vomiting patients. While is Patients achieving maximum sensorial block was observed that the mean duration of 9,18 min. The average time to reach the maximum motor block was observed that 11.3 min.CONCLUSION: In conclusion, unilateral spinal anesthesia provide effective anesthesia, minimal side effects thus by shortening the hospital stay maximized the satisfaction of patients undergoing elective endovenous radiofrequency catheter ablation treatment of bilateral varicose veins.

Keywords:

Hypobaric, low dose, spinal anesthesia,

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Imbelloni LE, Gouveia MA, Vieira EM, Cordeiro JA. A randomised, double-blind comparison of three different volumes of hypobaric intrathecal bupiva- caine for orthopaedic surgery. Anaesth Intensive Care. 2009 Mar;37(2):242-7.
Imbelloni LE, Gouveia MA, Carneiro AF, Grigorio R. Reducing the concentration to 0.4% enantiomeric excess hyperbaric levobupivacaine (s75: r25) pro- vides unilateral spinal anesthesia. Study with differ- ent volumes. Rev Bras Anestesiol. 2012 Sep;62(5):654-64.
Casati A, Fanelli G, Aldegheri G et al – Frequency of hypotension during conventional or asymetric hyperbaric spinal block. Reg Anesth Pain Med, ;24:214-219. Imbelloni LE. O uso racional da raquianestesia. Em: Imbelloni LE, Tratado de Anestesia Raquidiana, Medidática Informática Ltda, Curitiba, 2001, Capítulo 8, p. 74.
Kaya M, Oztürk I, Tuncel G, Senel GO, Eskiçirak H, Kadioğullari N. A comparison of low dose hyperbaric levobupivacaine and hypobaric levobupivacaine in unilateral spinal anaesthesia. Anaesth Intensive Care. 2010 Nov;38(6):1002-7.
Tanasichuk MA, Schultz EA, Matthews JH et al – Spinal hemianalgesia: An evaluation of a method, its applicability, and influence of the incidence of hy- potension. Anesthesiology, 1961;22:74-85.
Casati A, Fanelli G, Cappelleri G et al – Low dose hyperbaric bupivacaine for unilateral spinal anaes- thesia. Can J Anaesth, 1998;45:850-854.
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76:906
Esmaoglu A. Bilateral vs. unilateral spinal anes- thesia for outpatient knee artroscopies. Knee Surg Sports Traumatol Artrosc 2004;12:155–8.
Tanasichuk MA, Schultz EA, Matthews JH, Van Bergen FH. Spinal hemianalgesia: an evaluation of a method, its applicability, and influence on the inci- dence of hypotension. Anesthesiology 1961; 22:74-85.
Ben-David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R et al. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg 2000; :865-870.
Kuusniemi KS, Pihlajamaki KK, Pitkanen MT, Korkeila JE. A low-dose hypobaric bupivacaine spi- nal anesthesia for knee arthroscopies. Reg Anesth ; 22:534-538. Pittoni G, Toffoletto F, Calcarella G, Zanette G, Giron G P. Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. Anesth Analg 1995; 81:73-79.
Casati A, Fanelli G. [Unilateral spinal anesthesia. State of the art]. Minerva Anestesiol 2001; 67:855
Povey HMR, Jacobsen J, Westergaard-Nielsen J. Subarachnoid analgesia with hyperbaric 0.5% bupi- vacaína: Effect of 60-min period of sitting. Acta Anaesthesiol Scand 1989; 33:295-297.
Esmaoglu A, Boyaci A, Ersoy O, Guler G, Talo R, Tercan E. Unilateral spinal anaesthesia with hyper- baric bupivacaine. Acta Anaesthesiol Scand 1999; :1083-1087.
Imbelloni LE, Beato L, Gouveia MA. [Low hypo- baric bupivacaine doses for unilateral spinal anes- thesia]. Rev Bras Anestesiol 2003; 53:579-585.
Vanna O, Chumsang L, Thongmee S. Levobupi- vacaine and bupivacaine in spinal anesthesia for transurethral endosıcopic surgery. J Med Assoc Thai 2006;89:1133-1139.