Orhan ALİMOĞLU, Metin LEBLEBİCİ, Tuba ATAK, Jülide SAĞIROĞLU, Yadigar YILMAZ, Ercüment TOMBALAK, Elif DEMİRCİ, Muhammet İhsan KARAMAN
Cerrahi işlemlerde ketalar anestezi: Sierra Leone deneyimi
Giriş Yüksek doz ketamin genel anestezide ve düşük doz analjeziyi indüklemek için kullanılır. Damar içi ketamin anestezisi, genellikle herni onarımı için kullanıldığı gibi, aynı zamanda da kutanöz müdahalelerde, jinekolojide dilatasyon ve küretajda ve ürolojide hidrosel onarımında da kullanılır. Yöntemler Bu çalışma, 10 ile 16 Mart 2014 tarihleri arasında Sierra Leonede Yeryüzü Doktorları gönüllü cerrahi ekibi tarafından ameliyat edilen 49 hastanın sonuçlarını bildirmektedir. Tüm hastaların demografik özellikleri ve uygulanan cerrahi yöntemler kaydedildi. Tüm hastalar ketamin anestezi altında ameliyat edildi. Bulgular Ortalama yaşları 36.8 ± 17.8 olan beş kadın ve 44 erkek hasta ameliyat edildi. Bir hastada umblikal herni, birinde epigastrik ve 35'inde inguinal herni saptandı. Umbilikal ve epigastrik hernilere primer tamir yapıldı. İnguinal hernilerin 19' u sağ taraftaydı ve 16’ sı sol taraftaydı. Yirmi sekiz hastada indirekt herni vardı, 6 hastada direkt ve 1 hastada bilateral fıtık vardı. Hiçbir hastada obstrüksiyon veya boğulma görülmedi. Çocuk yaşta fıtığı olan dört hastaya high ligasyon yapıldı. Yetişkin yaş grubunda 28 hastaya ağ örme ameliyatı ve 3 hastaya Bassini tamiri yapıldı. Dört hastanın sağ tarafına, dört hastanın sol tarafına hidrosel için Winkelmann işlemi uygulandı. Bir hastaya testiste kitle için orşiektomi uygulandı; 1 hastada inguinal bölgede tümör saptandı ve rezeksiyonu yapıldı; bir hastada boyunda lipom eksizyonu ve bir hastada sol labium majusta kitle eksizyonu yapıldı. Hiçbir hastada anestezi ile ilgili komplikasyon gelişmedi. Sonuç Düşük doz intravenöz ketamin ve midazolam ile güvenli ve etkili sedasyon özellikle cerrahi anestezinin uygulanamadığı saha koşullarında cerrahi prosedürlerde yararlıdır.
Anahtar Kelimeler:
Ketamin; Cerrahi; Herni
Ketalar Anesthesia in Surgical Operations: An Experience of Sierra Leone
Introduction High dose of ketamine is administered in general anesthesia and low dose is used to induce analgesia. Intravenous ketamine is usually used for hernia repair as well as cutaneous interventions in general surgery, for dilatation and curettage in gynecology, and hydrocele repair in urology.Materials and Methods This study reports the outcomes of 49 patients who had been operated by volunteering surgical team of Doctors Worldwide in Sierra Leone during 10th to 16th of March 2014. Demographic features of all patients and surgical methods were recorded. All patients were operated on under ketamine anesthesia.Results Five female and 44 male patients with mean age of 36.8+17.8 were operated. One patient had umbilical, 1 had epigastric, and 35 had giant inguinal hernias. Umbilical and epigastric hernias underwent primary repair. Inguinal hernias were right sided in 19, and left sided in 16 patients. Twenty-eight patients had indirect hernias, while 6 had direct and 1 had bilateral hernias. None of the patients appeared with either obstruction or strangulation. Four patients in pediatric age with hernia underwent high ligation. In adult age group, 28 patients were operated by wall darn repair, and 3 had Bassini repair. Four patients had been diagnosed with right sided, and 4 left sided giant hydroceles all of which underwent Winkelmann procedure. One patient had orchiectomy for a right sided testicular mass; 1 had resection of an inguinal tumor; 1 excision of lipoma in the neck, and 1 excision of a solid mass in the left labium majus. None of the patients had complications related to anesthesia.Conclusion Safe and effective sedation by low dose intravenous administration of ketamine and midazolam is beneficial in surgical procedures, especially in field conditions where general anesthesia is not applicable.
Keywords:
Ketamine; Surgery; Hernia repair,
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- ISSN: 2149-5254
- Yayın Aralığı: Yılda 3 Sayı
- Başlangıç: 1933
- Yayıncı: Hayat Sağlık ve Sosyal Hizmetler Vakfı