Raziye GÖKREM, Ezgi ERKILIÇ, Tülin GÜMÜŞ, Orhan KANBAK

Arnold-Chiari malformasyonu ve anestezik yaklaşım (olgu sunumu)

Arnold-Chiari malformasyonu (ACM), serebellar tonsiller ve medullanın foramen magnumdan değişik derecelerde herniasyonunu kapsar. ACM' lu hastalarda vokal kord paralizisi, pulmoner aspirasyon riski, gag refleksi azalması veya yokluğu, postoperatif dönemde solunum yetmezliği gibi komplikasyonlar gözlenebilmektedir. Bu olgular preoperatif değerlendirme, anestezik yaklaşım ve postoperatif monitörizasyon ve izlem açısından özellik taşımaktadırlar. Biz Arnold-Chiari malformasyonu Tip I tanısı almış 4.5 yaşındaki bir olgu nedeniyle bu sendromu ve anestezik yaklaşımı irdelemeyi amaçladık.

Anahtar Kelimeler:

Anestezi, Arnold-Chiari malformasyonu

Arnold-Chiari malformation and anesthetic approach (case report)

Arnold-Chiari malformation includes,different degrees of herniation of cerebellar tonsils and medulla through foramen magnum. In patients with ACM complications like vocal cord paralysis, risk of pulmonary aspiration, absence or a decrease in gag reflex and postoperative pulmonary insufficiency could be seen. These cases show variation in respect to preoperative assessment, anesthetic approach and postoperative monitoring. In this report we aimed to evaluate this malformation and anesthetic approach, on account of a 4.5 years old case diagnosed as Arnold-Chiari type I malformation.

Keywords:

Anesthesia, Arnold-Chiari Malformation,

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1. Wisoff JH. Chiari malformations and hydromyelia. In: Tindall GT,Cooper PR, Barrow DL, (eds.) The Practice Of Neurosurgery, Pennsylvania, Williams & Wilkins 1996; 2741 -50.
2. Katz J. Anesthesia and Uncommon Disease.Third Edition,Saunders, Philadelphia, 1990: 582.
3. Martinot A, Hue V, Leclerc F, Vallee L, Closset M, Pruvo JP, Sudden death revealing Chiari type 1 malformation in two children. Intensive Care Med 1993; 19(2):73-4.
4. Williams DL, Umedaly H, Martin IL, Boulton A. Chiari type I malformation and postoperative respiratory failure. Can J Anaesth. 2000; 47(12): 1220-3.
5. Nakayama Y, Sonoda H, Namiki A. Propofol anesthesia for a patient with Arnold-Chiari deformity. Masui 1998; 47(6):726-9.
6. Monkhoff M, Schwarz U, Gerber A. Fanconi S. Banziger O. The effects of sevoflurane and halothane anesthesia on cerebral blood flow velocity in children. Anesth Analg. 2001; 92(4):891-6.
7. Bundgaard H, von Oettingen G, Larsen KM. Landsfeldt U, Jensen KA, Nielsen E, Cold GE. Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. A dose-response study ir) patients subjected to craniotomy for cerebral tu mours. Acta Anaesthesiol Scand. 1998; 42(6):621-7.
8. Yentis SM. Suxamethonium and hyperkalemia. Anaesth Intensive Care 1990; 18(1): 92-101.
9. Fiacchino F, Gemma M, Bricchi M, Giombini S, Regi B. Sensitivity to curare in patients with upper and lower motor neurone dysfunction. Anaesthesia 1991; 46(11 ):980-2.
10. Tanaka M, Harukuni I, Naito H. Intraoperative cardiovascular collapse in an infant with Arnold-Chiarimalformation.Paediatr Anaesth 1997; 7(2): 163-6.
11. Davis L, Ross N. Bilateral vocal cord palsy alter ventricular drainage in a child. Anesth Analg 2001 Feb: 92(2):358-61.
12. Williams DL, Umedaly H, Martin IL, Boulton A.Chiari type I malformation and postoperative respirator failure.Can J Anaesth 2000; 47(12): 1220-3.