Ciddi koroner veya pulmoner hastalığı olan üç olguda segmenter torakal epidural anestezi altında mastektomi (olgu sunumu)

Onkolojik meme cerrahilerinde genellikle uygulama kolaylığı nedeni ile genel anestezi tercih edilmektedir. Ancak son zamanlarda genel anestezinin dezavantajlarını önlemek amacı ile rejyonel anestezi yöntemleri önerilmektedir. Mastektomi operasyonu geçirecek ciddi koroner arter veya pulmoner hastalığı olan ASA III risk grubunda 3 olguda genel anestezi uygulamasının yüksek risk taşıması nedeniyle uygulanan seğmenler torakal epidural anestezi yönetimi sunulmuştur

Mastectomy under segmental thoracal epidural anesthesia in three cases with severe coronary artery or pulmonary disease (case report)

General anesthesia is prefered in oncologial breast surgery due tofacüity ofthe technique. However, regional anesthesia techniqu.es are suggested recently in order to prevent the disadvantages of general anesthesia. Anesthetic management of 3 ASA III class patients having severe coronary artery ör pulmonary diseases scheduled to undergo mastectomy under segemental thoracal epidural anesthesia because ofhigh risk of general anesthesia were presented.

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  • 1. Doss NW, Ipe J, Crimi T, et al. Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy. Anesth Analg 2001; 92: 1552-7.
  • 2. Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg 1995; 222: 663-9.
  • 3. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002; 183: 630-41.
  • 4. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85: 109-17.
  • 5. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology 1990; 73: 308-27.
  • 6. Oakley N, Dennison A, Shorhouse A. A prospective audit of simple mastectomy under local anesthesia. Eur J Surg Oncol 1996; 2: 131-6.
  • 7. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA.Thoracic paravertebral block for breast surgery. Anesth Analg 2000; 90: 1402-5.
  • 8. Fassoulaki A. Brachial plexus block for pain relief after modified radical mastectomy. Anesth Analg 1982; 61: 986-7.
  • 9. Atanassoff PG, Alon E, Weiss BM. Intercostal nerve block for lumpectomy: superior postoperative pain relief with bupivacaine. J Clin Anesth 1994; 6: 47-51.
  • 10. Giebler RM, Scherer RU, Peters J. Incidence of neurologic complications related to thoracic epidural catheterization. Anesthesiology 1997; 86: 55-63.
  • 11. Jarosz J, Pihowicz A, Towpik E. The application of continuous thoracic epidural anesthesia in outpatient oncological and reconstructive surgery of the breast Eur J Surg Oncol 1991; 17: 599-602.
  • 12. Kapacz DJ. Regional anesthesia of the trunk. In: Brown DL, (ed.) Regional Anesthesia and Analgesia. Philadelphia, W.B.Saunders 1996; 298-300.
  • 13. Atanassoff PG, Alon E, Pasch T, Ziegler WH, Gautschi K. Intercostal nerve block for minor breast surgery. Reg Anesth 1991; 16:23-7.
  • 14. Yeh CC, Yu JC, Wu CT, Ho ST, Chang TM, Wong CS. Thoracic epidural anesthesia for pain relief and postoperation recovery with modified radical mastectomy. World J Surg 1999; 23: 256-61.
  • 15. Takeshima R, Dohi S. Cervical epidural anesthesia and surgical blood loss in radical mastectomy. Reg Anesth 1986; 11: 171-5.
  • 16. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 1995; 82: 1474-506.
  • 17. Shribman AJ, Smith G, Achola KJ. Cardiovascular and cathecolamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987; 59: 295-9.
  • 18. Roizen MF. Editorial view: Should we all have a sympathectomy at birth? Or at least preoperatively? Anesthesiology 1988; 68: 482-4.
  • 19. Cousins MJ, Veering BT. Epidural Neural Blockade. In Cousins MJ, Bridenbaugh PO, (eds.) Neural Blockade. Philadelphia, Lippincott-Raven 1998; 243-321.
  • 2O. Blomberg S. Long-term home self-treatment with high thoracic epidural anesthesia in patients with severe coronory artery disease. Anesth Analg 1994; 79:413-21.
  • 21. Rolf N, Van de Velde M, Waiters PF, Mollhoff T, Weber TP, Van Aken HK. Thoracic epidural anesthesia improves functional recovery from myocardial in conscious dogs. Anesth Analg 1996; 83: 935-40.
  • 22. Moore CM, Cross MH, Desborough JP, Burrin JM, Macdonald IA, Hall GM. Hormonal effects of thoracic extradural analgesia for cardiac surgery. Br J Anaesth 1995; 75: 387-93.
  • 23. Ohkado S, Nishiyama T, Tarnai H, Yajima C, Hanaoka K. Combined intercostal nerve block and epidural anesthesia in a patient with severe aortitis syndrome. Masui 2000; 49:782-4 (abstract).
  • 24. Wong DH, Weber EC, ScheH MJ, Wong AB, Anderson CT, Barker Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995; 80: 276-84.
  • 25. Groeben H, Sch&fer B, Pavlakovic G, Silvanus MT, Peters J. Lung function under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive pulmonary disease undergoing breast surgery. Anesthesiology 2002; 96: 536-41.
  • 26. Barnes PJ. Modulation of neurotransmission in airways. Physiol Rev 1992; 72:699-729.
  • 27. Gruber EM, Tschemko EM, Kritzinger M. The effect of thoracic epidural analgesia with bupivacaine 0.25% on ventilatory mechanics in patients with severe chronic obstructive pulmonary disease. Anesth Analg 2001; 92: 1015-9.
  • 28. Trikha A, Sadhasivam S, Saxena A, Arora MK, Deo SV. Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report. J Clin Anesth. 2000; 12:75-9.
Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
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