AHMET CEMİL İSBİR, Cevdet DÜGER, İclal KOL ÖZDEMİR, Kenan KAYGUSUZ, Sinan GÜRSOY, Caner MİMAROĞLU

Duchenne musküler distrofili olguda total intravenöz anestezi -tek, düşük doz rokuronyum kullanımı

Duchenne Musküler Distrofi Xe bağlı kalıtımla aktarılan, 1/3.500 sıklıkta gözlenen ve erkek popülasyonu etkileyen progresif bir nöromüsküler hastalıktır. Kas güçsüzlüğü Duchenne Musküler distrofide temel problem olmakla birlikte; solunum kaslarının tutulması nedeniyle solunum problemleri ve dilate kardiyomiyopati nedeniyle kardiyak problemler olabileceğinden anestezi yaklaşımı önemlidir. Bu hastalıkta inhalasyon anesteziklerinin malign hipertermiye ve rabdomiyolize sebebiyet verebileceği bilinmektedir. Bu sunuda, Duchenne Musküler Distrofi tanılı yedi yaşındaki erkek hastada, sağ suprakondüler humerus fraktürü nedeniyle gerçekleştirilen cerrahide güvenli anestezi yaklaşımı tartışılmıştır. Olgumuzda malign hipertermi ve rabdomiyoliz olasılığı nedeniyle inhalasyon ajanlarından tamamıyla temizlenmiş anestezi cihazında %50/50 oksijen/hava karışımı, ayrıca düşük doz propofol ve remifentanil ile total intravenöz anestezi uygulandı. Nondepolarizan kas gevşeticilere duyarlılığın artmış olmasından dolayı, düşük doz rokuronyum ve revers ajanı olarak da sugammadeks kullanıldı. Peroperatif ve postoperatif dönemde herhangi bir komplikasyonla karşılaşılmadı. Olgu yoğun bakımda izlendikten sonra ortopedi kliniğine verildi. Bu olgularda propofol ve remifentanil ile total intravenöz anestezi ve düşük dozda rokuronyum bromür uygulamasının daha güvenli anestezi uygulaması sağlayabileceği sonucuna varılmıştır.

Total intravenous anesthesia in a case of duchenne muscular dystrophy -single low dose rocuronium usage

Duchenne Muscular Dystrophy is an X-linked progressive neuromuscular hereditary disease which effects men and is seen in 1/3.500 frequency. Although the basic problem in this disease is musclular weakness; anesthetic approach in Duchenne Muscular Dystrophy is important because the disease might cause cardiac and respiratory problems during anesthesia. Moreover, inhalation anesthetics might be the reason for malignant hyperthermia and rhabdomyolysis. This case report aims at discussing the safe anesthetic approach in a 7 year old patient who was operated by orthopedic surgeons with Duchenne Muscular Dystrophy and right supracondylar humerus fracture. In this case ventilator was totally cleaned from anesthetic agents to avoid from malignant hyperthermia and rhabdomyolysis. 50% oxygen-air mixture and low dose propofol with remifentanil were used in total intravenous anesthesia. Because of the non-depolarizing muscle relaxant sensitivity, low-dose rocuronium and sugammadex were used as its reverse agent. No complications were encountered during preoperative and perioperative period. After the case was observed in intensive care unit, he was transferred to the orthopedics clinic. It has been concluded that use of propofol and remifentanil together with total intravenous anesthesia, and low-dose rocuronium bromide will be a safer anesthesia application.

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