Nezih SERTÖZ, Cengiz ŞAHUTOĞLU, Esin BAŞ, Semra KARAMAN, Fatma Zekiye AŞKAR

FEMUR FRAKTÜRLÜ SOL VENTRİKÜL DESTEK CİHAZLI HASTADA ANESTEZİ YÖNETİMİ

Mekanik kalp desteği, hemodinamik bozukluğu, kronik konjestif kalp yetmezliği olan hastalarda tıbbi tedaviye bir alternatiftir. Mekanik ventrikül destek cihazları; bozulmuş ventrikül fonksiyonunu destekleyerek yeterli kardiyak debi sağlarlar ve uç organ fonksiyonlarının düzelmesine yardımcı olurlar. Bu cihazların miyokardit gelişen veya miyokard fonksiyonları olmayan kalp transplantasyonuna aday son dönem kardiyomiyopatili hastalarda miyokard fonksiyonunu artırması beklenir. Bu olguda 67 yaşında femur fraktürü gelişen ve kalp tranplant adayı olan, dilate kardiyomiyopatisi nedeniyle pulsatil olmayan sol ventrikül destek cihazı uygulanan hastamızda uyguladığımız non kardiyak anestezi uygulamamızı sunmayı amaçladık. Kanama diyatezi ve pulsatil olmayan ventriküler cihazı olması nedeniyle hastamıza radyal arter kateteri, juguler santral venöz kateter ve analjezi amacıyla femoral sinir bloğu ile lateral femoral kutanöz sinir bloğu ultrasonografi rehberliğinde uygulandı.

ANESTHETIC MANAGEMENT OF A PATIENT WITH A FEMUR FRACTURE AND VENTRICULAR ASSIST DEVICE

Mechanical cardiac support is an alternative to medical treatment in hemodynamic disturbances in patients with chronic congestive heart failure. Mechanical ventricular assist devices are used to provide support for impaired ventricular functions and they help to regulate end-organ functions by providing sufficient cardiac output. Ventricular assist devices are used to improve myocardial functions of patients with myocarditis, or they are used for patients who are candidates for cardiac transplantation whose myocardial functions are not expected to improve such as patients with end-stage cardiomyopathy. In this case, we present the anesthetic management of a 67-year-old patient with a left ventricular assist device who was a candidate for cardiac transplantation because of dilated cardiomyopathy and who underwent noncardiac surgery due to femur fracture. As the patient had a non-pulsatile ventricular assist device and bleeding diathesis, a radial artery catheter and a jugular central venous catheter were placed with ultrasound guidance. Besides, femoral nerve block and lateral femoral cutaneous nerve block were performed with ultrasound guidance for intraoperative and postoperative analgesia.

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