Fatma ÖZKAN SİPAHİOLU, KEZİBAN SANEM ÇAKAR TURHAN, BAŞAK CEYDA MEÇO, ALİ ABBAS YILMAZ

GERİATRİK HASTALARIN ALT EKSTREMİTE CERRAHİSİNDE DÜŞÜK DOZ SÜREKLİ SPİNAL ANESTEZİNİN PERİOPERATİF VE POSTOPERATİF KOMPLİKASYONLARA ETKİSİ

Amaç: Geriatrik hastalarda major alt ekstremite cerrahisinde mortalite, kısıtlı fizyolojik adaptasyon kapasiteleri, komorbiditeleri veemboli riski nedeniyle yüksektir. Bu hastalar için en güvenli anestezi tekniği halen tartışmalı konulardandır. Bu çalışmada majör altekstremite cerrahisi planlanan kardiyak riskli ileri yaş hastalarda hedef kontrollü sürekli spinal anestezi (SSA) ile genel anestezi (GA)yöntemlerinin hemodinamik stabilite ve perioperatif komplikasyon sıklığı açısından karşılaştırması amaçlanmıştır.Yöntem: Major alt ekstremite cerrahisi planlanan 65 yaş ve üzeri, ASA II-III, kardiyak riskli 50 hasta çalışmaya dahil edildi. HastalarSSA ve GA grubu olarak iki gruba ayrıldı. Grup SSA'da indüksiyonda spinal kateterden 2.5 mg %0.5 izobarik bupivakain verildi. SeviyeT10'a ulaşana kadar en fazla 10 mg olmak üzere 5 dk'da bir 2.5 mg bupivakain eklendi. Grup GA'de hastalara 4-6 mg kg-1tiyopentalsodyum + 0.6 mg kg-1rokuronyum + 0.5-1 mcg kg-1remifentanil ile yavaş indüksiyon uygulandı. İdame tedavisi %1.5-2.5 sevofluran ilesağlandı. Operasyon süresince ortalama kan basıncında bazal değerlerden>%30 azalma görülmesi 'hipotansiyon' olarak değerlendirildi.Bir dakikadan uzun süren hipotansiyon gelişmesi halinde efedrin 5 mg iv puşe uygulandı. Cerrahi süresince tüm hemodinamik parametreler,efedrin kullanım sıklığı ve total dozu ve postoperatif komplikasyonlar kaydedildi.Bulgular: Gruplar arasında hemodinamik parametreler, hipotansiyon sıklığı, efedrin kullanım sıklığı ve kullanılan efedrin dozuyönünden fark tespit edilmedi. SSA tekniği grubundaki tüm hastalara kolaylıkla ve güvenle uygulanabildi. Sonuç: Anestezi tekniğinin seçimi hastanın tercihi, yandaş hastalıkları, olası postoperatif komplikasyonlar ve anestezistin kliniktecrübesine dayanarak anestezist tarafından yapılmalıdır. Bu hastalara yaklaşım ortopedist, geriatrist ve anestezistin ortak görüşleri ilemultidisipliner olmalıdır

EFFECTS OF LOW DOSE CONTINUOUS SPINAL ANESTHESIA ON PREOPERATIVE AND POSTOPERATIVE COMPLICATIONS IN LOWER EXTREMITY SURGERY OF GERIATRIC PATIENTS

Objective: Mortality of geriatric patients undergoing major lower extremity surgery is high because of limited physiological adaptationcapacities, the presence of concomitant systemic diseases and risk of embolism. There is no consensus on the safest type of anesthesia forthese patients and the opinion related to the choice of general or regional anesthesia is still controversial. We aimed to compare continuousspinal anesthesia (CSA) and general anesthesia (GA) techniques in high risk geriatric patients undergoing major lower extremity surgeryin terms of hemodynamic variables and perioperative-postoperative complication rates.Method: Fifty consecutive, aged 65 and above, ASA II-III class, patients with cardiac risk undergoing major lower extremity surgerywere included to the study. The patients were randomly divided into two groups as CSA group and GA group. Hemodynamic parametersof patients were recorded every 5 minutes. In group CSA, 2.5 mg of 0.5% isobaric bupivacaine was given by catheter for induction. In every5 minutes, 2.5mg of bupivacaine (max 10 mg) was added until reaching target level of T10. In group GA, slow induction was performedwith 4-6 mg kg-1thiopental sodium+0.6 mg kg-1rocuronium br.+ 0.5-1 mcg kg-1remifentanil to patients. Anesthesia was maintained with1.5-2.5 % sevoflurane. During the operation, >30% reduction in baseline mean arterial blood pressure was accepted as ‘hypotension’.In case of hypotension lasting longer than one minute, iv bolus dose of ephedrine 5 mg was administered. The frequency of ephedrineadministration and total dose of ephedrine were recorded in all patients. Results: There was no difference between two groups in terms of hemodynamic profile (heart rate, arterial blood pressures), theincidence of hypotension, the frequency of ephedrine administration and total dose of ephedrine. CSA technique was performed easilyand safely to all patients in group CSA. Conclusion: The choice of anesthetic technique should be determined by the anesthesiologist based on the patient’s preference,comorbidities, potential postoperative complications and the clinical experience of the anesthesiologists. The overall therapeutic approach togeriatric patients should be multidisciplinary after consultation with orthopedic surgeon, the geriatrician and the anesthesiologist

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