ONUR PALABIYIK, Tuğba ÇAĞLAR, Ayça TAŞ TUNA, YAKUP TOMAK

GLUKOZ-6-FOSFAT DEHİDROGENAZ EKSİKLİĞİ OLAN HASTADA LATERAL SAGİTTAL İNFRAKLAVİKÜLER BLOK

Glukoz-6-fosfat dehidrogenaz (G6PD) eksikli¤i en s›k görülen enzim yetersizli¤idir. G6PD eksikli¤i olan hastalarda perioperatif dönemde cerrahi stres, baz› ilaçlar ve a¤r› hemolitik krizlere yol açabilece¤inden anestezi plan› dikkatli yap›lmal›d›r. Bu sunuda, ulna k›r›¤› nedeniyle üç gün arayla iki kez operasyona al›nan G6PD eksikli¤i ve gut hastal›¤› olan 56 yafl›ndaki erkek hastaya ultrasonografi (US) eflli¤inde baflar›yla gerçeklefltirdi¤imiz lateral sagittal infraklaviküler blok (LS‹B) uygulamas›n› irdelemeyi amaçlad›k. Malign hipertermi ve akut hemolitik kriz geliflme riskini engellemek amac›yla genel anesteziden kaç›n›ld›. Premedikasyon midazolam ve fentanil ile sa¤land›. Methemoglobinemiye yol açabilmeleri nedeniyle prilokain ve lidokainden kaç›n›ld›. US eflli¤inde LS‹B bupivakain kullan›larak yap›ld›. Postoperatif analjezi parasetamol ile sa¤land›. Sonuç olarak, G6PD eksikli¤inde hemolitik krize yol açabilecek ilaçlardan kaç›n›larak ve güvenli oldu¤u bildirilmifl ilaçlar kullan›larak premedikasyon, anestezi ve postoperatif analjeziyi içeren güvenli bir anestezi yönetimi planlanmal›d›r. Uygun cerrahi prosedürler için US eflli¤inde LS‹B’in etkili ve güvenli bir yöntem olaca¤› kanaatindeyiz.

LATERAL SAGITTAL INFRACLAVICULAR BLOCK IN A PATIENT WITH GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency. Anesthesia plan should be done carefully in a patients with G6PD deficiency because surgical stress, many drugs and pain may lead to hemolytic crisis in the perioperative period. In this present, we aimed to investigate the application of Ultrasound (US)- guided lateral sagittal infraclavicular block (LSIB), which we successfully performed in a 56 year old male patient with G6PD deficiency and gout disease who was operated twice for three days due to ulna fracture. General anesthesia was avoided in order to prevent the risk of developing malignant hyperthermia and acute hemolytic crisis. Premedication was provided with midazolam and fentanyl. Prilocaine and lidocaine were avoided because they could lead to methemoglobinemia. US-guided LSIB was performed using bupivacaine. Postoperative analgesia was provided with paracetamol. As a result, safe anesthesia management including premedication, anesthesia, and postoperative analgesia, should be planned using drugs that are reported to be safe and avoided from drugs that may lead to haemolytic crisis in G6PD deficiency. For the appropriate surgical procedures, we believe that US-guided LSIB is an effective and safe method.

PDF

___

Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet 2008; 371: 64-74.
Klaastad Ø, Smith HJ, Smedby O, et al. A novel infraclavicular brachial plexus block: the lateral and sagittal technique, developed by magnetic resonance imaging studies. AnesthAnalg 2004; 98: 252-256.
Gurkan Y. How I do it: Infraclavicular Block. 11th Annual ASRA Pain Medicine Meeting and Workshops Florida, USA. 15-18 November 2012: p17-19.
Beutler E. Glucose-6-phosphate dehydrogenase deficiency: a historical perspective. Blood 2008; 11: 16-24.
Konak fi, Polat M. Glukoz 6 fosfat dehidrogenaz enzim eksikli¤i; tan› ve tedavi. MAKÜ Sag Bil Enst Derg 2015; 3: 77-83.
Sukumar S, Colah R, Mohanty D. G6PD gene mutations in India producing drug induced haemolyticanemia. Br J Haematol 2002; 116: 671-672.
Elyassi AR, Rowshan HH. Perioperative management of the glucose-6-phosphate dehydrogenase deficient patient: a review of literature. Anesth Prog 2009; 56: 86-91.
Altikat S, Ciftci M, Buyukokuroglu ME. Invitroeffects of some anesthetic drugs on enzymatic activity of human red blood cell glucose-6-phosphate dehydrogenase. Polish J Pharmacol 2002;m 54: 67-71.
Büyükokuro¤lu ME, Süleyman H. Glukoz 6-fosfat dehidrogenaz eksikli¤i. Türkiye Klinikleri J Med Sci 2001; 21: 415-419.
Erkal H, Gaygusuz EA, Özyurt Y, Temizel F. Glukoz-6-fosfat dehidrogenaz eksikli¤i: olgu sunumu. J Kartal TR 2010; 21: 33-36.
Kantekin ÇÜ, Tur S. Glukoz-6-fosfat dehidrogenaz enzim eksikli¤i olan iki çocuk hastada günübirlik anestezi deneyimimiz. Bozok T›p Derg 2016; 6: 65-67.
Gölbafl› ‹, Türkay C, fiahin N, et al. Glukoz 6-fosfat dehidrogenaz eksikli¤inde koroner ypass cerrahisi. J Turkish Thorac Cardiovasc Surg 2001; 9: 49-50.
Valiaveedan S, Mahajan C, Rath GP, Bindra A, Marda MK. Anaesthetic management in patients with glucose-6- phosphate dehydrogenase deficiency under going neurosurgical procedures. Indian J Anaesth 2011; 55: 68-70.
Younker D, DeVore M, Hartlage P. Malignant hyperthermia and glucose-6-phosphate dehydrogenase deficiency. Anesthesiology 1984; 60: 601-603.
Sriganesh K, Manikandan S. Anesthetic management of a child with severe dystonia and G6PD deficiency for deep brain stimulation. J Neurosurg 2015; 27: 271-272.