Kardiyopulmoner baypasta anestezinin rolü nedir? Anestezi yöntemi nasıl olmalıdır?

Kardiyopulmoner baypas (KPB), kendinden önceki ve sonraki dönemlere göre daha sakin bir dönem olmasına rağmen kardiyak anestezistin devamlı varlığı ile kolaylaşabilecek durumları da içerir. Volatil anestezik ajanlarla iskemik ön koşulama yaparak miyokardı iskemiye hazır ve dayanıklı hale getirmek son yıllarda, gelecek vaat eden bir tedavi yaklaşımıdır. Kardiyak anestezisi farmakolojik ön koşullamayı tüm operasyon boyunca yaparak miyokardial nekrozu azaltarak postoperatif performansı da artırabilir. Dengeli anestezi çok rahatsız edici bir deneyim olan intraopeartif farkında olma deneyimini de engelleyebilir. Makro ve mikro emboli riskini en aza indirecek ısı ve asit-baz yönetimi ile serebral perfüzyon sağlamak son yıllarda kabul gören bir stratejidir. Rutin ve acil durumların en mükemmel yönetimi anestezist- perfüzyonist ve cerrahın iyi iletişimi ile sağlanır.

Anahtar Kelimeler:

Toraks cerrahisi, Kalp cerrahi işlemleri, Farkında olma, Anestezi, İntraoperatif uyanıklık, İskemi ön hazırlığı, miyokardiyal

What is the role of anesthetist during cardiopulmary bypass? How should be the anesthetic management?

Although cardiopulmonary bypass (CPB) typically constitutes a less busy time for anesthesiologists than the periods before and after it, many routine tasks are greatly facilitated by the presence of the cardiac anesthesiologist constant presence. Preconditioning by volatile anesthetics is a promising therapeutic strategy to render myocardial tissue resistant to preoperative ischemia. Cardiac anesthesiologist can provide a pharmacological preconditioning all through the operation so as to reduce myocardial necrosis and improve the cardiac performance in postoperative period. Anesthetic management with balanced anesthesia can also inhibit possibility of awareness under general anesthesia which can be a very distressing experience. Current strategies should include optimizing cerebral perfusion and minimizing macroembolic and microembolic damage by acid-base balance and temperature management. Best management of the routine and emergency situations involves dialogue among the anesthesiologist, perfusionist and surgeon.

Keywords:

Thoracic Surgery, Cardiac Surgical Procedures, Awareness, Anesthesia, Intraoperative Awareness, Ischemic Preconditioning, Myocardial,

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