İlkay ERDOĞAN, Murat ÖZKAN, Pınar ZEYNELOĞLU, Aynur CAMKIRAN FIRAT

Karsinoid Kalp Hastalığı Nedeniyle Triküspid Kapak Replasmanı Yapılan 14 Yaşındaki Erkek Çocuğunda Başarılı Anestezi Yönetimi

Amaç: Bu olgu sunumunda karsinoid kalp tutulumu nedeniyle triküspid kapak replasmanı yapılan çocuk hastada kardiyopulmoner baypastan (KPB) ayrılma sırasında uygulanan strateji anlatılmaktadır. Olgu Sunumu: On dört yaşında olan hastamızın evre IV karaciğer metastazı olan nöroendokrin tümörü vardı. Hastaya premedikasyon amacıyla peroral verilen midazolam ve hidroksizinin yanına somatostatin analogu (Octreotid®) ve feniramin maleat ilave edildi. Octreotid® ve 5-hidroksitriptamin reseptör antagonisti aynı zamanda pompa rezervuarına da yapıldı ve ısınma döneminde doz yinelendi. Triküspid kapak yerine biyolojik kapak yerleştirildi ve pulmoner çıkıma krosanüler yama koyuldu. Postoperatif ilk gün 5 µkg-1 dk-1 dopamin infüzyonu devam etti. Cerrahi sonrası 20. saatte ekstübe edilen hasta, postoperatif 6. gün taburcu oldu. Tartışma: Bu olgunun premedikasyonuna ve pompa rezervuarına somatostatin analogu, feniramin maleat ve metilprednizolon ilave edilmesi ve histamin salımınına neden olabilecek atrakuryum, morfin ve meperidin gibi ajanlardan kaçınılması ile karsinoid kriz gelişmeden cerrahinin tamamlanması sağlanmıştır.

Successful Anesthetic Management of a 14 Year Old Boy Undergoing Tricuspid Valvular Surgery for Carcinoid Heart Disease

Objective: We present our strategy for successful management of pediatric patients with carcinoid heart disease when weaning from cardiopulmonary bypass (CPB) during tricuspid valvesurgery.Case Presentation: The patient was a 14-year-old boy who had been diagnosed with a grade IVneuroendocrine tumor. The patient was premedicated with oral midazolam, hydroxyzine, somatostatin analogue (Octreotide®), and pheniramine maleate. Octreotide® and serotonin 5-hydroxytryptamine receptor antagonist were also added during the rewarming period. Dopaminewas continued as an infusion (5 µg kg-1 min-1) for the first day. Bioprosthetic valve placement andtransannular right ventricular outflow tract patch augmentation were performed. He was extubated within 20 hours and discharged from the hospital at postoperative 6 day.Discussion: Thanks to the premedication of this case and the addition of somatostatin analogue,pheniramine maleate and methylprednisolone to the pump reservoir and avoiding agents such asatracurium, morphine and meperidine, which may cause histamine release, the surgery wasaccomplished have been accomplished without development of carcinoid crisis.

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