FİLİZ ÜZÜMCÜGİL, Aysun YILBAFİANKAY, MERAL KANBAK

KONJENİTAL KALP CERRAHİSİNDE PERİOPERATİF DÖNEMDE PULMONER HİPERTANSİYON GELİŞEN ÇOCUK YAŞ GRUBU HASTALARDA ANESTEZİ YAKLAŞIMI

Pulmoner hipertansiyon (PH), konjenital kalp hastalıklarının (KKH) sık görülen komplikasyonlarından biridir. Perioperatifdönemde gelişebilecek morbidite ve mortalite riskini belirgin şekilde arttırır. Ameliyata alınmadan önce PH varlığının gösterilmesive derecesinin değerlendirilmesi, perioperatif dönemde gelişebilecek komplikasyonların engellenmesi ve ameliyatın başarısıaçısından önem taşır. Mortalite ve morbiditeyi arttıran en önemli etken, bu hastalarda pulmoner hipertansif kriz gelişme riskininyüksek olmasıdır. Pulmoner hipertansif kriz, anestezi yönetimi ile ilişkili birçok faktör nedeniyle tetiklenebilir; ani pulmonervasküler direnç artışı ile ortaya çıkar; akut sağ ventrikül yetmezliğine ve ciddi doku hipoksisine neden olup, ölümle sonuçlanabilir.Pulmoner hipertansif kriz gelişiminin engellenmesi, ortaya çıktığında tanınabilmesi ve doğru şekilde tedavi edilebilmesi gerekir.Perioperatif dönemde, yeni ortaya çıkan ya da kötüleşen pulmoner hipertansiyonun tedavisinde özellikle selektif pulmonervazodilatörler üzerinde durulmaktadır. Bu ajanlardan etkinlikleri üzerinde en fazla çalışılan ve karşılaştırılan iki ajan, inhalenitrik oksit ve inhale iloprosttur. Bu derlemenin hazırlanmasındaki amaç, PH'u olup, KKH nedeniyle ameliyata alınan çocuk yaşgrubu hastalarda, perioperatif dönemde gelişebilecek pulmoner hipertansif kriz ve sebep olduğu akut sağ ventrikül yetmezliğininengellenmesi ve ortaya çıktığında ise etkin bir şekilde tedavi edilebilmesi için kullanılabilecek yaklaşımları belirlemek ve etkinliklerikonusunda bugüne kadar edinilmiş olan bilgileri biraraya getirmektir

THE ANESTHETIC MANAGEMENT DURING CONGENITAL CARDIAC SURGERY IN PEDIATRIC PATIENTS WHO DEVELOP PULMONARY HYPERTENSION

Pulmonary hypertension (PH) is one of the common complications of congenital heart diseases (CHD) and significantlyincreases morbidity and mortality during perioperative period. The diagnosis of PH and assessment of its severity in the preoperativeperiod is crucial to avoid complications during the perioperative period and to improve the success of the surgery. The mostimportant factor that increases the mortality and morbidity is the high risk of pulmonary hypertensive crisis in these patients.Pulmonary hypertensive crisis can be triggered by various factors related to anesthetic management; such as acute rise in pulmonaryvascular resistance leading to acute right ventricular failure and severe tissue hypoxia resulting in death. The avoidance ofpulmonary hypertensive crisis, and when it develops, the recognition and treatment are indispensible. During the perioperativeperiod, particularly selective pulmonary vasodilators have been highlighted for the treatment of newly developed or worseningpulmonary hypertension. Among those, the most commonly addressed and compared agents for their effectiveness are inhalednitrous oxide and inhaled ilioprost. Our aim is to define and summarize the currently available data pertaining to effectivemethods to avoid the development of pulmonary hypertension and treatment methods to treat effectively when it occurs in pediatricgroup patients undergoing surgery for congenital heart disease

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