KONJEN

Son yıllarda, neonatal dönemde düzeltici ya da palyatif cerrahi yapılan, konjenital kalp anomalili hastaların sayısı belirginolarak artmıştır. Büyüyen bu populasyon, ilerleyen yıllarda çocuk ve genç erişkinler olarak karşımıza çıkmaktadır. Konjenital kalphastalığı olan çocuklarda non-kardiyak cerrahi artmış morbidite ve mortalite riski ile ilişkilidir. Kalp hastalığının başlıca fizyolojiketkisinin ve kardiyak patolojinin ayrıntılı bir şekilde anlaşılması, uygun anestezik tekniğin seçimi için önemlidir. Bu nedenle, buhastalarda anestezik değerlendirme doğrudan hastanın mevcut hastalığına yönelik olmalıdır. Son yıllardaki çalışmalarda, konjenitalkalp hastalığı olan çocuk hastalarda sevofluran ve desfluran gibi yeni anestezik ajanların opioidler veya rejyonel bloklarla berabergüvenli kullanımı bildirilmiştir. Konjenital kalp hastalıklı çocuklarda, non-kardiyak cerrahi boyunca spinal anestezinin kullanımınaait yayınların sayısı da artmaktadır Dikkatli perioperatif değerlendirme, deneyimli anestezist, uygun anestezik ajan ve tekniğinkullanılması ve invaziv monitorizasyon, konjenital kalp hastalıklı çocuklarda güvenli ve etkili anestezik yaklaşımın önemli birparçasıdır. Bu derlemede, kardiyak cerrahi uygulanan konjenital kalp hastalığı olan hastaların değerlendirmeleri ve spinal anesteziyaklaşımı özetlenmektedir.

SPINAL ANESTHESIC APPROACH IN PEDIATRIC PATIENTS WITH CONGENITAL CARDIAC DISEASE FOR NON-CARDIAC SURGERY

In recent years, the number of patients with congenital cardiac anomalies who underwent corrective or palliative surgery inneonatal period has increased markedly. This growing population emerges as children and young adults in later years. Noncardiacsurgery in children with congenital heart disease (CHD) may be associated with increased risk of morbidity and mortality. Theprimary physiological effect of heart disease and detailed understanding of cardiac pathology is important for the choice ofsuitable anesthetic technique. Therefore, in these patients anesthetic assessment should be directed to the patient's current disease.In recent literature, the safe use of newer anesthetic agents, such as sevoflurane or desflurane in combination with opioids orregional blocks have been reported in pediatric patients with congenital cardiac disease. Nowadays the number of publicationsfor the use of spinal anesthesia during non-cardiac surgery has also been increasing in children with congenital cardiac pathologies.Careful peroperative assesment, experienced anesthesiologists, appropriate use of anesthetic agents and techniques, and the invasivemonitoring are important parts of safe and effective anesthetic management in children with congenital heart disease. In thisreview, specific considerations and spinal anesthetic approach of patients with congenital cardiac disease undergoing non-cardiacsurgery are summarized.

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