Ayşe MIZRAK, Rauf GÜL, Senem KORUK, Levent ŞAHİN, Ferdi DOĞANAY, İbrahim ERKUTLU, MEHMET ALPTEKİN

Kraniotomi sonrası vokal kord paralizisi

59 yaşında, 88 kg ağırlığında ASA III sınıfında olan hastaya, sağ serebellopontin köşe tümörü nedeniyle kraniotomi planlandı. Preoperatif değerlendirmede hasta 13 yıldır hipertansiyon ve 5 yıldır diyabet hastası olup AC E (Angiotensin Converting Enzyme) inhibitörü ve oral antidiabetik kullanıyordu. Preoperatif değerlendirmede kan şekeri 186 mg dL', kan basıncı (KB) 180/115 mmHg idi. İndüksiyon intravenöz (i.v.) tiopental (5 mg kg'1) kullanılarak yapıldı. Anestezi idamesinde izofluran kullanıldı. Ventilasyon maske ile yapıldı ve hasta entübe edildi. Hastanın başı çivili başlıkla tespit edildi. Hastaya remifentanil (0.11 pıg kg'1 saat-1) infüzyonu ve gliserol trinitrat (0.11 jug kg' saat') infüzyonu yapıldı. Kan basıncı ve nabız normal sınırlarda seyretti. Operasyon 7 saat 30 dk sürdü. Herhangi bir hemodinamik ve solunumsal komplikasyon ile karşılaşılmadı. Operasyondan kısa bir süre sonra hastada ses kısıklığı, ses boğukluğu ve solunum sıkıntısı gelişti. Hastada vokal kord paralizisi (VKP) olduğu belirlendi. Acilen entübasyon yapılan hasta 24 saat sonra ekstübe edildi. Solunum sıkıntısı nedeniyle trakeostomi açılan hastanın trakeostomisi 7 gün sonra kapatıldı ve hasta 10 gün sonra taburcu edildi ve 3 ay sonra ses tonu düzeldi.

Vocal cord paralysis after craniotomy

59 years old, 88 kg weight patient with ASA grade III, was planned craniotomy because of right corner serebellopontin tumor. Preoperative evaluation of patient, had hypertension for 13 years and diabetes for 5 years and were using ACE inhibitors and oral antidiabetic. Preoperative evaluation of blood sugar was 186 mg dL', blood pressure (BP) 180/115 mmHg, respectively. Anesthesia induction was performed using thiopental intravenously (i.v.) (5 mg kg'). Isoflurane was used for the maintenance of anesthesia. After the mask ventilation the patient was intubated. The patient's head fixed with pin holder. Remifentanil (O.T1 mg kg1 h1) infusion and gliserol trinitrat (O.T1 mg kg'' la1) infusion were administered. Blood pressure and pulse were within normal limits. Operation lasted for 7 hours 30 min. Any hemodynamic and respiratory complications were not observed. Immediately after surgery hoarseness and respiratory distress developed. Vocal cord paralysis (VCP) was determined. Urgent tracheostomy was performed and 7 days later the patient's tracheostomy closure performed. Patient was discharged after 10 days and 3 months after the voice tone has improved.

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