Onur ÖZLÜ, Serkan ŞİMŞEK, Güllen ÜTEBEY, Mustafa AKSOY, Çetin AKYOL, Murad BAVBEK

Kraniovertebral bölge ameliyatlarında fiberoptik bronkoskop ile endotrakael entübasyon: Retrospektif inceleme

Kraniovertebral bölge (KVB) patolojisi bulunan hastalarda; beyin sapı, üst omurilik, spinal sinirler veya vasküler yapıların etkilenmesi klinik bulguları belirler. Bu hastalarda, anestezi uygulamaları amacı ile endotrakeal entübasyon sırasında, vertebra hareketlerinin engellenmesi nörolojik hasarın artmasını önler. Haziran 2006-Eylül 2009 tarihleri arasında, konjenital anomali, dejenerasyon veya travmaya bağlı KVB instabilizasyonu nedeni ile elektif posterior stabilizasyon ve kemik füzyon ameliyatları geçiren hastalarda anestezi uygulamalarımız retrospektif olarak değerlendirilmiştir. Yaşları 6,0 ile 76,0 yıl arasında değişen toplam 30 hastaya topikal faringeçl anestezi ve nazal dekonjesyon sağlandıktan sonra; 0,5 mg kg'1 iv propofol titrasyonu ile sedasyon beraberinde, fiberoptik bronkoskop ile endotrakeal entübasyon gerçekleştirilmiştir. Hastaların 19'unda oral, 11'inde nazal endotrakeal entübasyon uygulanmış, operasyon sırasında kas gevşemesi 27 hastada nondep olar izan, 3 hastada depolarizan ajanlar ile sağlanmıştır. Anestezi idamesi; 22 hastada sevofluran, 6 hastada izofluran, 2 hastada desfluran ile gerçekleştirilmiştir. Tip II odontoid kırığı 14, Tip III odontoid kırık 3, dejeneratif-konjenital anomaliye bağlı Cl-2 dislokasyon 8, C2-4 kırıklı çıkık 5 hastada belirlenmiş bütün operasyonlar pron pozisyonda gerçekleştirilmiştir. Ortalama 164,40±33,59 dakika süren anestezi sonrası bütün hastalar ameliyathanede sorunsuz ekstübe edilerek cerrahi yoğun bakım ünitesine nakilleri sağlanmıştır. KVB instabilizasyonu için elektif posterior stabilizasyon ve kemik füzyon ameliyatları gerçekleştirilen hastalarda; sedasyon altında FOB ile endotrakeal entübasyon ve inhalasyon anestezisi uygulaması, güvenli anestezi ve derlenme dönemleri sağlamıştır.

Fiberoptic endotracheal intubation for the craniovertebral junction operations: A retrospective surveillance

In craniovertical junction (CVJ) pathologies, the injuries of brainstem, spinal nerves and vasculary structures are the reasons of neurologic symptomes. Further neurologic injury is prevented by immobilization during endotracheal intubation. Between fully 2006 and September 2009, 30 patients undergoing elective posterior stabilization and bone fusion surgeries due to congenital abnormality, degeneration or trauma were evaluated retrospectively with respect to endotracheal intubation and anesthetic techniques. After pharyngeal analgesia, nasal decongestion and sedation with 0.5 mg kg'1 iv propofol titration, 19 oral and 11 nasal intubations were performed using fiberoptic broncoscope (FOB) on the patients who were aged between 6.0 and 76.0 years. Depolarizing and nondepolarizing drugs were used for 3 and 27 patients respectively. Anesthesia was maintained with sevoflurane (for 22 patients), isoflurane (for 6 patients) and desflurane (for 2 'patients). Mean duration of anesthesia was 164.4±33.5 min. Posterior instrumentation was performed because of odontoid fracture type II in 14, type III in 3 patient, degenerative or congenital CI -2 dislocation in 8, C2-4 fracture and dislocation in 5 patients. At the end of the anesthesia, all patients were extubated and transported to the neurosurgery intensive care unit. Safe endotracheal intubation, anesthesia and recovery periods were obtained with endotracheal intubation using FOB and inhalational anesthesia for posterior stabilization operations because of CVJ instabilization.

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