LARENJEKTOMİ VE BOYUN DİSEKSİYONU OPERASYONLARINDA ANESTEZİ YÖNETİMİ: RETROSPEKTİF ANALİZ
Amaç: Larenjektomi ve boyun diseksiyonu cerrahi uygulaman›n yan› s›ra anestezi yönetimi aç›s›ndan da özellikli ameliyatlar aras›ndad›r. Bu retrospektif çal›flmada Kulak Burun Bo¤az Klini¤i taraf›ndan larenjektomi ve/veya boyun diseksiyonu operasyonu uygulanan hastalar›n perioperatif anestezi yönetiminin de¤erlendirilmesi ve elde edilen verilerin tart›fl›lmas› amaçlanm›flt›r. Yöntem: Hastanemizde 2014-2017 y›llar› aras›nda larenjektomi ve/veya boyun diseksiyonu operasyonu geçiren toplam 44 hasta retrospektif olarak de¤erlendirilmifltir. Bulgular: Hastalar›n 2’sinin tüm kay›tlar› elde edilemedi¤inden çal›flma 42 hasta ile tamamlanm›flt›r. Hastalar›n 40’› erkek (%9.2), 2’si kad›n idi. 31 hastada (%73.8) total larenjektomi+boyun diseksiyonu, 11 hastada (%26.2) total larenjektomi+total tiroidektomi+ boyun diseksiyonu operasyonu uyguland›¤› kaydedilmifltir. Operasyon s›ras›ndaki ortalama kan kayb› 239±156 ml olarak belirlendi. Hastalar›n 35’inde (%83.3) operasyon s›ras›nda hiç kan ve kan ürünleri transfüzyonu yap›lmad›. Eritrosit süspansiyonu uygulamas› 4 hastada 1’er ünite, 3 hastada 2’fler ünite fleklinde oldu¤u kay›tlardan elde edilmifltir. Operasyon s›ras›nda gözlenen ve tedavi gerektiren en s›k komplikasyon %23.8 (10 hasta) ile derin hipotansiyondu. Hipotansiyon tedavisinde efedrin ve adrenalin uyguland›¤› kaydedildi. Üç hastada tedavi gerektiren derin bradikardi geliflti¤i ve tedavide intravenöz atropin uyguland›¤› kaydedildi. Postoperatif dönemde 12 hastada hipokalsemi geliflmifltir. Sonuç: Larenjektomi ve boyun diseksiyonu operasyonlar› gerek cerrahi gerek anestezi yönetimi aç›s›ndan özellikli ameliyatlar olup peroperatif ve/veya postoperatif olas› komplikasyonlar için yak›n takip gerektirmektedir.
ANESTHETIC MANAGEMENT OF LARYNGECTOMY AND NECK DISSECTION SURGERY: RETROSPECTIVE ANALYSIS
Objective: Laryngectomy and neck dissection are among the special operations in terms of anesthesia management as well as surgical application. In this retrospective study, it was aimed to evaluate the perioperative anesthesia management of the patients who underwent laryngectomy and/or neck dissection operation by the otolaryngology department and discuss. Method: A total of 44 patients between 2014 and 2017 were retrospectively evaluated. Results: The study was completed with 42 patients as all records of 2 could’nt obtained. Forty patients were male and 2 were female. Total laryngectomy+neck dissection was performed in 31 patients(73.8%), total laryngectomy+total thyroidectomy+neck dissection operation was performed in 11 patients (26.2%). Mean blood loss was 239±156 ml. No blood and blood products were transfused for 35 patients (83.3%). Four patients had 1 unit and 3 patients had 2 erythrocyte suspension units. The most common complication observed during the operation was deep hypotension with 23.8% (10 patients). Ephedrine and adrenaline were applied in the treatment of hypotension. Three patients required deep bradycardia for treatment and atropine was administered. Hypocalcemia developed in 12 patients, postoperatively. Conclusion: Laryngectomy and neck dissection operations are special operations in terms of surgery and anesthesia management and require close follow-up for possible peroperative and/or postoperative complications.
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