Elif A. AKPEK, Sevim BALTALI, Aslı DÖNMEZ, Şükrü MERCAN

Pediyatrik kalp cerrahisinde kaudal blok uygulaması ile erken ekstübasyon

Amaç: Hastanemizde pediyatrik kalp cerrahisinde erken ekstübasyon planlanan hastalarda, uygulamaya yeni başladığımız kaudal bloğun etkisini incelemek ve bu uygulamayı önceki standart anestezi yöntemimiz ile karşılaştırmaktır. Yöntem: Hastane Etik Kurulu onayı alındıktan sonra 6 ay- 12 yaş arası, erken ekstübasyon için uygun hastalar çalışmaya alındı. Kontrol grubu olarak yaş ve kardiyak patoloji bakımından benzer olan, ama standart anestezi protokolü uygulanan hastalar retrospektif olarak dosya kayıtlarından incelendi. Tüm hastalarda sevofluran veya intravenöz midazolam ile birlikte kontrol grubunda fentanil (10-20 fig kg'1) indüksiyonunu takiben izofluran vefentanil infüzyonu (10-20 fig kg'sf') ile idame; kaudal grubunda isefentanil (3-5 fig kg'1) indüksiyonunu takiben izofluran ve remifentanil infüzyonu (0.2-0.4 fig kg'dak'1) ile idame sağlandı. Invaziv monitorizasyonun sağlanmasından sonra %0.25 bupivakain ve 50 fig kg'1 morfin toplam volüm 1 mL kg'1 olacak şekilde serum fizyolojik ile tamamlanarak kaudal blok uygulandı. Bulgular: Kaudal blok uygulanan grupta tüm hastalar ameliyathane odasında, kontrol grubunda ise yoğun bakımda ekstübe edildi. Ekstübasyon sonrası alınan ilk arteriyel kan gazında kaudal grubunda pH daha düşük, pCO2 ise daha yüksek bulundu. Yoğun bakımda ilk 24 saatlik toplam fentanil ve midazolam ihtiyacı kaudal grubunda daha azdı. Sonuç: Bulgularımız pediyatrik kalp cerrahisinde kaudal blok uygulaması ile erken ekstübasyon sağlanmasının güvenli ve konforlu bir yöntem olduğunu göstermektedir.

Anahtar Kelimeler:

Anestezi, kaudal, Geriyedönük çalışma, Kalp damar cerrahi işlemleri

Use of caudal block for early extubation in pediatric cardiac anesthesia

Objective: To assess the use of caudal block for early extubation in patients undergoing pediatric cardiac surgery and to compare this new method with the previous standard anesthetic protocol of the department. Method: Following Institutional Ethics Committee approval, children aged between 6 months and 12 years, who had undergone pediatric cardiac surgery and had been extubated in the operating room were included in this retrospective study. Children in the same age group with cardiac pathology but who were extubated later in the ICU acted as control. For induction of anesthesia, all patients recieved sevoflurane or IV midazolam along with IV fentanil (10-20 fig kg1) induction in the control group or fentanil (3-5 fig kg') plus caudal block in the caudal group. Maintenance was provided with isofluranel O2I air along with IVfentanil (10-20 fig kg1 h'1) and remifentanil (0.2-0.4 fig kg'1 min'1) infusions respectively. The caudal block was performed using 1 mL kg1 of 0.25% bupivacaine and 50 fig kg1 of morphine sulphate. Results: All children in the caudal group were extubated in the operating room and those in the control group were extubated in the ICU. The first arterial blood gas analysis after extubation revealed lower pH and higher pCO2 in the caudal group. Total fentanil and midazolam requirements in the first 24 hours post-surgery were lower in the caudal group. Conclusion: The findings of this study demonstrate that the use of caudal block for early extubation in patients undergoing pediatric cardiac surgery provides a safe and comfortable method of anesthetic management.

Keywords:

Anesthesia, Caudal, Retrospective Studies, Cardiovascular Surgical Procedures,

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