Leyla İYİLİKÇİ, Şule ÖZBİLGİN, Esma ADIYAMAN, Hazal KÜÇÜKALİ

PEDİYATRİK MANYETİK REZONANS GÖRÜNTÜLEME OLGULARINDA AMELİYATHANE DIŞI ANESTEZİ UYGULAMALARI: TEK MERKEZİN 1507 OLGU İLE 15 YILLIK DENEYİMİ

Amaç: Son yıllarda, pediyatrik olgularda Manyetik Rezonans Görüntüleme (MRG) yöntemi ile tanısal amaçlı yapılan çekimlerde sedasyon ve/veya genel anestezi ile olan uygulamalar artmıştır. Bu retrospektif çalışmada 2000-2014 yılları arasında pediyatrik olgularda MRG sırasında ortaya çıkan komplikasyon sıklığını ve ameliyathane dışı anestezi deneyimlerimizi sunmayı amaçladık. Yöntem: 2000-2014 yılları arasında, MRG sırasında anestezi verilen pediatrik olgular retrospektif olarak incelendi. Yapılan girişimler, yaş, ağırlık, uygulanan anestezi yöntemleri, komplikasyonlar kaydedildi. İşlem sırasında olguların hepsi, MRG uyumlu monitör ile (EKG,SpO2) izlendi. Tüm olgulara damar yolu açıldıktan sonra midazolam ile premedikasyon yapıldı. Oksijen 2-4 L dk-1 maske ile verildi. Sedasyon işleminde hipnotik ilaçlar midazolam, ketamin ve propofol tercih edildi. İşlem öncesinde endotrakeal entübe ve mekanik ventilatör desteğinde olan olgular ise, MRG uyumlu anestezi cihazı ile genel anestezi verildi. İşlem sonrası tüm olgular yaklaşık 1 saat izlendikten sonra, Aldrete skoru > 9 olunca taburcu edildiler. Bulgular: 1507 pediyatrik olgunun verileri analiz edildi. Bu seride komplikasyon olarak, 1 olguda kardiyak arrest, 2 olguda allerjik reaksiyon, 16 olguda desatürasyon, 8 olguda kusma oldu. Kardiyak arrest olan olguda nörolojik sekel meydana geldi. Sonuç: Pediyatrik MRG sırasında anestezi uygulamalarında, olguların tanılarının genelde bilinmemesi, kardiyak patolojiler, Down Sendromu, serebral palsi, mental retardasyon vb. gibi yandaş hastalıklar, ortama ait özellikler, hava yolunun idamesinin güçlüğü, olgunun dış ortamdan izlenmesi, seçilen ilaçlar, kontrasta bağlı allerjik reaksiyonlar nedeniyle bu işlemler sırasında uygun monitörizasyon ve ilaç kullanımı, deneyimli anestezi ekibi önem arz etmektedir.

ANAESTHESIA OUTSIDE THE OPERATING ROOM FOR PEDIATRIC MAGNETIC RESONANCE IMAGING CASES: 15 YEARS EXPERIENCE WITH 1507 CASES AT A SINGLE CENTER

Objective: In recent years the administration of sedation and/or general anesthesia for pediatric cases undergoing diagnostic magnetic resonance imaging (MRI) methods has increased. This study presents the complications and our anesthesia experience outside the operating room for pediatric cases undergoing MRI from 2000 to 2014. Method: From 2000 to 2014, pediatric cases administered anesthesia during MRI were retrospectively investigated. The intervention, age, weight, applied anesthesia methods and complications were recorded. During the procedure all cases had MRI-appropriate monitoring (ECG, SpO2) applied. All cases had premedication with midazolam after a vein was entered. Oxygen of 2-4 L min-1 was administered through a mask. For sedation procedures hypnotic medications of midazolam, ketamine and propofol were chosen. Before the procedure for cases with endotracheal intubation and mechanical ventilator support, general anesthesia was administered with an MRI-appropriate anesthetic device. After the procedure cases were observed for nearly 1 hour before being discharged with Aldrete score > 9. Results: Data from 1507 pediatric cases were analyzed. In this series in terms of complications 1 case had cardiac arrest, 2 cases had allergic reactions, 16 cases had desaturation, and 8 cases had vomiting. In the cardiac arrest case neurologic sequelae occurred. Conclusion: Anesthesia management for pediatric MRI requires appropriate monitoring and medication use due to lack of knowledge of diagnosis of cases, accompanying diseases like cardiac pathologies, Down Syndrome, cerebral palsy and mental retardation, properties of the environment, difŞculty of airway maintenance, observing the case from an external location, and allergic reactions to chosen medications and contrast material; an experienced anesthesia team is of great importance.

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