Ahmet YILDIRIM, Yonca YANLI, Mehtap ÖZDEMİR, Nevin KURT ÇELEBİ, Zelin TOPAÇ, Nurten BAKAN

PNÖMONEKTOMİLİ HASTADA ROBOTİK PROSTATEKTOMİ ANESTEZİ DENEYİMİMİZ

Teknolojik gelişmeler sayesinde pek çok operasyon robotik olarak yapılabilmektedir. Robotik cerrahinin yaygınlaşması ileyandaş patolojisi olan hastaların da, cerrahi endikasyon konularak operasyonu söz konusu olmaktadır. Robotik cerrahi sırasındakullanılan derin trendelenburg (45°) pozisyonu ve pnömoperitonyum, sistemik değişikliklere neden olarak anestezi yönetiminiözellikli kılmaktadır. Literatürde robotik cerrahiyi de kapsayan laparoskopik cerrahiler ve akciğer patolojileri ile ilgili kısıtlı sayıdaolgu bulunmaktadır. Hastamız, akciğer kanseri nedeniyle 10 yıl önce sağ pnömonektomi, 4 yıl önce beyin metastazı nedeniylegama-knife cerrahisi uygulanan 65 yaşında erkek hasta idi. Preoperatif solunum fonksiyon testinde (SFT); zorlu vital kapasite(FVC):1,52 (% 39), birinci saniye zorlu ekspiratuvar volüm (FEV1):1,32 (% 43) olması dışında özellik yoktu. Anestezi indüksiyonundan sonra desfluran, remifentanil ve O2/Hava ile idamesine devam edildi. Ameliyat süresince end-tidal karbondioksit (EtCO)50 mmHg'nın üzerine çıktığında veya kan gazında karbondioksit parsiyel basıncı (PaCO2) yükseldiğinde solunum sayısı (SS)arttırıldı. Dikkatli bir takip ve monitorizasyon ile sorunsuz geçen (stabil hemodinamik ve solunumsal parametreler) perioperatifsürecin sonunda, hastamız 3. günde sorunsuz olarak taburcu edildi. Bu olgu sunumumuzda, robotik prostatektomi operasyonuyapılan sağ pnömonektomili hastamızdaki anestezi deneyimimizi paylaşmayı amaçladık

OUR ANESTHESIA EXPERIENCE OF A PATIENT WITH PNEUMONECTOMY UNDERGOING ROBOTIC PROSTATECTOMY SURGERY

Many operations can be done as robotics thanks to technological advances. With the widespread use of robotic surgery, patientswith comorbid pathology and surgical indication can be operated. Deep trendelenburg (45°) position and pneumoperitoneumused during robotic surgery causes systemic changes that makes anesthetic management spesific. In current literature there are afew cases related to laparoscopic surgery that includes robotic surgery with lung problems. Our patient, a 65-years-old male,pneumonectomized 10 years ago due to lung cancer and treated with gamma knife 4 years ago for brain metastasis. There was nosignificant value other than preoperative breathing test’s forced vital capaicty was FVC:1,52 (39%) first second expiratory voumewas FEV1:1,32 (43%). After anesthesia induction desflurane, remifantanyl and O2/Air was used. Breath rate was increased if endtidal CO2was above 50 mmHg or in blood gase PaCO2was elevated. With a careful follow up and monitorisation the procedurewas completed without any complication and the patient was discharged after 3 days. In this case report we aim to share ourexperience of anesthetic management for robotic prostatectomy on a patient who had performed right pneumonectomy

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1. Irvine M, Patil V. Anaesthesia for robot-assisted laparoscopic surgery. Continuing Education in Anaesthesia, Critical Care & Pain 2009; 9: 125-129.
2. Savarese D, Kupelian P, Klein E. Overview of treatment of early prostate cancer. 2005 www.uptodate.com
3. Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol 2014; 66: 3-11.
4. Hsu RL, Kaye AD, Urman RD. Anesthetic Challenges in Roboticassisted Urologic Surgery. Reviews in Urology 2013; 15: 178-184.
5. Ga›nsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy. Minerva Anestesiologica 2012; 78: 596-604.
6. Danic MJ, Chow M, Alexander G, Bhandari A, Menon M, Brown M. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robotic Surg 2007; 1: 119-123.
7. Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest 1993; 104: 1445-1451.
8. Licker M, Diaper J, Villiger Y, et al. Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery. Crit Care 2009; 13: R41.
9. Ried M, Steinberg HS, Zügel N, Forst H. Laparoscopic cholecystectomy in a patient with honeycomb lung. Anaesthesist 2001; 50: 162-166.
10. Petri R, Brizzolari M, Sorrentino M, Bassi F, Muzzi R, Zuccolo M. Minimally invasive esophagectomy in a previously pneumonectomized patient. J Laparoendosc Adv Surg Tech A 2012; 22: 695-700.
11. Malladi V, Palanivelu C, Kalpesh V, et al. Laparoscopic Cholecystectomy for Acute Calculous Cholelithiasis with previous Pneumonectomy-case report. 29 Dec 2010 http://www.priory.com/ anaes/chole.htm
12. Gainsburg DM, Wax D, Reich DL, Carlucci JR, Samadi DB. Intraoperative management of robotic-assisted versus open radical prostatectomy. JSLS 2010; 14: 1-5.
13. Kalmar AF, Foubert L, Hendrickx JF, et al. Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth 2010; 104: 433-439.
14. Phong SV, Koh LK. Anaesthesia for robotic-assisted radical prostatectomy: considerations for 205 laparoscopy in the Trendelenburg position. Anaesth Intensive Care 2007; 35: 281-285.
15. Benumof JL, Alfery DD. Anesthesia for thoracic surgery. In: Miller RD (ed). Anesthesia. 5th ed. Philadelphia: Churchill-Livingstone, 2000; 1665-1752.