Murat Türkeün ILGINEL, Yasemin GÜNEŞ, Derviş Mansuri YILMAZ, DEMET LAFLI TUNAY, Feride KARACAER, EBRU BİRİCİK

VAGAL SİNİR STİMÜLASYONUNDA ANESTEZİK YAKLAŞIM: RETROSPEKTİF VAKA SERİSİ ÇALIŞMASI

Amaç: Vagal sinir stimülasyonu medikal tedaviye dirençli epilepsi hastalarında alternatif bir tedavi yöntemidir. Bu retrospektifolgu serisinde, vagal sinir stimülatörü (VNS) takılan epilepsi olgularında, anestezik yaklaşımımız ve olası komplikasyonlarincelenmiştir.Yöntem: Bu çalışmada Ocak2015 ile Aralık 2016 tarihleri arasında VNS takılan 10 hastanın sonuçları incelenmiştir. Olgular19-35 yaş aralığında ASA I-II grubu erişkin hastalardı. İntraoperatif aritmi veya asistoli ile postoperatif aspirasyon, hipoksi,vokal kord paralizisi gibi olası komplikasyonlar kaydedildi.Bulgular: Yalnızca bir olguda cerrahi stimülasyonun kesilmesi ile düzelen intraoperatif bradikardi gözlendi; diğer olgulardabradikardi veya asistoli ile karşılaşılmadı. Üç aylık takipler sonunda nöbet frekansında %30-75'lik bir azalma bulundu. PostoperatifHorner sendromu, peritrakeal hematom, vokal kord paralizisi, aspirasyon hiçbir olguda gözlenmezken iki olguda erken postoperatifdönemde farinkste ağrı saptandı.Sonuç:VNS'nin yerleştirilmesi genel anestezi ve endotrakeal entübasyon gerektirir. Vagal sinirin internal karotid artere vejuguler vene yakınlığı nedeniyle büyük çaplı IV kateter güvenlidir. VNS yerleştirilmesi sırasında çeşitli aritmiler, bradiaritmiler veasistoli görülebileceğinden yakın hemodinamik monitorizasyon ve takip gereklidir

ANESTHETIC APPROACH OF VAGAL NERVE STIMULATION: RETROSPECTIVE CASE SERIES STUDY

Objective: Vagal nerve stimulation is an alternative treatment method for epileptic patients who are resistant to medical treatment.In this retrospective case series, we investigated our anesthetic approach and possible complications in patients implanted vagalnerve stimulator (VNS).Method: In this study, the results of 10 patients, who were implanted VNS between January 2015 and December 2016, wereexamined. Cases were ASA I-II adult patients between 19-35 years of age. Intraoperative arrhythmia or asystole and possiblepostoperative complications such as aspiration, hypoxia, vocal cord paralysis were noted.Results: Intraoperative bradycardia improved by interruption of surgical stimulation was observed only in one patient, nobradycardia or asystole was observed in others. At the end of 3 months follow-up a 30-75% reduction in seizure frequency wasidentified. Postoperative Horner syndrome, peritracheal hematoma, vocal cord paralysis, aspiration were not observed, but in twocases pharynx pain was detected in early postoperative period.Conclusion: Implantation of VNS requires general anesthesia and endotracheal intubation. Large diameter iv catheter is safebecause of the proximity of vagal nerve to internal carotid artery and jugular vein. Close hemodynamic monitoring and follow-upis essential because of possibility of arrhythmia, bradyarrhythmia, and asystole during VNS placement

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