Hatice YAĞMURDUR, Bülent BALTACI, Ferda YAMAN, Ceren AKDEMİR, Hülya BAŞAR

Yaşamı tehdit eden akut intraoperatif atelektazi (olgu sunumu)

Bu olgu sunumuyla, genel anestezi indüksiyonunu takiben yaşamı tehdit eden akut intraoperatif atelektazi gelişen olgunun sunulması amaçlandı. 43 yaşında erkek hasta L2 vertebrasında kırık nedeniyle genel anestezi altında operasyona alındı. Anamnezinde sigara kullanımı, balgam şikayeti ve ağrıya bağlı olarak yetersiz mobilizasyon öyküsü mevcuttu. Anestezi indüksiyonundan 15-20 dakika sonra ventilasyon zorluğu, hava yolu basıncında artma ve periferik oksijen satürasy onunda ani düşme olması üzerine çekilen akciğer grafisinde sol akciğerin tama yakın atelektatik olduğu görüldü. İntratrakeal lavajda koyu kıvamlı sekresyon gelmesi üzerine sekresyonlar azalana kadar bronşiyal lavaja devam edildi. Atelektatik akciğerin açılması amacıyla yapılan iyileştirme manevrasıyla birlikte PEEP uygulandı ve 5 cmH2O'dan başlayarak kademeli olarak 15 cmH2O'ya çıkıldı. Ardından PEEP tekrar kademeli bir şekilde 5 cmH2O'ya azaltıldığında hastanın periferik oksijen satürasyonunun yükseldiği görüldü. Tekrarlanan akciğer grafisinde sol akciğerdeki atelektazinin belirgin olarak azaldığı saptandı. Kan gaz analizinde de arter iy el oksijenizasyonun iyi olduğu göster Hince hasta ekstübe edilerek yoğun bakıma alındı.

Anahtar Kelimeler:

Erişkin, Pulmoner atelektazi, Bronkoalveolar lavaj, Erkek, İntraoperatif dönem, Pozitif-basınçlı solunum

Acute life threatening intraoperative atelectasis (case report)

We aim to report the case of a patient with acute life threatening intraoperative atelectasis after the induction of general anesthesia. A 43-year-old man was presented for operation under general anesthesia due to L2 burst fracture. The patient's history indicated habitual smoking, copious sputum and inadequate mobilization due to pain. Ventilation difficulty, increased peak airway pressure and a sudden decrease in peripheral oxygen saturation were noticed 15-20 min after induction of anesthesia. The chest roentgenogram taken showed almost complete left lung atelectasis. We observed thick mucosal secretions during intratracheal lavage, so we continued to bronchial lavage until the secretions were reduced. In order to reexpand all previously collapsed lung tissue, recruitment manoeuvre was applied combined with PEEP increased in steps of 5 cmH2O up to a maximum of 15 cmH2O. After PEEP was decreased twice to obtain PEEP 5 cmH2O, it was observed that the patient's peripheral oxygen saturation was increased. A repeat chest roentgenogram showed significantly reduced atelectasis in the left lung. After it was seen in blood gas analysis that arterial oxygenation had improved, the patient was extubated and transferred to the intensive care unit.

Keywords:

Adult, Pulmonary Atelectasis, Bronchoalveolar Lavage, Male, Intraoperative Period, Positive-Pressure Respiration,

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