Baş-Boyun Mukormikozisli Hastalarda Anestezi
Amaç: Mukormikozis özellikle immunsuprese veya diyabetik hastalarda görülen fırsatçı bir mantar enfeksiyonudur. Tedavisi antifungal tedavi ve cerrahi debridman olan bu mantar enfeksiyonunda, hastaların çoğunluğu hemodinamik olarak anstabildir ve çoklu organ yetmezliği bulunabilir. Bu derlemede mukormikozis tanılı cerrahi girişim planlanan hastalarda anestezi ile ilgili zorluklara dikkat çekmek istedik.Tartışma: Mukormikozisli hastalar komorbiditelerinin fazlalığına bağlı olarak %95’lere varan oranda mortaliteye sahiptirler. Sepsis, multi organ yetmezliği, kötü hematolojik profil (örn. pansitopeni) bu hastalarda sıklıkla eşlik etmektedir. Yine bu hastalarda anestezi uygulaması kadar preoperatif değerlendirme de önem kazanmaktadır. İntravenöz erişim ve hava yolu yönetiminde zorluklar yaşanabileceği gibi hastalar ciddi kan kan transfüzyonuna ve hemodinamik desteğe ihtiyaç duyabilir. Hastaların bir kısmında ise diyabetes mellitus ve hatta diyabetik ketoasidoz vardır. Bu nedenle, bu hastalarda kan şekerinin yakın takibi ve regülasyonu gerekir. Enfeksiyonlar, organ yetmezlikleri, kan transfüzyonları ve medikal antifungal tedavi nedeniyle bu hastalarda multidisipliner yaklaşım gereklidir. Cerrahinin yeri ve büyüklüğü de cerrahi öncesi hazırlık açısından göz önünde bulundurulmalıdır.Sonuç: Mukormikozisli hastalar, gerek immün suprese olmaları gerekse eşlik eden komorbiditeleri nedeniyle anestezi uzmanları için dikkat gerektiren hasta grubudur. Anahtar kelimeler: Anestezi, baş-boyun mukormikozisi, preoperatif değerlendirme.
Anahtar Kelimeler:
Anestezi, baş-boyun mukormikozisi, preoperatif değerlendirme
Emergent intubation induced iatrogenic tracheoesophageal fistula
We report a case of a rare complication of emergent entubation in a trauma patient; symptomatic tracheoesophageal fistula. A 53 years old, obese, female patient with a history of falling down from a hieght was evaluated at the emergency department. Patient was immidiately entubated in an outer medical center by her severely detoriorated neurological status. A cardiopulmonary resusitation was also reported to be successfully at the same center. In our clinic, cranial computerised tomography scans revaled deep inracranial hemorrhage and parenchymal edema of occipital lobe. We observed an excessive amount of liquid drainage from tracheal aspiration at the sixth day of treatment. This liquid aspiration material also warned us for a suspicion of gastric juice/gastric feeding ingredients. Thus, we performed an endoscopic examination of trachea to clearify a possible fistula existance. This evaluation proved a proximally located TEF which we belived to be creating a passage from gastric content to tracheal/pulmonary side. Thoracic surgery consultation resulted with a decision of conservative medical treatment because of her severe neurological status. After a tracheostomy cannula insertion, TEF complications reduced by a possible direct closure effect of a compression from the cannula. Patients neurological and clinical status healed gradually by a month of treatment. Patient was transferred to thoracic surgery department with her tracheostomy cannula by the end of this period for elective surgery. We believe that, especially for trauma patients, intubation difficulties and several attempts may always carry a risk of TEF creation. Clinical suspicion of TEF must be clearifed in every case by endoscopic direct evaluation or other appropriate radiological methods such as multislice CT and magnetic resonance imaging. Existance of TEF indicates early definitive surgical repair. Thus, a multidisciplinary approach with participations of thoracic surgery, pulmonology, radiology and gastroenterology is essential during intensive unit treatment.
Keywords:
difficult entubation,
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- Yayın Aralığı: Yılda 3 Sayı
- Başlangıç: 2018
- Yayıncı: Merthan Tunay
Sayıdaki Diğer Makaleler
Baş-Boyun Mukormikozisli Hastalarda Anestezi
Ebru BİRİCİK, Demet LAFLI TUNAY
Preoperatif değerlendirmede kılavuzların önerilerini uyguluyor muyuz?
Özge TURGAY YILDIRIM, Ayşegül TURGAY
Emergent intubation induced iatrogenic tracheoesophageal fistula
Süreyya TALAY, Emre Can MERMİ, Levent ENVER