Uyanık Kraniyotomide Anestezi Yaklaşımı: Olgu Sunumu

Uyanık kraniyotomi tekniği ilk olarak epilepsinin cerrahi tedavisinde kullanılmış ve daha sonra kritik beyin bölgelerine yakın, supratentoriyal tümörlerin cerrahi tedavisinde veya arteriyovenöz malformasyon gibi lezyonların tedavisinde kullanılmıştır. Bu cerrahi yaklaşım; motor, somatosensör ve dil alanları gibi beynin önemli alanlarını korurken, lezyon rezeksiyonunu maksimum düzeyde gerçekleştirmeyi amaçlar. Bu cerrahi teknik sırasında, hastanın cerrahiye aktif katılımı, kortikal haritalamayı kolaylaştırmak için gereklidir. Bu tip bir prosedürde, anestezistin amacı, operasyonu güvenli ve etkili kılmak; ayrıca hastanın psikofiziksel rahatsızlığını azaltmaktır. Literatürde uyanık kraniyotomi için pek çok anestezi protokolü tanımlanmakla birlikte, en iyi anestezi tekniğine dair ortak bir fikir birliğine henüz ulaşılamamıştır. Biz de bu yazıda; frontal bölgede Broka alanına yakın tümörü olan bir hastadaki anestezik yaklaşımımızı sunmayı amaçladık.

Anahtar Kelimeler:

Uyanık kraniyotomi, deksmedetomidin, skalp bloğu

Effect of Intrathecal Injection Speed on Post-Dural Puncture Headache in Parturients Undergoing Cesarean Section: A Prospective, Randomized Study

Aim: In this study, it was aimed to evaluate the effect of intrathecal injection rate on post- dural puncture headache (PDPH) in cesarean patients.Material and Methods: 140 patients between 18-45 years of age who were scheduled for caesarean section with spinal anesthesia were randomly divided into two groups. From the L4-L5 level in the sitting position, 10 mg hyperbaric 0.5% bupivacaine with a 25 G Quincke spinal needle, median inlet; Intrathecal injection was performed as quickly as possible in the patients in Group I and administered to patients in Group II by intrathecal injection in 40 seconds. Hemodynamic data, ephedrine use and frequency of nausea and vomiting were recorded intraoperatively. 7 days after the procedure, the patients were called by phone and questioned for PDPH. The ICHD-III criteria were used to question the PDPH.Results: There was no significant difference in the incidence of postdural headache (Group I: 29.0% and Group II: 31.4%) and severity (p> 0.05). There was no significant difference between the groups when haemodynamic data, ephedrine usage, nausea and vomiting frequency were compared (p> 0.05). Conclusion: In the cases of cesarean section with spinal anesthesia, hyperbaric bupivacaine is given to the intrathecal area at different rates; We conclude that PDPH frequency and severity do not affect haemodynamic parameters, ephedrine requirement and frequency of nausea and vomiting.

Keywords:

Spinal anesthesia, post-dural puncture headache, cesarean section,

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