Endovasküler aort tamirinde anestezi yaklaşımları: tek merkez deneyimi

Amaç: Endovasküler aort tamiri son yıllarda birçok avantajı nedeniyle açık cerrahiye alternatif olmuştur. Anestezi seçimi anestezistin tercihine bağlı olarak genel, lokal ya da sedasyon şeklinde olabilir. Bu çalışmada endovasküler aort tamiri uygulamalarındaki anestezi deneyimlerimizin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2015 ile Aralık 2016 yılları arasında, aort anevrizması ve/veya diseksiyonu tanısıyla endovasküler girişim yapılan 35 olgu retrospektif olarak değerlendirildi. Olguların demografik verileri, eşlik eden hastalıkları, hastanede ve yoğun bakımda kalış süreleri, mortalite ve morbidite oranları incelendi.Bulgular: Olguların yaş ortalaması 65.51 (39-82), kadın erkek oranı 2/33 idi. Olguların hepsinin sigara içicisi olduğu ve %82.9’unda kliniğe eşlik eden en az bir ek hastalığının olduğu gözlendi. Anestezi seçiminde lokal anestezi ve sedasyon kombinasyonunun genel anestezi uygulamasına göre daha fazla tercih edilmiş olduğu görüldü. Yoğun bakımda kalma süresi ortalama 2 gün, hastanede kalma süresi ise ortalama 5 gün idi. Girişim sonrası 4 olguda akut böbrek yetmezliği geliştiği, iki olguda prognozun mortal seyrettiği, diğer iki olgunun şifa ile taburcu olduğu gözlendi. Sıvı rejimi uygulamasında kristaloidlere ek olarak iki olguda kolloid, altı olguda eritrosit süspansiyonu kullanıldığı, hiçbir olguda taze donmuş plazma kullanılmadığı gözlendi. Mortalite oranı %5.7 idi ve mortalite gelişen iki olguda da genel anestezi eşliğinde Tip 3 diseksiyon tamiri yapıldığı gözlendi.Sonuç: Anjio laboratuvarlarında endovasküler aort tamiri girişimleri için sedasyon eşliğinde lokal anestezi uygulamaları, genel anestezi uygulamaları kadar güvenli ve konforlu bir çalışma ortamı sağlamaktadır.

Anahtar Kelimeler:

endovasküler aort tamiri, anestezi

Anesthesia approaches in endovascular aortic repair: single center experience

Purpose: In recent years, endovascular aortic repair has been an alternative to open surgery due to its many advantages. The choice of anesthesia may be general, local or sedation depending on the preference of the anesthetist. In this study, we aimed to evaluate our anesthesia experience in endovascular aortic repair applications.Materials and Methods: Thirty-eight patients underwent endovascular surgery for aortic aneurysm and/or dissection repair between January 2015 and December 2016 were evaluated retrospectively. Demographic data, concominant diseases, length of stay hospital and intensive care unit, mortality and morbidity rates were examined.Results: The mean age of the patients was 65.51 (39-82) and female/male ratio was 2/33. All of the patients were smokers and 82.9% of them had at least one additional disease. Local anesthesia and sedation combination was more preferred than general anesthesia. The mean length of stay hospital and intensive care were 2 and 5 days. After the prosedure, acute renal failure developed in 4 cases and two of them died but the other two patients were discharged. In addition to crystalloid, colloid was used in two cases, erythrocyte suspension was used in six cases, and fresh frozen plasma was not used in any case. The mortality rate was found at 5.7%, Type 3 dissection repair with general anesthesia was performed in two patients with mortality. Conclusion: Local anesthesia and sedation combination provides a comfortable and safe working environment as well as general anesthesia for endovascular aortic repair in angio laboratories.

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