Posterior fossa cerrahisinde anestezi yönetimi

Amaç: Posterior fossa cerrahisinde anestezi yönetimi, anatomik özellikler, hasta profilinin değişkenliği ve operasyon pozisyonu nedeniyle özelliklidir. İntraoperatif hemodinamik değişiklikler, beyin sapı hasarı ve venöz hava embolisi gibi komplikasyonlar oluşabilmektedir. Bu çalışmada, hastanemizde posterior fossada tümör nedeniyle opere olan hastalardaki anestezi deneyimlerimizin paylaşılması ve sonuçlarımızın literatür eşliğinde tartışılması amaçlanmıştır.Gereç ve Yöntem: Hastanemizde 2015-2017 yılları arasında posterior fossada tümör cerrahisi uygulanan 1 ile 77 yaş arasındaki 30 hastanın kayıtları retrospektif olarak değerlendirildi. Bulgular: Hasta yaşlarının 1 ile 74 yıl arasında olup, hastaların %76,7’sinin erkek olduğu saptandı. Ortalama operasyon süresi 242,7 dakika idi. İntraoperatif dönemde 6 (%20) hastada hipotansiyon, 4 (%13,3) hastada bradikardi, 1 (%3,3) hastada asistoli, 2 (%6,6) hastada venöz hava embolisi geliştiği tespit edildi. 25 (%83,3) hastanın operasyon sonunda ekstübe edildiği, 5 (%16,7) hastanın ise entübe şekilde yoğun bakım ünitesine çıkarıldığı saptandı. Yoğun bakım ünitesinde ortalama kalış süresi 5,6±4,6 gün, hastanede kalış süresi 14,7±15,7 gün idi. Postoperatif dönemde 5 (%16,7) hastanın yeniden opere edildiği, 1 (%3,3) hastanın exitus olduğu, 29 (%96,7) hastanın ise hastaneden taburcu edildiği saptandı. Sonuç: Posterior fossa cerrahisinde anestezi yönetimi, dinamik ve zorlu bir süreç olabilmektedir. Uygun hasta seçimi ve preoperatif hazırlık, intraoperatif monitörizasyon ve anestezik ajanların seçimi ile komplikasyon oranı en aza indirilebilmektedir.

Anahtar Kelimeler:

Posterior fossa cerrahisi, anestezi

Anesthesia management in posterior fossa surgery

Purpose: Anesthesia management in posterior fossa surgery may be challenging due to anatomical features, patient profile and operation position. Intraoperative hemodynamic changes, brain stem damage, and venous air embolism may occur. The aim of this study was to present our anesthesia experience in patients who underwent posterior fossa tumor surgery and to discuss the current literature.Materials and Methods: Thirty patients between the ages of 1-74 years, who underwent posterior fossa tumor surgery between 2015-2017 years were evaluated retrospectively. Results: The age of the patients was between 1 and 74 years and 76.7% of them were male. The mean operation time was 242,7 minutes. Complications observed during intraoperative period were hypotension (20%), brdycardia (13.3%), asystole (3.3%), venous air embolism (6.6%). 25 (83.3%) patients were extubated and 5 (%16,7) patients could not be extubated at the end of the operation. The mean duration of stay in the intensive care unit was 5.6 ± 4.6 days and the duration of hospital stay was 14.7 ± 15.7 days. In the postoperative period, 5 (16.7%) patients were re-operated, 1 (3.3%) patient was exitus, and 29 (96.7%) patients were discharged from the hospital.Conclusion: In posterior fossa surgery, anesthesia management may be a dynamic and challenging process. The complication rate can be minimized with appropriate patient selection and preoperative preparation, intraoperative monitoring and selection of anesthetic agents.

Keywords:

Posterior fossa surgery anesthesia, venous air emboli.,

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