Şiddetli restriktif akciğer hastalığı olan hastada kolesistektomi operasyonu için kombine spinal epidural anestezi

Restriktif akciğer hastalıklarında genel anestezi uygulaması titizlikle yapılmalıdır. Volatil anestezikler atelektazi oluşumuna ve fonksiyonel rezidüel kapasite (FRC)’de azalmaya (%16-0.5 litre) neden olarak intraoperatif hipoksi oluşturabilirler. Bu hasta grubunda operasyon için uygun olduğunda rejyonel anestezi veya periferik sinir blokları en iyi seçim gibi görünmektedir. Yapılan epidural veya spinal anestezinin solunum kasları ve diyafragmayı etkilemeyecek düzeyde uygulanması gereklidir. Özellikle kolesistektomi gibi üst batın cerrahisi uygulanacak hastalarda rejyonel yöntemlerin kullanımı tercih edilebilir. Bu olgu sunumunda laparoskopik kolesistektomi yapılması planlanan şiddetli restriktif akciğer hastalığı olan 80 yaşında, fiziksel durum sınıflaması American Society of Anesthesiologists (ASA) III hastanın kombine spinal-epidural anestezi uygulamamızı paylaştık.

Combined spinal epidural anesthesia in a patient with severe restrictive pulmonary disease for laparascopic cholecystectomy

General anesthesia should be done carefully in restrictive lung diseases. Volatile anesthetics may cause intraoperative hypoxia, leading to atelectasis and a reduction in functional residual capacity (FRC) (16-0.5 liters). Regional anesthesia or peripheral nerve blocks seem to be the best choice when appropriate for surgery in this patient group. The epidural or spinal anesthesia should be performed at a level that does not affect the respiratory muscles and diaphragm. The use of regional methods may be preferred in patients undergoing upper abdominal surgery, especially cholecystectomy. In this case report, we present the combined spinal-epidural anesthesia application of the American Society of Anesthesiologists (ASA) III in an 80 years old patient with severe restrictive pulmonary disease planned for laparoscopic cholecystectomy.

Keywords:

Cholecystectomy elderly patient, regional anesthesia,

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