Salih YILDIRIM, Fikret ÖZKAN, Yılmaz APAYDIN, Fatih ÖZKAN

İleri derecede kifoskolyozda spinal anestezi: Olgu sunumu

Kifoskolyoz yaşla birlikte artan progresif bir hastalıktır. Kifoz ve/veya skolyoz, anestezi uygulamaları sırasında endotrakeal entübasyon güçlüğüne ve rejyonel girişim tekniklerinin zorlaşmasına neden olmaktadır. Bu hastalarda ilerlemiş yaşın yanında nörolojik defisit ve yürüme güçlüğü gibi deformiteye bağlı direk etkilerle birlikte kardiyopulmoner fonksiyonlarda da önemli bozulmalar görülebilmektedir. Bu olguda, 72 yaşında ileri derecede kifoskolyozu olan erkek hastada sağ inguinal herni operasyonu nedeniyle uygulanan spinal anestezi deneyimimizi sunmayı amaçladık. Hastaya L4-L5 aralığından tek doz 15 mg hiperbarik bupivakain ile spinal anestezi yapıldı. Hastada cerrahi için yeterli duysal ve motor bloğun sağlandığı ve duysal bloğun maksimum T6 dermatom seviyesine yükseldiği görüldü. Peroperatif dönemde hastada herhangi bir komplikasyon gözlenmedi ve başarılı bir spinal anestezi uygulaması gerçekleştirildi. Sonuç olarak, kifoskolyozlu yaşlı bir hastada spinal anestezi uygulamasının hemodinamik ve solunumsal komplikasyonların azaltılması ya da önlenmesi için genel anesteziye iyi bir alternatif olabileceği kanısına varıldı.

Spinal anesthesia in a patient with advanced kyphoscoliosis: A case report

Kyphoscoliosis is a progressive disease that increases by age. While applying anesthesia, kyphosis and/or scoliosis can lead to difficulty in both during endotracheal intubation and also during performing regional interventional technics. In addition to aging and the direct effects of deformity such as neurological deficities and immobility; deterioration in cardiopulmonary functions can also develop in these patients. In this case, we aimed to report our spinal anesthesia experience in a 72 year-old man with advanced kyphoscoliosis who underwent right inguinal hernia operation. Spinal anesthesia was performed through L4-L5 space by single dose of 15 mg hyperbaric bupivacain. Sufficient sensorial and motor block was provided and sensorial block was increased to maximum at T6 dermatome level. There was no complication during the peroperative period and succesful spinal anesthesia was performed. Finally we conclude that spinal anesthesia is a good alternative to general anesthesia in reducing or preventing hemodynamic and respiratory complications for an elderly patient with kyphoscoliosis.

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1. McMaster MJ, Glasby MA, Singh H, Cunningham S. Lung function in congenital kyphosis and kyphoscoliosis. Spinal Disord Tech 2007; 20: 203-8
2. Kepkep N, Ersoy Ü, Kurtay G. Severe kyphoscoliosis and modified transabdominal delivery (Case report). Turkiye Klinikleri J Gynecol Obst 2000; 10: 249-52
3. Baydur A, Milic-Emili J. Respiratory mechanics in kyphoscoliosis. Monaldi Arch Chest Dis 1993; 48: 69-79.
4. Kleinman W.Spinal,epidural and caudal blocks.In:Clinical Anesthesiology, edit by Morgan GE, Mikhail MS, Murray MJ& Larson CP. Lange medical boks,Mc Graw-Hill, New york 2002; 253-82
5. Moran DH, Johnson MD. Continuous spinal anesthesia with combined hyperbaric and isobaric bupivacaine in a patient with scoliosis. Anesth Analg 1982; 70: 445-7.
6. Barlow AP, Crumplin MKH, Zarifa Z, Edwards E, Shillito RG, McCarthy J. Surgery in a geriatric population. Annals of the Royal College of Surgons of England 1989; 71: 110-4.
7. Hepaguslar H, Elar Z.[Choice of general anesthesia or regional anesthesia in geratric patients ]. T Klin Anest Reanim 2003; 1: 41-5.
8. Kayhan Z. [Local/ Regional Anesthesia]. 2. Baskı. Klinik Anestezi. İstanbul: Logos Yayıncılık, 2004: 524-89.
9. Morgan E. Regional Anesthesia and Pain Management, in Clinical Anesthesiology. Prentice-Hall International, Inc, 1996: 211-74.
10. Gracey DR, Divertie MB, Didier EP. Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study. Chest 1979; 76: 123-6
11. Farber NE, Pagel SP, Warltier DC. Pulmonary pharmacology of inhaled anaesthetics. In Miller RD (ed): Anesthesia 5th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2000. Chapter 5B 125-46.
12. Smith PS, Wilson RC, Robinson APC, Lyons GR. Regional blockade for delivery in women with scoliosis or previous spinal surgery. Int J Obstet Anesth, 2003; 12: 17-22.
13. Sakura S. Factors influencing the level of spinal anesthesia: (I). Characteristics of anesthetic solutions. Masui 2000; 49: 18-25.
14. Özyurt G, Basagan ME, Bilgin H. Spinal anesthesia in a patient with severe thoracolumbar kyphoscoliosis. Thoku J. Exp. Med 2005; 207: 239-42