NİLAY BOZTAŞ, Sevda BİRLİK ÖZKARDEŞLER, Mert AKAN, Volkan ONAY, Mücahit ÖZBİLGİN

Kolorektal cerrahi uygulanan geriyatrik bir olguda kombine spinal epidural anestezi

Kolorektal cerrahi olgularını daha çok geriyatrik hasta popülasyonu oluşturmaktadır. Ülkemizde de geriyatrik hasta popülasyonu giderek artış göstermektedir. 79 yaşında, fiziksel durum sınıflaması ASA-II olan erkek hastaya sigmoid kanseri nedeniyle sigmoid rezeksiyon ve kolorektal anastomoz planlandı. İzotonik NaCl solüsyonu ile 10 ml/kg intravenöz sıvı yüklemesini takiben L3-L4 aralığından direnç kaybı tekniğiyle epidural aralığa girildi ve iğne-içinden-iğne tekniği kullanılarak 27G Quincke iğne ile subaraknoid mesafeye ulaşıldı. Berrak beyin omurilik sıvısı gelişi gözlendikten sonra 10 mg %0,5 hiperbarik bupivakain + 25 μg fentanil karışımı intratekal uygulandı. On dakika sonra duyusal blok seviyesinin T6 olduğu gözlenen olguya epidural kateterden 10 ml %2 prilokain + 9 ml %0,5 izobarik bupivakain + 50 μg fentanil karışımından 5 ml volüm verildi. Epidural ilaç uygulamasından 15 dakika sonra duyusal blok seviyesinin T4 olduğu saptandı. Yaklaşık 1,5 saat süren ve hemodinamik olarak stabil seyreden operasyonda epidural kataterden ek doz uygulanmadı. Operasyon sonunda duyusal blok seviyesinin T4 olduğu saptandı. Bu olguda, düşük doz lokal anestezik + opioid ile uygulanan kombine spinal epidural anestezi yöntemi ile stabil hemodinami, yeterli kas gevşemesi ve hasta-cerrah memnuniyeti sağlanmıştır.

Combined spinal epidural anesthesia in a geriatric patient undergoing colorectal surgery

Colorectal surgery patients are mostly in the geriatric age group. In our country, geriatric patient population is gradually increasing. For the 79 years old male patient, evaluated in the ASA II classification of physical status, sigmoid resection and colorectal anastomosis was planned due to sigmoid cancer. Following intravenous isotonic NaCl loading at 10 ml/kg, epidural space was located and entered at L3-L4 level using the loss of resistance technique, and subarachnoid space was reached with a 27G Quincke needle using the needle-throughneedle technique. After clear cerebrospinal fluid was detected, 10 mg 0.5% hyperbaric bupivacaine and 25 μg fentanyl combination was administered intrathecally. Sensory block level was observed at T6 within 15 minutes, and the patient was given 5 ml of the mixture of 10 ml 2% prilocaine + 9 ml 0.5% isobaric bupivacaine + 50 μg fentanyl through epidural catheter. 15 minutes after the epidural injection, T4 level of sensory block was determined. In operation which lasted approximately 1.5 hours, the patient remained hemodynamically stable, and no additional epidural injection was administered. At the end of the operation, T4 level of sensory block was determined. In this case, combined spinal epidural anesthesia method was performed with low-dose local anesthetic and opioid and we achieved stable intraoperative hemodynamics, adequate muscle relaxation, and patient-surgeon satisfaction as well.

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