Gülcan ERK, Vildan TAŞPINAR, Dilek KALAYCI, Handan ŞAŞTIM, Hasan Karahan SÖNMEZ, Eyüp HORASANLI

Laparoskopik kolesistektomi sonrası gelişen karaciğer fonksiyon bozukluğu

Regüle hipertansiyon ve düşük ventrikül hızlı atriyal fıbrilasyon tanısı ile antihipertansif tedavi almakta olan hastamıza 2 yıl önce izofluran anestezisi altında aort kapak replasmam yapılmıştı. Preoperatif laboratuar değerleri normaldi. ASA III risk hastaya midazolam, fentanil, propofol, vekuronyum indüksiyonu ve düşük akımlı desfluran anestezisi altında laparoskopik kolesistektomi operasyonu uygulandı. Peroperatif 4 L CO2 ile CO2 insuflasyon basıncı 15mmHg'da tutuldu. Uyanma döneminde kan basıncı yükselince 1.5 $mu$cg/ kg/ dk hızla kan basıncı regüle oluncaya kadar nitrogliserin verildi. Derlenme odasına alınan hastada 10 dakika sonra yüksek ventrikül hızlı atriyal fıbrilasyon gelişince metoprolol suksinat 2 mg uygulandı. Kan basıncı 115/80 mmHg, nabız 93/dk olunca servisine gönderildi. Hastamızın postoperatif dönemde karaciğer fonksiyon testleri ve hemostaz paneli bozuldu. Gastroenteroloji Kliniği tarafından iskemik hepatit lehine değerlendirildi. Eritrosit süspansiyonu, taze donmuş plazma, K vitamini, metoprolol suksinat, NaHCO3 verildi. Postoperatif 13. günde taburcu oldu. Geriatrik hastalarda postoperatif erken dönemde gelişebilecek kardiyorespiratuar instabilite ile karaciğer fonksiyon bozukluğunun presipite olabileceği göz önünde tutulmalıdır.

Liver dysfunction after laparoscopic cholecystectomy

The patient (ASAM) was scheduled for laparoscopic cholecystectomy. She had a history of low ventricle rate AF and hypertension treated with an antihypertensive drug and a history of aortic valve replacement surgery during which she received isoflurane. Her prcoperative laboratory findings were normal. In the laparoscopic cholecystectomy operation anesthesia was induced with midazolam, fentanyl, propofol and vecuronium and maintained with low flow desflurane anesthesia. The CO2 insuflation pressure was kept at 15 mmHg with peroperative 4L CO2. When blood pressure increased during the recovery period, a nitroglycerin infusion (1.5 $mu$g/kg/min) was administered until the blood pressure was regulated. In the recovery room high ventricular rate AF developed and was treated with metoprolol succinate 2 mg. When blood pressure was 115/80 mmHg and heart rate was 93 beats per minute she was transferred to the ward. During the postoperative period the liver function tests and hemostasis parameters became abnormal. Gastroentcrology specialists evaluated the situation as ischemic hepatitis. Erythrocyte suspension, fresh frozen plasma, vitamin K, metoprolol succinate and NaHCO3 were administered. She was discharged on the 13th postoperative day. It should be kept in mind that in geriatric patients liver function disorders may be precipitated by cardiorespiratory instability that may develop during the early postoperative period.

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