Abdullah ÖZDEMİR, Ahmet ŞEN, Başar ERDİVANLI, Asiye ÖZDEMİR, Vaner KÖKSAL

Intraoperative spinal ınjection in a morbidly obese patient

Morbid obezite dünya genelinde hızla artan bir sağlık problemidir. Anestezistler, elektif ve acil cerrahi gereken, artan sayıda obez hasta ilekarşılaşmaktadır. Morbid obezite ile birlikte kardiyovasküler, pulmoner, dejeneratif eklem hastalıkları, obstrüktif uyku apne sendromu gibiklinik problemler görülebilmektedir. Morbid obez hastalarda genel anesteziye bağlı atelektazi nedeniyle operasyon sırasında ve sonrasındahipoksiye bağlı komplikasyonlar görülebilmektedir. Bu yazıda spinal anestezi altında spinal cerrahi uygulanan morbid obez olgu irdelendi.Spinal bloğun etkisinin, cerrahi bitmeden geçmesi üzerine, cerrah tarafından operasyon alanından spinal anestezi uygulandı ve operasyonkomplikasyonsuz tamamlandı. Olgu ertesi gün taburcu edildi. Genel anestezinin riskli olduğu uygun vakalarda rejyonel anesteziuygulanmasının, perioperatif komplikasyonları ve hastanede kalış süresini azaltacağı kanaatindeyiz.

Morbid obez hastada intraoperatif spinal enjeksiyon

Morbid obesity is becoming a worldwide health concern. Anesthesiologists face increasing numbers of obese patients requiring electiveand emergency surgeries. Morbid obesity is associated with cardiovascular, pulmonary, degenerative joint disorders, and clinical syndromessuch as obstructive sleep apnea syndrome. Hypoxic events are common in anesthetised morbidly obese patients due to atelectasis.This paper discusses spinal surgery with spinal anesthesia in a morbidly obese patient. The spinal block ended before the surgery wascompleted and the surgeon injected local anesthetic intradurally through the surgical incision and the operation ended without anycomplications. The patient was discharged the next day. We conclude that in selected cases when general anesthesia increases the risk,regional anesthesia may decrease perioperative complications and hospital stay.

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1. Türkiye İstatistik Kurumu Bülteni, 25 Nisan 2013, Sayı:13490
2. Andersson GBJ. Intervertebral disc herniation: epidemiology and natural history. In: Weinstein JN, Gordon SL, eds. Low Back Pain: A Scientific and Clinical Overview. 1st edition. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1996. p. 7-21.
3. Baxi V, Budhakar S. Anesthesia management of a morbidly obese patient in prone position for lumbar spine surgery. J Craniovertebr Junction Spine 2010;1(1):55-7.
4. Sadrolsadat SH, Mahdavi AR, Moharari RS, Khajavi MR, Khashayar P, Najafi A et al. A prospective randomized trial comparing the technique of spinal and general anesthesia for lumbar disk surgery: a study of 100 cases. Surg Neurol 2009;71:60-5.
5. Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth 2008;100:165-83.
6. Hanrem CW. The implications of morbid obesity for anaesthesia. Anaesthesiol Rev 1979;6:29-35.
7. Lee LA, Lam AM, Roth S. Causes of elevated intraocular pressure during prone spine surgery. Anesthesiology 2002;97(3):759.
8. Rodgers A, Walker N, Schug S, McKee A, Kehlet E, van Zundert A et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493-7.