Erdem AKÇAY, Yonca YANLI, Nurten BAKAN, Cafer YÜRÜK

Hipertermik kemoterapi uygulanan apandis tümörü hastasında anestezik yaklaşım

Sitoredüktif cerrahi ile birlikte uygulanan hipertermik intraperitoneal kemoterapi (HİPEK), peritoneal ve apandise ait malignitelerde gittikçe artan oranda kullanılan, kompleksve multidisipliner bir yöntemdir. Önce görülebilen bütün tümör dokuları çıkarılır, daha sonra 42°C’ye ısıtılmış kemoterapötik solüsyon, drenler yolu ile batına verilerek peritoneal perfüzyon yapılır. Perioperatif dönemde normovoleminin sürdürülmesi, sitoredüktif faz sırasında hipoterminin, HİPEK sırasında hiperterminin kompanse edilmesive intraabdominal basıncın artmasına bağlı ortaya çıkanhemodinamik değişikliklerin regüle edilmesi, koagülasyonve renal parametrelerin takip edilerek düzeltilmesi önemlidir.Biz de nüks apandis müsinöz tümörü nedeniyle sitoredüktif cerrahi ve HİPEK planlanan 45 yaşındaki ASA I erkek hastamız nedeniyle, hastanemizde yeni yapılmaya başlanan bu yöntem konusundaki deneyimimizi paylaşmayı ve anestezi açısından oluşabilecek sorunları gözden geçirmeyi amaçladık.

Anesthetic management in an appendix tumor patient undergoing hyperthermic chemotherapy

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex and multidiscipliner procedure that is being used increasingly for peritoneal and appendix malignency. First of all the macroscopic tumor tissues are extracted after that peritoneal perfusion is started with giving heated 42°C chemother- apeutic solution via abdominal drains. It is important to maintain normovolemia, to regulate coagulation and renal parameters during perioperative period, to compansate hypothermia during cytoreductive surgery and hyperthermia during HIPEC and to regulate hemodynamic changes due to increased abdominal pressure during HIPEC. In this case report, we aimed to share anaesthetic experience and to evaluate anaesthetic problems in 45 years old ASA I patient undergoing cytoreductive surgery and hypertermic intraperitoneal chemotherapy in which newly established in our hospital for appendix tumor.

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