Serkan TULGAR, İbrahim BOĞA, Tuba CAN, Elif BOMBACI, İbrahim GEZGEL

Mental retarde ve bakım hastalarında genel anestezi altında diş çekimi: Farklı anestezi uygulamalarımızı içeren retrospektif bir çalışma

Amaç : Mental retarde ve bakım hastalarında diş çekimleri için sıklıkla genel anesteziye ihtiyaç duyulmaktadır. Bu hasta grubunda nöromusküler kas gevşetici kullanılan ve kullanılmayan iki farklı genel anestezi tercihini karşılaştırmayı planladık Metod: Mayıs 2013- Haziran 2014 tarihleri arası genel anestezi altında diş çekimi uygulanan mental retarde ve bakım hastalarının dosyaları retrospektif olarak değerlendirildi. Hastalar iki gruba ayrıldı. Grup A: İndüksiyonda propofol: 3 mg/kg, fentanil: 1 mcg/kg, rocuronyum: 0,6 mg/kg, Grup B: İndüksiyonda propofol: 3 mg/kg, alfentanil: 10 mcg/kg, lidokain: 1 mg/kg, entübasyon öncesi kısa süre yüksek MAC Minimal alveolar konsantrasyon sevofluran şeklinde idi. İki grup entübasyona hemodinamik yanıt ve anestezi süreleri açısından değerlendirildi. Bulgular: Çalışmamıza 9'u kadın, 15'i erkek olmak üzere toplam 24 olgu dâhil edilmiştir. Olguların 13'üne A grubu anestezi, 11'ine B grubu anestezi uygulanmıştır. Gruplar arası entübasyon öncesi sistolik, diastolik, ortalama arter basınçları, nabız ve Hız basınç ürünü açısından anlamlı farklılık bulunmazken, B grubunda belirtilen parametrelerde entübasyon sonrası anlamlı değişim görülmezken, A grubunda anlamlı yükselme tespit edilmiştir. Ayrıca grubunda anestezi süresi, cerrahi bitimi sonrası uyanma için bekleme süresi, derlenme süresi ortalamaları B Grubundan anlamlı şekilde yüksek bulunmuştur. Sonuç: Mental retarde ve bakım hastalarında kas gevşetici kullanılmadan midazolam, alfentanil, propofol ve lidokain kullanarak entübasyonu takiben volatil ajanla idamenin sağlanacağı genel anestezinin kısa anestezi süresi, entübasyona hemodinamik yanıtta azalma ve hızlı derlenme sağlayarak uygun bir anestezi tercihi olabileceğini düşünmekteyiz

Anahtar Kelimeler:

mental retardasyon, dental anestezi, kas gevşetici, non-depolarizan

Tooth extraction under general anesthesia in mentally retarded and homecare patients: A retrospective study included different anesthesia techniques

Aim: General anesthesia is often required for tooth extration in patients with mental retardation or homecare. In this study we aimed to study the requirement for use of neuromuscular muscle relaxants in this patient group Method: This was a retrospective medical file review of mentally retarded or homecare patients undergoing tooth extration under general anesthesia from May 2013 until June 2014. Patients were divided into two groups. Group A: propofol 3mg/kg for induction followed by fentanyl 1mcg/kg and rocuronium 0.6mg/kg and Group B: propofol 3mg/kg for induction followed by alfentanyl 10mcg/kg, lidocaine 1mg/kg and high MAC minimum alveolar concentration sevoflurane for a short period before intubation. Hemodynamic response and time under anesthesia were compared between these two groups. Results: A total of 24 patients 9 female, 15 male were included in this study. There were 13 patients in group A and 11 in group B. There was no difference in pre-intubation systolic, diastolic or mean arterial blood pressure or pulse and Rate Pressure Product. While there was no significant change in these parameters in group B after intubation, there was a significant increase observed in group A. Time under anesthesia, waiting time for awakeness after finishing surgery, postanesthesia recovery time, was significantly higher in group A when compared to group B. Conclusion: In homecare patients and those with mental retardation, the use of midazolam, alfentany, propofol and lidocaine followed by maintanence with volatile agents leads to shorter time under anesthesia, less hemodynamic response and faster postanesthesia recovery; and can safely be used in this patient group without the need for muscle relaxants.

Keywords:

mental retardation, dental anaesthesia, muscle relaxant, non-depolarizing,

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