Aykut URFALIOĞLU, Mahmut ARSLAN, Gökçe GİŞİ, Bora BİLAL, Ali Erdal KARAKAYA, Hafize ÖKSÜZ

Trakeobronşial sisteme yabancı cisim aspirasyonu olan pedatrik olgularda uygulanan rijit bronkopi işleminde anestezi deneyimlerimizin retrospektif analizi

Amaç: Çocuklarda yabancı cisim aspirasyonu YCA sık olarak görülen acillerdendir. Bu çalışmada, YCA nedeniyle rijit bronkoskopi RB yapılan çocukların demografik bilgileri, bronkoskopide seçilen anestezi yöntemi ve oluşan komplikasyonların incelemesi 41 amaçlanmıştır. Metod: Ekim 2013 ile Ocak 2015 tarihleri arasında YCA şüphesi veya tanısı nedeniyle RB 43 yapılan 51 hasta incelenmiştir. Bulgular: Hastaların %68.6'sı erkek, %31.4'ü kız, yaş ortalaması 2,72±2.51 yıldı. En sık görülen semptomlar; %86.2 öksürük ve %58.8 dispne idi. Radyolojik bulguların dağılımı ise %29.4 normal görünüm, %23.5 obstrüktif amfizem ve %23.5 atelektazi idi. Bronkoskopi ile çıkarılan YC'lerin çoğunu organik materyaller oluşturmaktaydı. YC'ler sırasıyla %31.3 sol bronşial ağaç, %33.4 de sağ bronşial ağaçta idi. YC'in proksimal yerleşimli olduğu 6 olguda spontan ventilasyo n SV yöntemi, diğer 45 olguda nöromuskuler bloker kullanılarak Manuel intermittant pozitif pressure ventilasyon MIPPV tercih edildi. Her iki ventilasyon yönteminde desatürasyon, aritmi ve bronşiolaringeal spazm, anestezi sırasında meydana gelen komplikasyonlardı. Hastaların hiçbirisinde mortaliteye rastlanmadı. Sonuç: Çocuklarda YCA'larının hayatı tehdit eden bir durum olduğunu, bronkoskopinin derhal yapılması gerektiğini, anestezistin; hastanın genel durumu, YC'in yerleşimine göre uygun anestezi yöntemini seçmesi gerektiğini ve bu konuda anestezist ile bronkoskopistin işbirliği içinde olmasının mortalite oranını azaltacağı düşünülmüştür.

Anahtar Kelimeler:

yabancı cisim aspirasyonu, rijit bronkoskopi, anestezi yöntemi, çocuk

A retrospective analysis of our anesthesia experience in rigid bronchoscopy interventions in pediatric patients due to foreign body aspiratıons in tracheobranchial system

Aim: Foreign body aspirations FDA are one of the major problems in pediatric emergency services. The objective of this study is to explore the relations between the preferred anesthesia method and common complications emerging under rigid bronchoscope RB in children exposed to FDA along with their preoperative history retrospectively. Methods: RB based upon the diagnosis or any suspicion of FDA between October 2013 and January 2015. Result: Gender distributions were 68.6% male and 31.4% female. Mean age was 2.72 ± 2.51 years. Most common symptoms were cough and dyspnea 86.2% and 58.8% respectively . Distributions of radiological findings were as follows: normal view 29.4%, obstructive emphysema 23.5% and atelectasia 23.5 %. Most of the substances achieved were composed of organic materials during bronchoscope. Placements of the foreign bodies were on the left bronchial and righ bronchial trees 31.3% and 33.4% respectively. Spontaneous ventilation SV in 6 cases where the proximal localization of the FB, in other 45 cases Manual intermittent positive pressure ventilation using a manual neuromuscular blocking MIPPV was prefered. On the both ventilation methods, desaturation, arrhythmia and broncholaryngeal spasm were complications occurred during anesthesia. None of the patients were found mortality. Conclusion: FDA is known as an important life-threatening situation. Therefore, it is substantial to initiate bronchoscope process immediately by assigning the convenient anesthesia method referring to the placement of the foreign body and general situation of the patient in collaboration with anesthesiologist and bronchoscopy performer that will eventually lead future promising results in decreasing mortality.

Keywords:

foreign body aspiration, rigid bronchoscope, anesthesia method, pediatric,

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