Serdar Ekemen, Meryem Onay, Mehmet Ali Harbelioglu, Murat Vural

Derin Beyin Stimulatörü Uygulanan Hastalarda Skalp Bloğu ve İnfiltrasyon Anestezisinde Methemoglobinemi Riski

Skalp bloğu gibi kanlanması yüksek olan bölgelerde lokal anesteziklerin uygulanması, emilim hızının ve intravasküler enjeksiyon riskinin yüksekliği nedeniyle methemoglobinemi gibi lokal anesteziklerin sistemik etkilerine karşı daha hassastır. Çalışmamızda, özellikle Parkinson olmak üzere nörolojik hastalıklara bağlı derin beyin stimülatörü (DBS) yerleştirilen hastalarda skalp bloğu sonrası methemoglobin değerlerini retrospektif inceleyerek methemoglobinemi riskini değerlendirmeyi amaçladık.Çalışmaya DBS için Ocak 2017 ve Aralık 2018 tarihleri arasında başvuran, 18 yaş üstü ve rejyonel anestezi uygulanan 41 hasta dahil edildi. Hastalara skalp bloğu (n: 10) ve infiltrasyon anestezisi (n: 31) uygulandı. Hastaların yaş, Amerikan Anesteziyologlar Derneği fiziksel sınıflaması (ASA), cinsiyet, DBS endikasyonu, skalp bloğu / infiltrasyon anestezisi, arteriyel kan gazında pH, pO2, Spo2, en yüksek methemoglobin düzeyleri ve klinik semptomlar istatistiksel olarak analiz edildi.DBS endikasyonları 29 hastada Parkinson hastalığı, diğerleri hiper-reaktivite, distoni ve titremeydi. Ayrıca 33 hasta ASA Sınıf II olarak sınıflandırıldı. Skalp bloğu yapılan 2 hastada ve infiltrasyon anestezisi uygulanan 6 hastada MeHb düzeyi% 2’nin üzerindeydi. Ancak skalp bloğu ve infiltrasyon anestezisi arasında methemoglobin düzeylerinde istatiksel olarak anlamlı bir fark gözlenmedi.Skalp gibi kanlanmanın yüksek olduğu bölgelerde klinik bulgu olmadan, lokal anestezi uygulamalarında methemoglobinemia gelişme riski nedeniyle dikkatli olunmalıdır

Risk of Methemoglobinemia in Scalp Block and İnfiltration Anesthesia in Patients Undergoing Deep Brain Stimulation

The application of local anesthetics in areas with a high blood supply, such as scalp block, is more susceptible to systemiceffects of local anesthetics such as methemoglobinemia because of the high absorption rate and the risk of intravascular injection.In this study, we aimed to evaluate the risk of methemoglobinemia by reviewing methemoglobin values after scalp block in patientswith a deep brain stimulation (DBS) due to neurological diseases, especially Parkinson’s.The study included 41 patients aged >18years who were admitted between January 2017 and December 2018 for DBS and underwent regional anesthesia (n = 41). Patientswere administered scalp block (n = 10) and infiltration anesthesia (n = 31). Using data from the patients’ medical records, westatistically analyzed the patients’ age, American Society of Anesthesiologists (ASA) status, gender, DBS indication, scalpblock/infiltration anesthesia, highest methemoglobin level in arterial blood gas, pH, pO2, SpO2, and clinical symptoms.Theindications for DBS were Parkinson’s disease in 29 patients hyperreactivity, dystonia and tremor in the remaining patients.Furthermore, 33 patients were classified as ASA class II. The methemoglobinemia level was >2% in two patients who underwentscalp block and six patients who underwent infiltration anesthesia. However, there was no statistically significant difference inmethemoglobin levels between scalp and infiltration anesthesia.In areas with high blood flow, such as the scalp, caution should beexercised in administering local anesthesia because of the patient’s risk of developing methemoglobinemia, although there are noclinical findings on this topic.

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