ÖZOFAGUS ATREZİLİ YENİDOĞANLARDA ANESTEZİK RİSKLER, MORBİDİTE VE MORTALİTE

Amaç Özofagus atrezisi (ÖA), özofagusun proksimal ve distal bölümlerinin bağlantısının olmamasıdır ve 2500-5000 canlı doğumda bir görülür. ÖA ve trakeo özofageal fistül (TÖF), beslenme ve solunum sorun larından dolayı ilk birkaç saatin içinde acilen tanı ko nulması gereken konjenital bir anomalidir. Bu defekt, oral sekresyon artışı ve beslenme anında aspirasyon ve regürjitasyona yol açar. TÖF’lü bebekte, ağlama ve öksürme anında, hava fistül yolu ile mideye ge çer, sonuç olarak mide ve ince barsak genişler. ÖA’ da onarım ve postoperatif komplikasyonlarla mücadele etmek cerrahi ve anestezik açıdan genellikle zordur. ÖA’dan dolayı opere olan yenidoğanlarda perioperatif yaklaşım, ÖA onarımı sonrası erken gelişen sonuçlar, komplikasyonlarla ilişkili olabilecek faktörler, morbidi te ve mortaite oranlarını tanımlamayı amaçladık. Gereç ve Yöntem Ocak 2010 - Ocak 2018 tarihleri arasında Zekai Tahir Burak Eğitim ve Araştırma Hastanesi’nde ÖA nede niyle cerrahi onarım geçiren tüm bebekler retrospektif olarak incelendi. Her iki grupta (Grup 1: ara boşluk mesafesi az olan yani hemen onarılabilen ÖA’ lı ye nidoğanlar, Grup 2: uzun dönemde yani aralıklı ÖA onarımı yapılabilen yenidoğanlar) demografik veriler, entübe kalma süreleri, hipotansiyon gelişme oranları, tedavi şekilleri, ventilatörde kalma süreleri, prematü rite oranları , majör kardiyak bozukluklar ve diğer cer rahi malformasyonlar tespit edildi ve istatiksel olarak karşılaştırıldı. Bulgular Özefagus anastomoz cerrahisi uygulanan bebeklerin yaşı, ortanca süre en fazla 70 günlük veya en kısa 1 günlük bebekler şeklindeydi (p= 0.01). İntraoperatif ventilasyon güçlüğü 28 bebekte (% 28) görüldü. Pos toperatif hastane içi mortalite oranı aralıksız ÖA gru bunda % 10 (8 infant) ve uzun aralıklı ÖA grubunda ise % 15 (3 infant) bulundu. Sonuç Aşamalı cerrahi gerektiren uzatmalı özofagus atrezi ameliyatı olan bebekler (n:20) ve aralıksız (hemen ya pılabilen) özofagus atrezisi operasyonu olan bebekler (n:80) karşılaştırıldığında perioperatif komplikasyon insidansı benzerdir. Bununla birlikte, uzun süreli ona rım için mevcut cerrahi yaklaşımlar daha uzun anes tezik maruziyet, özofagus devamlılığını korumak için çoklu prosedürler gerektirir. Bu durum mortalite ve morbidite oranını artırır.

ANESTHETIC RISKS, MORBIDITY AND MORTALITY IN NEWBORNS WITH ESOPHAGEAL ATRESIA

Objective Esophageal atresia (OA) is the disconnection of the proximal and distal parts of the esophagus and oc curs every in 2500-5000 live-births. OA and tracheo esophageal fistula (TOF) is a congenital anomaly that needs to be diagnosed immediately within the first few hours due to nutritional and respiratory problems. This defect leads to increased oral secretion and as piration and regurgitation at the time of feeding. The in infants of TOF when crying and coughing the air passes through the fistula into the stomach, resulting in enlarged stomach and small intestine. Struggles of OA repairs and postoperative complications are ge nerally difficult in terms of surgery and anesthetics. We aimed to define the perioperative approach, early results after repair of OA, factors that may be associ ated with complications, morbidity and mortality rates of in operated OA newborns. Materials and Methods All newborns who underwent surgery due to OA in Zekai Tahir Burak Training and Research Hospital between January 2010 and January 2018 were retros pectively analyzed. Demographic data in both groups (Group 1: newborns with low intermediary gap of OA that can be repaired immediately, Group 2: newborns with long-gap repairs of OA in the long period), intuba tion times, hypotension development rates, treatment types, ventilator residence times, prematurity rates, major cardiac disorders and other surgical malforma tions were compared. Results The age of the babies who underwent esophageal anastomosis surgery was median duration of 70 days or shortest 1 day (p= 0.01). Intraoperative ventilation difficulties were seen in 28 babies (28%). Postopera tive mortality rate of in-hospital was 10% (8 infants) in the uninterrupted of OA group and 15% (3 infants) in the long-gap of OA group. Conclusion The incidence of perioperative complications is simi lar when newborns with long-gap of OA surgery requ iring progressive surgery (n: 20) and infants with im mediate of OA operation (n: 80) are similar. However, current surgical approaches for long-gap repair of OA require longer anesthetic exposure, multiple procedu res to maintain esophageal persistence. Therefore, the mortality and morbidity rate increases for long-gap repair of OA .

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