Kemal Tolga Saraçoğlu, Ömer Baygın, Merve Soral

Spinal travmanın eşlik ettiği Wolf Parkinson White Sendrom’lu hastaların anestezi yönetimi

Wolff-Parkinson-White sendromu nadir görülen, patolojik aksesuar yolak olan Kent demetinden kaynaklanan iletinin ventriküle ulaştığı preeksitasyon sendromudur. Çoğu preeksitasyon sendromlu hastalar olumsuz bir klinik sunuma sahip olmasalar da hafif ve orta derecede göğüs ağrısından ciddi kardiyopulmoner rahatsızlıklara kadar değişen hatta ani kardiyak ölümle sonuçlanan bulgulara sahip olabilirler. Anestezik ilaçlar ve anestezi uygulama yöntemleri atriyoventriküler (AV) nodun iletiminde değişikliklere neden olarak taşiaritmi riskinde artışa neden olabilir. Wolff-Parkinson-White sendromlu hastaların anestezi yönetimleriyle ilgili olarak literatürde olgu sunumları yer almasına rağmen genel anestezi verilen hastalarda sugammadeks kullanımıyla ilgili bir olgu sunumu literatürde yer almamaktadır. Wolff-Parkinson-White tanısı almış, elektrokardiyografisinde delta dalgası ve kısa PR intervali bulunan, 28 yaşında, 75 kg erkek hasta 3 yıl önce geçirdiği araç içi trafik kazası sonrası spinal travmaya bağlı gelişen bilateral bacaklarda spastisite nedeniyle baklofen pompası takılması amacıyla ameliyathaneye kabul edildi. Sorunsuz bir cerrahi sonrasında hastaya nöromüsküler bloker olarak verdiğimiz rokuronyumun etkisinin geri döndürülmesinde bu hastalar için fatal aritmi potansiyeli bulunan neostigmin ve atropin kombinasyonu yerine sugammadeks verildi. Anestezi yönetiminin başarılı olduğu bu hasta komplikasyon gelişmeden servise devredildi. Genel anestezi altında cerrahi uygulanacak olan Wolff-Parkinson-White sendromlu hastaların anestezi yönetiminde sugamadeks kullanımının daha güvenli olacağı kanısına varılmıştır.

Anahtar Kelimeler:

Spinal travma, preeksitasyon, anestezi yönetimi

Anesthesia Management in a Patient with Spinal Trauma and Wolff-Parkinson White-Syndrome

Wolff-Parkinson-White syndrome is a rare ventricular pre-excitation syndrome which is caused by a pathological accessory pathway, Kent bundle. Although patients with pre-excitation syndrome may not have a negative clinical presentation, various symptoms arising from mild-moderate chest pain to serious cardiopulmonary dysfunction even sudden cardiac death may occur. Anesthetic drugs and methods tend to change the physiology of atrioventricular node conduction, hence causing an increase in risk of tachyarrhythmia. Despite the case reports in literature about anesthetic management of patients with Wolff-Parkinson-White syndrome, the use of sugammadex was not reported before. The patient was 28-year-old, 75 kg, diagnosed with Wolff-Parkinson-White syndrome and scheluded for elective insertion of baclofen pump due to bilateral leg spasticity, three year after spinal trauma because of a car accident. His electrocardiography showed shortened PR interval and delta waves. After an uneventful surgery, sugammadex was administered as a reversal agent of rocuronium bromide instead of neostigmine and atropine that may cause potentially fatal arrhythmias for these patients. This patient was discharged to his service after a successful anesthetic management without complications. We concluded that surgical procedures under general anesthesia for patients with Wolff-Parkinson-White syndrome may be safer with the use of sugammadex for anesthetic management.

Keywords:

spinal trauma, preexcitation, anesthesia management,

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