İleri yaş Pierre Robin sendromunda uyanık fiberoptik entübasyon:Bir olgu

İleri yaş Pierre Robin Sendromlu hastaların anestezisi, ventilasyon ve entübasyonun güç olması, teknik zorluklardan dolayı operasyonun uzun sürmesi ve basıdan dolayı dil dil kökü ve suprahyoid ödem görülebilmesi nedeniyle zordur. Bu olguda uyanık fiberoptik bronkos-kopi (FOB) ile yapılan anestezi deneyimi sunulmuştur. 19 yaşında Pierre Robin Sendromlu olgu mikrognati nedeniyle operasyona alındı. Mallampati grade 3, tiromental mesafesi 5 cm, sternomental mesafesi 11 cm idi. Premedikasyon amacı ile 3 mg dormikum, refleksleri bastırmak ve işlemi kabul edilebilir hale getirmek amacıyla 0,1 mg fentanil, sekresyonları azaltmak amacıyla da 0.5 mg atropin i.v. yapıldı. Vazokonstrüksiyon ve topik anestezi amacıyla, .%1 aritmal ve %0,5 efedrin emdirilmiş pamuk tamponları her iki burun deliği içine yerleştirildi. Uygun1'burun deliğinden wendl nazofaren-geal tüp geçirildi. Lidokain %2 sprey ile hipofarenks bölgesine topik anestezi uygulandı. % 100 O2 ile 5 L/dk preoksijenize edildikten sonra kullanılacak entübasyon tüpü fiberoptik bronkoskop üstünden geçirilerek tespit edildi. Kord vokaller ortalandıktan sonra FOB portundan %1'lik lidokain püskürtülerek larinks ağzının topik anestezisi sağlandı. FOB hipofarenkse çekilerek 1-2 dakika beklendi; sonra tekrar ilerletilerek kord vokallerin arasından geçildi. Trakeaya %1'lik lidokain püskürtülüp tekrar geri çekilerek hipofarenkste uygun süre beklendikten sonra kord vokaller arasından geçilip trakeaya girerken hastaya 2 mg/kg propofol, 0,5 mg/g Atrakuryum besilat, 1,5 mg/kg prednisolon i.v. yapıldı. Endotrakeal tüp, bronkoskop üzerinden kaydırılarak trakeaya girildi. Mandibuler osteotomi ve kemik kaydırma yöntemi ile rekonstrüksiyon yapılan olgu stile yerleştirilerek ekstübe edildi.

Awake fiberoptic intubation forth age Pierre Robin syndrome: A case report

Awake Fiberoptic Intubation Forth Age Pierre Robin Syndrome: A case report Anaesthesia of the forth age Pierre Robin Syndrome is difficult, because of the difficulties of ventilation and entubation, long duration time of operation because of the technical difficulties and suprahyoid, tongue edema that have been because of press. In this case we represent you an anaesthesia experience about awake Fiberoptic Broncoscopi (FOB). Surgery was planned for a 19 years old patient with Pierre Robin Syndrome to correct micrognathia. Mallampati grade was 3, thyromental distance was 5 cm, and sternomental distance was 11 cm. Premedication involved 3 mg'dormicum (extra 1 mg when needed), 0.1 mg'fentanyl (extra 0.05 mg when needed) to inhibit the reflexes and assist the procedure, and 0.5 mg atropine i.v to reduce the secretions. Cotton packs soaked by 1% lidocaine and 0.5% ephedrine were placed into nostrils to achieve vasoconstriction and topical anaesthesia. A Wendl nasopharyngeal tube was passed through the appropriate nostril. Lidocaine 2% spray was used to provide anaesthesia of hypopharyngeal region. After preoxygenation by 100% O2 for 5 minutes, tube was passed over bronchoscopy and fixed. When vocal cords were positioned in the middle lidocaine 1% was sprayed through FOB port to achieve topical anaesthesia of laryngeal orifice. FOB was retracted to hypopharynx and after 1 or 2 minutes of waiting period, it was re-advanced through the vocal cords. Lidocaine 1% was sprayed into the trachea and once more retracted to stay in hypopharnyx for a reasonable period of time after which 2 mg/kg propofol, 1 mg/kg atracurium besilate, 1.5 mg/kg prednisolon was administered via i.v. route while passing through vocal cords into the trachea. Endotracheal tube was slid over bronchoscope to enter the trachea. Reconstruction by mandibular osteotomy and bone transfer was performed and patient was extubated after full awakening.

Kaynakça

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