Derya TOPUZ, Aysun POSTACI, M. Ahu KORKMAZ, Bayazıt DİKMEN

Kifoskolyoz ve hipertrofik kardiyomiyopatili olguda anestezi uygulaması

Santral nöral blokların kifosolyozda teknik güçlükler içermesi, yüksek bir blok seviyesine ulaşması, hipertrofik kardiyomiyopatide ise kardiyak fonksiyonlar yönünden preloadu ve afterloadu azaltması önemli dezavantajları olarak karşımıza çıkmaktadır. Bu olguda kifoskolyoz ve hipertrofik kardiyomiyopatisi olan ve transüretral rezek-siyon ile prostatektomi uygulanacak 66 yaşındaki erkek hastaya genel anestezi uygulanmıştır. Operasyon odasında 2 mg iv midozalam premedikasyonu sonrasında sol radial arterden invaziv kan basıncı monitorizasyonu uygulandı. 3 dakikalık preoksijenizas-yon sonrası 5 mcg kg-1 alfentanil uygulanan hastaya 4L taze gaz akımında %8 sevofluran ile %50 O2-%50 N2O içinde tidal volüm solunum yöntemi ile inhalasyon indük-siyonu yapıldı. İndüksiyon 54 sn’de gerçekleşti. İndüksi-yondan bir dakika sonra ağız açıklığı tam olan olguya sorunsuz bir şekilde LMA uygulandı. Hasta 2 L taze gaz akımında %2 sevofluran konsantrasyonu ile SIMV modunda takip edildi ve operasyon süresince hemodi-nami stabil seyretti. Operasyon komplikasyonsuz bir şe-kilde 51 dakikada sonlandırıldı. Hastanın bulantısı, kus-ması ve boğaz ağrısı olmadı. Hasta postoperatif 2. günde sorunsuz bir şekilde taburcu edildi. Sonuç olarak, yaşlı, kifoskolyozu ve hipertrofik kardiyo-miyopatisi olan olgumuzda, 5 mcg kg -1 alfentanil sonrası tidal-volüm solunum yöntemiyle uygulanan %8 sevof-luran indüksiyonu sonrası LMA yerleştirilmesi, yumuşak, komplikasyonsuz, minimal hemodinamik etki sağlayarak bu tip hastalarda tercih edilebilir.

Anaesthesia management in a patient with kyphoscoliosis and hyperthropic cardiyomyopathy

Central neural blockade in has technical difficulties, reach a higher blockade level afterload and preload in hyperthropic cardyomyopathy (HCM) which reduce. In this case, general anesthesia was performed in a 66 years old male patient with kyphoscoliosis and hyper-thropic cardyomyopathy who underwent transurethral prostate resection. In the operation room after premedication with 2 mg iv midazolam, a left radial arterial cathater was inserted for invasive pressure monitorisation. After giving oxygen for three minutes and 5 mcg kg-1 alfentanyl, general anesthesia induction was performed with tidal volume inhalational technique with 4L fresh gas flow sevofluran 8% and 50% N2O in oxygen in 54 seconds. Laryngeal mark airway (LMA) was performed to the patient who had an adequate mouth opening one minute after the induction of anesthesia without difficulty. The patient was monitorised by 2L fresh gas flow with sevoflurane 2% and SIMV mode and the hemodynamic parameters were stable during the operation. The operation was finalised in 51 minutes without any complication. The patient had no symptoms like nausea, vomiting and sore throat after the operation and he was discharged 2 days after surgery. As a result, patients with kyphoscoliosis and HCM, LMA administeration with a tidal volume inhalation technique after alfentanyl 5 mcg kg-1 can be preferable for maintenance of a smooth induction of anesthesia and stable hemodynamic parameters.

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