Next Issue
<< Back Print
Next Issue: - doi: 10.5578/khj.67067

Aort Kapak Replasmanı Geçiren Myasthenia Gravisli Hastada Anestezi Yönetimi

Anesthesia Management In A Patient With Myasthenia Gravis Who
Underwent Aortic Valve Replacement Surgery

Tülay Örki, Deniz Avan


İstanbul Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye

ÖZET

67 yaşında, 18 aydır pridostigmin tedavisi alan Tip IIa Myasthenia Gravis'li (MG) hastaya Aort kapak replasmanı için genel anestezi planlandı. Piridostigmin tedavisine ameliyat sabahı devam edildi. Anestezi indüksiyonunda propofol, fentanil ve rokuronyum, idamede sevofluran kullanıldı.

Operasyon standart sternotomi ve heparinizasyonu takiben kardiyopulmoner bypassta antegrad hipotermik kan kardiyoplejisiyle gerçekleştirildi. Kardiyopulmoner bypass'tan sorunsuz çıkıldı. Operasyon bitiminde remifentanil infüzyonu kesildi, hasta entübe şekilde kardiyovasküler cerrahi yoğun bakım ünitesine transfer edildi. Postoperatif 8. saatte ekstübasyon kriterleri sağlandıktan sonra ekstübe edildi. Takip dönemi sorunsuzdu. Hasta  postoperatif  5.gün komplikasyonsuz olarak taburcu edildi.

Sonuç olarak, MG'li hastalarda dikkatli bir preoperatif değerlendirme ve postoperatif takip, azaltılmış dozlarda kas gevşetici kullanımı ve antikolinesteraz tedaviye devam edilmesi ile kardiyopulmoner bypass eşliğinde açık kalp cerrahisi güvenle uygulanabilir.

Anahtar kelimeler: Miyasthenia Gravis, Aort kapak replasmanı, Anestezi yönetimi

ABSTRACT

General anesthesia was planned for aortic valve replacement in a 67-year-old patient with type II a Myasthenia Gravis, who were on pyridostigmine treatment for 18 months. Pyridostigmine treatment was continued on the morning of surgery. Propofol, fentanyl and rocuronium were administered for the induction of anesthesia, and sevoflurane for maintaining the surgery.

The operation was performed by a standard sternotomy and under antegrade hypothermic blood cardioplegia for cardiopulmonary bypass.  The cardiopulmonary bypass was uneventful. At the end of the operation, remifentanil infusion was discontinued, and the patient was transferred to the intensive care unit of cardiovascular surgery, being intubated. At 8 hours postoperatively, the patient who met the criteria for extubation was extubated. No problem occurred during follow-up.  The patient was discharged on 5 postoperative day without complication.

In conclusion, open heart surgery accompanied by cardiopulmonary bypass is likely to perform safely by careful preoperative evaluation and postoperative follow-up in patients with MG as well as administering muscle relaxant in reduced doses, and continuing treatment with anticholinesterase inhibitors.

Key Words: Myasthenia Gravis, Aortic Valve Replacement Surgery, Anesthesia Management

Geliş Tarihi: 16.05.2018 - Kabul Tarihi: 06.06.2018

[ PDF ]
<< Back Print
index