Pediatrik EPS Hastalarında BİS Kullanımının Önemi
Özet
Pediyatrik yaş grubundaki elektrofizyolojik çalışma (EPS) işlemlerinde, aritmilerin baskılanmasını önlemek için kullanılan anestezik ilaçların dozları ve seçimleri kritik bir öneme sahiptir. Bu süreçte Bispektral İndeks (BİS) sistemi, hastanın sedasyon derinliğini ve beyin aktivitesini takip ederek hem yetersiz anestezi riskini hem de aşırı dozun neden olabileceği kardiyovasküler instabiliteyi minimize eder. Özellikle çocuklarda intraoperatif farkındalık riskinin yüksek olması, BİS kullanımını anestezi derinliğinin optimize edilmesi ve hasta konforunun artırılması açısından değerli bir rehber haline getirmektedir.
Anesthesia management and the choice of drugs are vital in pediatric electrophysiologic study (EPS) procedures to ensure successful arrhythmia induction and treatment. The Bispectral Index (BIS) system monitors sedation depth and brain activity, helping clinicians avoid both intraoperative awareness and the hemodynamic side effects of excessive anesthetic doses. Given the higher risk of awareness in children compared to adults, BIS provides a significant advantage in optimizing anesthesia depth and enhancing post-operative recovery.
Referanslar
Erdem A. Yazıcı M. The Cardiac Electrophysiologic Study. doi: 10.5505/abantmedj.2012.03521
Muresan L, Cismaru G, Martins RP, Bataglia A, Rosu R, Puiu M, Gusetu G, Mada RO, Muresan C, Ispas DR, Le Bouar R, Diene LL, Rugina E, Levy J, Klein C, Sellal JM, Poull IM, Laurent G, de Chillou C. Recommendations for the use of electrophysiological study: Hellenic J Cardiol. 2019 Mar-Apr;60(2):82-100. doi: 10.1016/j.hjc.2018.09.002. Epub 2018 Sep 29. PMID: 30278230
Peach C. ,Wagner F. , Strehlow V. , Gebauer R.A. Drug-Induced Loss of Preexcitation in Pediatric Patient with WPW Pattern During Electrophysiologic Study. Pediatric Cardiology doi: 10.1007/s00246-018-1979-4
Vladinov G. Fermin L. Longini R. Ramos Y. Maratea E. (2018). Choosing the anesthetic and sedative drugs for supraventricular tachycardia ablations: A focused review. Pacing and Clinical Electrophysiology, doi:10.1111/pace.13511
Sharpe MD, Cuillerier DJ, Lee JK, et al. Sevoflurane Has No Effect on Sinoatrial Node Function or on Normal Atrioventricular and Accessory Pathway Conduction in Wolff-Parkinson-White Syndrome during Alfentanil/Midazolam Anesthesia. Anesthesiology. 1999;90(1):60-65. doi:10.1097/00000542-199901000-00010.
Yip AS, Mcguire MA, Davis L, et al. Lack off effect of midazolam on inducibility of arrhythmias aelectrophysiologic study. Am J Cardiol. 1992;70(6):593-597. doi:10.1016/0002-9149(92)90197-7
Erb TO, Kanter RJ, Hall JM, Gan TJ, Kern FH, Schulman SR. Comparison of electrophysiologic effects of propofol and isoflurane-based anesthetics in children under-going radiofrequency catheter ablation for supraventricular tachycardia. Anesthesiology 2002; 96:1386-1394
Warpechowski P, Lima GG, Medeiros CM, et al. Randomized study of propofol effect on electrophysiological properties of the atrioventricular node in patients with nodal reentrant tachycardia. Pacing Clin Electrophysiol 2006; 29: 1375-1382
Niksch A, Liberman L, Clapcich A, Schwarzenberger JC, Silver ES, Pass RH. Effects of remifentanil anesthesia on cardiac electrophysiologic properties in children undergoing catheter ablation of supraventricular tachycardia. Pediatr Cardiol 2010;31:1079-1082
Hemings HC & Egan TD, Pharmacology and physiology for anesthesia: foundations and clinical application, Philadelphia, PA: Elsevier Saunders [2013]
Thomas, S. P., Thakkar, J., Kovvor, P., Thiagalingam, A., Ross, D.L. (2014). Sedation for electrophysiological procedures. Pace 37 (0) 781-790. doi: 10.1111/pace.12370
Lau W, Kovoor P, Ross DL. Cardiac electrophysiologic effects of midazolam combined with fentanyl. Am J Cardiol. 1993;72(2):177-182. doi:10.1016/0002-9149(93)90156-7
Sinner B, Graf BM. Ketamine, Handb Exp Pharmacol , 2008; 182:313-33
Anderson R, Harukuni I, & Sera V. Anesthetic considerations for electrophysiologic procedures. Anesthesiol Clin, 2013; 31(2), 479-489. doi:10.1016/j.anclin.2013.01.005
Char D, Drover DR, Motonaga KS, Gupta S, Miyake CY, Dubin AM, & Hammer GB. The effects of ketamine on dexmedetomidine‐induced electrophysiologic changes in children. Paediatr Anaesth. 2013;23(10):898-905.
Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol. 2006. PMID: 16634416 Review.
Murat I, Constant I & Maud’huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatric Anaesthesia 2004; 14: 158–166.
Davidson AJ, Huang GH, Czarnecki C et al. Awareness during anesthesia in children: a prospective cohort study. Anesthesia & Analgesia 2005; 100: 653–661.
Davis PJ. Goldilocks: the pediatric anesthesiologist’s dilemma. Anesthesia & Analgesia 2005; 100: 650–652.
