Omurilik Acillerinde Anestezi Yönetimi
Özet
Acil omurilik yaralanmaları, yüksek mortalite ve morbidite oranları nedeniyle dünya genelinde kritik bir sağlık sorunudur. Bu vakaların anestezi yönetimi; havayolu stabilizasyonu, hemodinamik dengenin korunması ve nöromonitorizasyon sinyallerinin doğru yorumlanması gibi zorlukları beraberinde getirir. C3-C5 seviyesindeki hasarlar diyafram fonksiyonunu bozarak solunum yetmezliğine yol açarken, T1-T4 seviyesindeki yaralanmalar vagal bradikardi ve nörojenik şoka neden olabilir. Preoperatif dönemde radyolojik inceleme ve nörolojik değerlendirme hayati önem taşır. Entübasyon sırasında servikal omurganın korunması için aşırı hareketten kaçınılmalı, ciddi yaralanmalarda uyanık fiberoptik entübasyon tercih edilmelidir. İntraoperatif süreçte, nöromonitorizasyon kullanılacaksa sinyalleri etkilemeyen total intravenöz anestezi (TIVA) önerilir. Hemodinamik yönetimde ortalama arter basıncının 50 mmHg üzerinde tutulması ve uygun vazopresör kullanımı sekonder hasarları önlemek için kritiktir. Ayrıca, kronik dönemdeki T7 üzeri yaralanmalarda otonom hiperrefleksi riskine karşı derin anestezi uygulanmalıdır. Postoperatif süreçte ise laringofaringeal ödem gibi havayolu komplikasyonlarına hazırlıklı olunmalı ve multimodal ağrı tedavisi planlanmalıdır.
Emergency spinal cord injuries are a critical global health issue due to high mortality and morbidity rates. Anesthesia management of these cases involves challenges such as airway stabilization, maintaining hemodynamic balance, and correct interpretation of neuromonitoring signals. Injuries at the C3-C5 level cause respiratory failure by impairing diaphragm function, while injuries at the T1-T4 level can lead to vagal bradycardia and neurogenic shock. Radiological examination and neurological assessment are vital in the preoperative period. During intubation, excessive movement must be avoided to protect the cervical spine, and awake fiberoptic intubation is preferred in severe injuries. During the intraoperative process, if neuromonitoring is to be used, total intravenous anesthesia (TIVA), which does not affect signals, is recommended. In hemodynamic management, maintaining mean arterial pressure above 50 mmHg and using appropriate vasopressors are critical to prevent secondary damage. Additionally, deep anesthesia should be applied against the risk of autonomic hyperreflexia in injuries above T7 in the chronic period. In the postoperative period, one should be prepared for airway complications such as laryngopharyngeal edema, and multimodal pain treatment should be planned.
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