Erişkin Gastrointestinal Endoskopi Olgularında Anestezi Yönetimi
Özet
Gastrointestinal endoskopik girişimlerin artan sayısı ve karmaşıklığı, özellikle geriatrik ve ek hastalığı olan popülasyonda anestezi yönetimini kritik hale getirmiştir. İşlem öncesinde ASA skorları, açlık süreleri ve komorbid durumların titizlikle değerlendirilmesi riskleri minimize eder. Anestezi yöntemi; hastanın durumuna ve işlemin türüne göre orta-derin sedasyon veya genel anestezi (entübasyon) olarak seçilir. Propofol, hızlı etkisiyle sık tercih edilse de dar terapötik indeksi nedeniyle dikkatli uygulanmalıdır; midazolam ve opioidler (fentanil, remifentanil) ise analjezi ve sedasyon desteği sağlar. Hava yolu yönetimi, hipoksi ve aspirasyon riskine karşı hayati önem taşır; özellikle ERCP ve akalazya gibi yüksek riskli durumlarda genel anestezi önerilir. İşlem sonrası hastalar, hemodinamik stabilite sağlanana kadar izlenmelidir. COVID-19 vakalarında ise kişisel koruyucu ekipman ve negatif basınçlı odalar kullanılmalıdır.
The increasing frequency and complexity of gastrointestinal endoscopic procedures have made anesthesia management critical, especially for geriatric and comorbid populations. Thorough preoperative assessment of ASA scores, fasting times, and comorbid conditions minimizes risks. The anesthesia method is selected as moderate-to-deep sedation or general anesthesia (intubation) based on the patient's condition and the type of procedure. Propofol is frequently preferred for its rapid onset but requires caution due to its narrow therapeutic index; midazolam and opioids (fentanyl, remifentanil) provide analgesia and sedation support. Airway management is vital against risks of hypoxia and aspiration, with general anesthesia recommended for high-risk cases like ERCP and achalasia. Post-procedure, patients must be monitored until hemodynamic stability is achieved. For COVID-19 cases, personal protective equipment and negative pressure rooms should be utilized.
Referanslar
75 Million Endoscopies Performed Annually According to iData Research Procedure Analysis. Available at: https://idataresearch.com/75-million-endoscopies-performed-annually-according-to-idata-research-procedure-analysis/ (Accessed on February 04, 2019).
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology 2017; 126:376.
Approved by the ASA House of Delegates on October 13, 1999, and last amended on October 15, 2014. Published in: American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96:1004. Copyright © 2002 & 2014 American Society of Anesthesiologists, Inc. Reproduced with permission from Lippincott Williams & Wilkins. Unauthorized reproduction of this material is prohibited.
Bhananker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 2006; 104:228.
Nay MA, Fromont L, Eugene A, et al. High-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation in patients at risk of hypoxaemia: a multicentre randomised controlled trial (ODEPHI trial). Br J Anaesth 2021; 127:133.
Khodadoostan M, Sadeghian S, Safaei A, et al. Viscous lidocaine solution versus lidocaine spray for pharyngeal local anesthesia in upper gastroesophageal endoscopy. J Res Med Sci 2018; 23:102.
Smith MR, Bell GD, Quine MA, et al. Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases. Br J Clin Pharmacol 1993; 36:573.
Cohen LB, Wecsler JS, Gaetano JN, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006; 101:967.
Haytural C, Aydınlı B, Demir B, et al. Comparison of Propofol, Propofol-Remifentanil, and Propofol-Fentanyl Administrations with Each Other Used for the Sedation of Patients to Undergo ERCP. Biomed Res Int 2015; 2015:465465.
Akhondzadeh R, Ghomeishi A, Nesioonpour S, Nourizade S. A comparison between the effects of propofol-fentanyl with propofol-ketamine for sedation in patients undergoing endoscopic retrograde cholangiopancreatography outside the operating room. Biomed J 2016; 39:145.
Goyal R, Hasnain S, Mittal S, Shreevastava S. A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP. Gastrointest Endosc 2016; 83:928.
Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol 2009; 22:502.
Goudra B, Nuzat A, Singh PM, et al. Association between Type of Sedation and the Adverse Events Associated with Gastrointestinal Endoscopy: An Analysis of 5 Years' Data from a Tertiary Center in the USA. Clin Endosc 2017; 50:161.
Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: A systematic review. World J Gastrointest Endosc 2013; 5:359.
