Anesthesia Management in the Surgical Treatment of Venous System Diseases
Özet
Venous system diseases (VSD) present significant health and socioeconomic challenges, prompting a shift from conventional surgeries like ligation and stripping to minimally invasive techniques such as radiofrequency ablation, endovascular ablation, n-butyl cyanoacrylate, and foam sclerotherapy. This transition highlights the critical role of choosing the right anesthetic approach—including general anesthesia, spinal anesthesia, peripheral nerve blocks, and tumescent anesthesia—tailored to patient characteristics and surgical needs. General anesthesia, though less common, is reserved for complex open surgeries and high-risk patients to maintain hemodynamic stability. Spinal anesthesia offers a rapid onset, keeping patients awake while promoting early mobilization, often utilizing low-dose bupivacaine for stable outcomes. Peripheral nerve blocks, such as femoral and sciatic nerve blocks, serve as excellent alternatives for day surgeries by minimizing cognitive impact and reducing vasospasms. Tumescent anesthesia, which involves infusing a large volume of diluted local anesthetic solution, provides extensive regional anesthesia, mitigates bleeding, and protects surrounding tissues from thermal damage during laser or radiofrequency procedures. Ultimately, selecting the optimal anesthesia method requires careful, collaborative evaluation by both the anesthesiologist and the surgeon to maximize patient safety and comfort.
Referanslar
Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg. 2004; 40(4): 650-9.
Cires Drouet RS, Fangyang L, Rosenberger S, Startzel M, Kidwell M, Yokemick J, et al. High prevalence of chronic venous disease among health care workers in the United States. J Vasc Surg Venous Lymphat Disord. 2020; 8(2): 224-30.
Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpantier P and et al. Management of chronic venous disorders of the lower limbs: Guidelines according to scientific evidence. International Angiology. 2008; 27: 1-59.
Royle J, Somjen GM. Varicose veins: Hippocrates to Jerry Moore. ANZ J Surg. 2007; 77 (12): 1120-7.
Shami SK, Sarin S, Cheatle TR, Scurr JH, Smith PD. Venous ulcers and the superficial venous system. J VascSurg. 1993; 17(3): 487-90.
Sünbül AS, Kahraman N, Demir D, Gücü A, Göncü MT, Özyazıcıoğlu AF. Varis cerrahisi. Kahraman N, editör. Venöz ve Lenfatik Sistem Hastalıkları.1. Baskı. Ankara: Akademisyen Kitabevi; 2020. p.91-110.
Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013; 58 (3): 727-34.
Sayan HE. Varis cerrahisinde anestezi. Kahraman N, editör. Venöz ve Lenfatik Sistem Hastalıkları.1. Baskı. Ankara: Akademisyen Kitabevi; 2020. p. 233-46.
Luger TJ, Kammerlander C, Luger MF, Kammerlander-Knauer U, Gosch M. Mode of anesthesia, mortality and outcome in geriatric patients. Z Gerontol Geriatr. 2014; 47(2): 110-24.
Smith I, Joshi G. The laryngeal mask airway for outpatient anesthesia. J Clin Anesth. 1993; 5: 22-8.
Kayhan Z. Santral bloklar. Klinik Anestezi. 3. baskı. Ankara: Logos Yayıncılık; 2005. p.552-87.
Valentin N, Lomholt B, Jensen JS, et al. Spinal or general anaesthesia for surgery of the fractured hip. Br J Anaesth. 1986; 58: 284-91.
Dahl V, Gierloff C, Omland E, Raeder JC. Spinal, epidural or propofol anaesthesia for outpatient knee arthroscopy? Acta Anaesthesiol Scand. 1997; 41: 1341-5.
Muhammedoğlu N, Başaranoğlu G, Teker MG, Umutoglu T, Ozdemir H, Küçük S, et al. Varicose Vein Stripping Under Low-Dose Spinal Anaesthesia. Haseki Tıp Bülteni, 2014; 52: 25-8.
Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, Sumida SM, et al. Analgesic efficacy of ultrasound-guided regional anesthesia: a metaanalysis. J ClinAnesth. 2011; 23(2): 90-6.
Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A, et al. Cardiovascular effects of two different regional anesthetic techniques for unilateral leg surgery. Acta Anaesth Scand. 1998; 42: 80-4.
Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001; 95(4): 875-80.
Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018; 43(3): 263-309.
Aysel İ. Alt ekstremite blokları. Ultrasonografi ve nörostimülatör eşliğinde periferik sinir blokları. 1.baskı. Ankara: Palme Yayıncılık; 2013.p.241-50.
Ehab F, Loran MS, Brown DL. Brown's Atlas of Regional Anesthesia. Fifth Edition. Philadelphia, PA: Elsevier, Inc; Chapter 14, pp.115-26.
Jeng CL, Rosenblatt MA. Lower extremity nerve blocks: Techniques 2020, October 09. <https://www.uptodate.com/contents/lower-extremity-nerve-blocks-techniques>
Mansour NY, Benetts FE. An observational study of combined continuous lumbar plexus and single-shot sciatic nerve blocks for post-knee surgery analgesia. Reg Anesth. 1996; 21: 287-91.
Klein J. The Tumescent Technique for Lipo-Suction Surgery. Am J Cosmet Surg. 1987; 4(4): 263-7.
Cohn MS, Seıger E, Goldman S. Ambulatory phlebectomy using the tumescent technique for local anesthesia. Dermatol Surg. 1995; 21(4): 315-8.
Ozyaprak B, Kahraman N, Erkan G, Eroglu A. Experience of Peripheral Arterial Disease Surgery with Tumescent Local Anesthesia. Int J AnesthRes. 2019; 7(3): 572-6.
Yılmaz S, Barış Ö, Yalçınkaya A, Yılmaz BK. Extra anatomic by-pass with tumescent anesthesia: a case report. Kocaeli Tıp Dergisi. 2016; 5(2): 46-50.
Ostad A, Kageyama N, May RL. Tumescent anaesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996; 22: 921-7.
Sidawy Anton N, Perler Bruce A. Rutherford's vascular surgery and endovascular therapy. Ninth edition, Philadelphia, PA: Elsevier, Inc; 2019. pp154- 5.
Merchant RF, Min RJ, Morrison N. Endovenous thermal ablation in the management of varicose veins. Fronek HS. eds, The Fundamentals of Phlebology: Venous Disease for Clinicians. London: Royal Society of Medicine Press. 2008. pp.28.
Klein JA. Tumescent technique chronicles: local anesthesia, liposuction, and beyond. Dermatol Surg. 1995; 21: 449- 547
Lapid O. Syringe-delivered tumescent anesthesia made easier. Aesthetic Plast Surg. 2011; 35(4):601-2.
Bush RG, Hammond KA. Tumescent anesthetic technique for long saphenous stripping. J Am Coll Surg. 1999; 189(6): 626-8.
