İnferior Vena Kavaya Tümör İnvazyonunun Eşlik Ettiği Malignite Olgularında Anestezi Yönetimi
Özet
İnferior vena kava (İVK) tutulumu gösteren malign karın içi kitlelerin anestezi yönetimi, üç farklı olgu üzerinden incelenmektedir. İlk iki olguda renal ve adrenal kaynaklı tümörlerin sağ atriyuma kadar uzandığı veya masif emboliye yol açtığı görülmüş; cerrahi ve teknolojik tüm desteğe rağmen hastalar kaybedilmiştir. Üçüncü olguda ise İVK'ye bası yapan retroperitoneal kitle, başarılı bir sıvı yönetimi ve anlık izlemle sorunsuz bir şekilde eksize edilmiştir. Vakalar, bu tür yüksek riskli operasyonlarda transözofageal ekokardiyografinin (TEE) hem tanı hem de cerrahiyi yönlendirmedeki hayati önemini ortaya koymaktadır. Özellikle intraoperatif süreçte gelişebilecek ani hemodinamik dalgalanmaların ve emboli riskinin yönetilmesinde TEE, gerçek zamanlı görüntüleme sağlayarak ekibe kritik avantajlar sunar. Sonuç olarak, İVK tutulumu olan majör vakaların; kardiyovasküler cerrahi erişimi, kardiyopulmoner bypass (KPB), ECMO ve deneyimli bir anestezi ekibine sahip tam teşekküllü merkezlerde yönetilmesi önerilmektedir.
The anesthetic management of malignant intra-abdominal masses with inferior vena cava (IVC) involvement is examined through three different cases. In the first two cases, renal and adrenal tumors were found to extend to the right atrium or cause massive embolism; despite all surgical and technological support, the patients were lost. In the third case, a retroperitoneal mass compressing the IVC was successfully excised without complications, thanks to effective fluid management and instantaneous monitoring. The cases demonstrate the vital importance of transesophageal echocardiography (TEE) in both diagnosis and guiding surgery in such high-risk operations. TEE provides a critical advantage to the team by offering real-time imaging, especially in managing sudden hemodynamic fluctuations and embolism risks that may develop intraoperatively. In conclusion, it is recommended that major cases with IVC involvement be managed in fully equipped centers with cardiovascular surgery access, cardiopulmonary bypass (CPB), ECMO, and an experienced anesthesia team.
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