Karotis Endarterektomi Sonrası Boyun Hematomu Olan Hastada Havayolu Yönetimi ve Oksijen Reserv İndeks Monitörizasyonu
Özet
Karotis endarterektomi (KEA) sonrası gelişen boyun hematomu, hava yolu obstrüksiyonuna yol açabilen ve acil cerrahi müdahale gerektiren ciddi bir komplikasyondur. Bu vakada, KEA sonrası dispne ve stridor şikayetleriyle başvuran 68 yaşındaki bir erkek hastanın zor hava yolu yönetimi ele alınmıştır. Fiziksel muayene ve görüntülemeler sonucunda sağ boyunda büyük bir hematom ve trakeal deviasyon saptanmıştır. Zor hava yolu öngörülen hastada, geleneksel yöntemlere ek olarak Oksijen Rezerv İndeksi (ORI) monitörizasyonu kullanılmıştır. ORI, özellikle orta dereceli hiperoksik aralıkta (PaO2 100-200 mmHg) oksijenasyon değişimlerini noninvaziv ve anlık olarak takip eden yeni bir parametredir. Başlangıçta preoksijenizasyona rağmen düşük seyreden oksijen değerleri, sedoanaljezi altında yapılan minör hematom eksplorasyonu ile hematom basısının azaltılması sonucu yükselmiş; ORI değerinin 0'dan 0.24'e çıkmasıyla güvenli indüksiyon sağlanmıştır. Hasta, videolaringoskopi eşliğinde başarılı bir şekilde entübe edilmiş ve postoperatif dönemde sorunsuz taburcu edilmiştir. Sonuç olarak ORI, zor hava yolu yönetiminde desatürasyonu önceden tahmin eden etkili bir erken uyarı sistemi olarak hasta güvenliğini artırmaktadır.
Neck hematoma following carotid endarterectomy (CEA) is a serious complication that can cause airway obstruction and require emergency surgical intervention. This case discusses the difficult airway management of a 68-year-old male patient who presented with dyspnea and stridor after CEA. Physical examination and imaging revealed a large hematoma in the right neck and tracheal deviation. In addition to conventional methods, Oxygen Reserve Index (ORI) monitoring was utilized for this patient with a predicted difficult airway. ORI is a novel parameter that noninvasively and instantaneously monitors changes in oxygenation, particularly in the moderate hyperoxic range (PaO2 100-200 mmHg). Despite initial preoxygenation, oxygen levels remained low but improved following a minor hematoma exploration under sedoanalgesia to reduce pressure; induction was safely performed once the ORI value rose from 0 to 0.24. The patient was successfully intubated via video laryngoscopy and discharged without complications postoperatively. In conclusion, ORI enhances patient safety in difficult airway management as an effective early warning system for predicting desaturation.
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