Multipl Skleroz Tanılı, Mastektomi Operasyonuna Alınan Olguda Anestezi Yönetimi
Özet
İnvaziv meme kanseri teşhisi ile sol total mastektomi, aksiller diseksiyon ve protez operasyonu planlanan hastanın, preoperatif anestezi değerlendirilmesinde Multipl Skleroz (MS) tanısı aldığı, takipli ve son iki yıldır ise remisyon aşamasında olduğu öğrenildi. Nöroloji konsültasyonunda, taraf bulgusuna rastlanılmadığı, hastanın opere olmasında sakınca olmadığı belirtildi. Ameliyathane odasına alınan hasta elektrokardiyografi (EKG), non invaziv kan basıncı (KB), puls oksimetre, sağ orta parmak ve özofagial bölgeye yerleştirilen ısı probları ile monitörize edildi. Isıtıcı blanket kullanılmadı. Anestezi indüksiyonu, 0.03 mg kg-1 midazolam, 1µg kg-1 fentanil, 2 mg kg-1 propofol bolus infüzyonunu takiben 0.6 mg kg-1 roküronyum ile sağlandı. İdamesine volatil anestezik olarak desfluran ve ortalama 0.1 µg kg-1 dk-1 remifentanil infüzyonu ile devam edildi. Postoperatif analjezi amacıyla hastaya 1000 mg parasetamol ve 1mg kg-1 tramadol hidroklorür infüzyon şeklinde uygulandı. Operasyon süresince hastanın vital bulguları stabildi. Ek doz roküronyum kullanılmadı. Nöromüsküler blokaj 2 mg kg-1 sugammadeks ile antagonize edildi. Oksijenizasyonu, hemodinamik verileri ve sözlü uyaranlara yanıtı iyi olan hasta, postoperatif takip amacıyla derlenme ünitesine ekstübe edilmiş olarak transfer edildi. Postoperatif 15. günde telefonla yapılan görüşmede herhangi bir alevlenme bulgusuna rastlanılmadı.
A patient scheduled for a left total mastectomy, axillary dissection, and prosthesis operation with a diagnosis of invasive breast cancer was found to have a history of Multiple Sclerosis (MS) during the preoperative anesthesia evaluation, which was being followed up and had been in remission for the past two years. In the neurology consultation, no lateralizing signs were found, and it was stated that there was no contraindication for the patient to undergo surgery. Upon being taken into the operating room, the patient was monitored with electrocardiography (ECG), non-invasive blood pressure (BP), pulse oximetry, and temperature probes placed on the right middle finger and esophageal region. A warming blanket was not used. Anesthesia induction was achieved with 0.03 mg kg⁻¹ midazolam, 1 µg kg⁻¹ fentanyl, and 2 mg kg⁻¹ propofol bolus infusion, followed by 0.6 mg kg⁻¹ rocuronium. Maintenance was continued with desflurane as the volatile anesthetic and an average of 0.1 µg kg⁻¹ min⁻¹ remifentanil infusion. For postoperative analgesia, 1000 mg paracetamol and 1 mg kg⁻¹ tramadol hydrochloride were administered to the patient via infusion. The patient's vital signs were stable throughout the operation. No additional doses of rocuronium were used. Neuromuscular blockade was antagonized with 2 mg kg⁻¹ sugammadex. The patient, whose oxygenation, hemodynamic data, and response to verbal commands were good, was transferred to the recovery unit extubated for postoperative follow-up. In a telephone interview conducted on the postoperative 15th day, no signs of exacerbation were observed.
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