Kronik Spinal Kord Hasarlı Sezaryen Hastasında Anestezi Yönetimi
Özet
Kronik Spinal kord hasarlı hastaların cerrahi girişimlerinde anestezi yönetimi çok önemlidir. Anestezi altında ve cerrahi işlem sırasında otonomik hiperrefleksi, şiddetli hipotansiyon, ciddi aritmiler, kardiyak arrest gibi komplikasyonlar gelişebilir. Bu hastalarda otonomik hiperrefleksi oldukça inatçı ve anesteziklere yanıt vermeyebilir. Ameliyatın kendisi bile durumu tetikleyebilir. Bu gebelerde ağırlaşmış komplikasyonlar görülmektedir. Azalmış solunum rezervi ve baskılanmış öksürük refleksi gelişebilmektedir. İnterkostal kas hasarı gelişmişse ve abdominal kas fonksiyonu bozulmuşsa pnömoni ve atelektazi ile karşılaşılabilir. Anemi ve derin ven trombozu olabilir. İdrar yolu enfeksiyonları, proteinüri, böbrek yetersizliği görülebilir. Dermatolojik olarak uzun süreli yatmalara bağlı dekübitis ülserleri görülebilir ve bozulmuş termoregülasyonla karşılaşılabilir. Kas gevşeticilere karşı artmış bir hassasiyet nedeniyle gelişen hiperkalemi de anestezisti ilgilendiren diğer bir problemdir. Bu olgu sunumunda kronik spinal kord hasarlı hastada sezaryen anestezisi yönetiminden bahsedilccektir (1,2).
Anesthetic management is crucial during surgical interventions in patients with chronic spinal cord injury. Complications such as autonomic hyperreflexia, severe hypotension, serious arrhythmias, and cardiac arrest can develop under anesthesia and during the surgical procedure. In these patients, autonomic hyperreflexia can be highly refractory and may not respond to anesthetics; the surgery itself can even trigger the condition. Aggravated complications are observed in these pregnant patients. Decreased respiratory reserve and a suppressed cough reflex may develop. If intercostal muscle injury has occurred and abdominal muscle function is impaired, pneumonia and atelectasis may be encountered. Anemia and deep vein thrombosis may occur. Urinary tract infections, proteinuria, and renal failure can be seen. Dermatologically, decubitus ulcers due to prolonged recumbency may be observed, and impaired thermoregulation may be encountered. Hyperkalemia, which develops due to an increased sensitivity to muscle relaxants, is another problem of concern for the anesthesiologist. In this case report, the management of cesarean section anesthesia in a patient with chronic spinal cord injury will be discussed (1,2).
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