Feokromositomalı Pediatrik Hastada Anestezi Yönetimi
Özet
On yaşındaki kız çocukta saptanan feokromositoma vakası üzerinden pediatrik hastalarda anestezi yönetimi ele alınmaktadır. Ailesel geçişli Von Hippel Lindau genetik bozukluğu bulunan hastada, ataklar halinde gelen hipertansiyon ve taşikardi şikayetleri mevcuttur. Preoperatif dönemde kan basıncı ve kalp hızı kontrolü için 14 gün boyunca alfa-bloker (doksazosin) ve ardından beta-bloker (propranolol) tedavisi uygulanmış, sıvı replasmanı ile damar içi hacim dengelenmiştir. Cerrahi sırasında invaziv arteriyel monitörizasyon ve santral venöz kateterizasyon eşliğinde sevofluran ve remifentanil ile anestezi sürdürülmüştür. Tümör manipülasyonu sırasında gelişen hipertansif ataklar nitrogliserin ile yönetilmiş, bilateral adrenelektomi sonrası adrenal yetmezliği önlemek için steroid replasmanına başlanmıştır. Operasyon sonrası hipoglisemi veya kalıcı hipotansiyon gözlenmeyen hasta, yedinci günde şifa ile taburcu edilmiştir. Sonuç olarak, feokromositoma cerrahisinde titiz preoperatif hazırlık ve dikkatli intraoperatif hemodinamik izlem, sağ kalımı ve başarıyı artıran temel unsurlardır.
Anaesthesia management in a pediatric patient with pheochromocytoma is discussed through the case of a ten-year-old girl. The patient, who had familial Von Hippel Lindau genetic disorder, presented with episodic hypertension and tachycardia. During the preoperative period, alpha-blocker (doxazosin) and subsequently beta-blocker (propranolol) treatments were administered for 14 days to control blood pressure and heart rate, while intravascular volume was balanced with fluid replacement. During surgery, anesthesia was maintained with sevoflurane and remifentanil under invasive arterial monitoring and central venous catheterization. Hypertensive episodes during tumor manipulation were managed with nitroglycerin, and steroid replacement was initiated to prevent adrenal insufficiency following bilateral adrenalectomy. The patient, who did not develop hypoglycemia or persistent hypotension postoperatively, was discharged in good health on the seventh day. In conclusion, meticulous preoperative preparation and careful intraoperative hemodynamic monitoring in pheochromocytoma surgery are essential elements that increase survival and success.
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Abacı A. Adrenal Hastalıklarda Perioperatif Yaklaşım http://www.cocukendokrindiyabet.org/uploads/dokumanlar/C3WWmKNOWHva32oZS4OB.pdf
