Yüksek Kardiyak ve Pulmoner Riskli Olgularda Ultrasonografi Rehberliğinde Rejyonel Anestezi
Özet
Yüksek kardiyak ve pulmoner risk taşıyan cerrahi hastalarında anestezi yöntemi seçimi, perioperatif mortalite ve morbiditeyi doğrudan etkileyen kritik bir karardır. Genel anestezi, özellikle ciddi kalp yetmezliği veya aktif solunum yolu enfeksiyonu olan bireylerde sistemik komplikasyon riskini önemli ölçüde artırabilir. Bu bağlamda, ultrasonografi (USG) rehberliğinde uygulanan periferik sinir blokları (PSB), hemodinamik stabiliteyi koruyan ve solunum fonksiyonları üzerindeki etkileri minimal olan güvenli bir alternatif sunmaktadır. Sunulan olguların ilkinde, ejeksiyon fraksiyonu %25 olan ASA IV bir hastaya göbek fıtığı cerrahisi için bilateral rektus kılıf bloğu uygulanmış ve sorunsuz bir süreç yönetilmiştir. İkinci olguda ise solunum yolu enfeksiyonu nedeniyle yüksek pulmoner risk taşıyan 2 yaşındaki bir çocuğa, acil humerus kırığı cerrahisi için supraklaviküler brakiyal pleksus bloğu yapılmıştır. Her iki vakada da USG kullanımı, blok başarısını artırırken lokal anestezik dozunun minimize edilmesine ve olası toksisite riskinin azaltılmasına olanak tanımıştır. Sonuç olarak, PSB teknikleri üstün analjezi sağlamanın yanı sıra hastanede yatış süresini kısaltarak yüksek riskli gruplarda efektif bir yönetim stratejisi oluşturmaktadır.
Selecting the anesthesia method for surgical patients with high cardiac and pulmonary risk is a critical decision that directly impacts perioperative mortality and morbidity. General anesthesia can significantly increase the risk of systemic complications, particularly in individuals with severe heart failure or active respiratory tract infections. In this context, ultrasound (USG)-guided peripheral nerve blocks (PNB) offer a safe alternative that maintains hemodynamic stability and has minimal effects on respiratory functions. In the first case presented, a bilateral rectus sheath block was applied to an ASA IV patient with an ejection fraction of 25% for umbilical hernia surgery, and the process was managed without complications. In the second case, a supraclavicular brachial plexus block was performed for emergency humerus fracture surgery on a 2-year-old child with high pulmonary risk due to a respiratory infection. In both cases, the use of USG increased block success while allowing for minimized local anesthetic doses and reduced risk of potential toxicity. Consequently, PNB techniques constitute an effective management strategy in high-risk groups by providing superior analgesia and shortening hospital stays
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