Hipertrofik Kardiyomiyopatili Hastada Anestezi Yönetimi
Özet
Hipertrofik kardiyomiyopati (HKMP), gençlerde ani kardiyak ölümün en yaygın nedeni olan ve anestezi yönetimi açısından kritik önem taşıyan genetik bir kardiyovasküler bozukluktur. Bu olgu sunumunda, üreter taşı nedeniyle üreteroskopi planlanan 46 yaşında bir erkek hastada, preoperatif değerlendirme sırasında tesadüfen saptanan HKMP ve buna yönelik anestezi yönetimi ele alınmaktadır. Hastanın EKG'sinde saptanan T negatifliği üzerine yapılan ekokardiyografide sol ventrikül hipertrofisi belirlenmiş ve HKMP tanısı konulmuştur. HKMP'li hastalarda anestezi yönetiminin temel hedefleri; sinüs ritminin korunması, preload ve afterload'un optimize edilmesi ve taşikardiden kaçınılmasıdır. Rejyonel anestezinin preload ve afterload'u azaltma riski nedeniyle hastaya genel anestezi uygulanmış, indüksiyonda propofol, ketamin, fentanil ve lidokain tercih edilerek larengeal maske (LMA) yerleştirilmiştir. Operasyon boyunca invaziv arteriyel basınç takibi yapılmış ve EKG'de vaka boyunca devam eden ST segment çökmesi dışında hemodinamik bir dengesizlik gözlenmemiştir. Postoperatif dönemde komplikasyon gelişmeyen hasta, üçüncü günde taburcu edilmiştir. HKMP'li vakalarda preoperatif detaylı değerlendirme, yakın peroperatif monitörizasyon ve olası komplikasyonlar için yoğun bakım hazırlığı hayati önem taşımaktadır.
Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disorder that is the most common cause of sudden cardiac death in young people and carries critical importance for anesthesia management. This case report details the anesthesia management of a 46-year-old male patient who was incidentally diagnosed with HCM during preoperative preparation for a planned ureteroscopy due to ureteral stones. Following the detection of T-wave negativity on the ECG, an echocardiography revealed left ventricular hypertrophy, leading to the diagnosis of HCM. The primary goals of anesthesia management in patients with HCM are maintaining sinus rhythm, optimizing preload and afterload, and avoiding tachycardia. Due to the risk of regional anesthesia decreasing preload and afterload, general anesthesia was performed; induction was achieved using propofol, ketamine, fentanyl, and lidocaine, and a laryngeal mask airway (LMA) was placed. Invasive arterial pressure was monitored throughout the operation, and no hemodynamic instability was observed other than persistent ST-segment depression on the ECG. The patient, who experienced no postoperative complications, was discharged on the third day. In surgical cases with HCM, detailed preoperative evaluation, close perioperative monitoring, and the availability of intensive care facilities for potential complications are vital.
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