Conn Sendromlu Olguda Anestezi Yönetimi
Özet
Bu olgu sunumu, primer hiperaldosteronizm olarak da bilinen Conn sendromlu 29 yaşındaki kadın hastanın laparoskopik sağ total sürrenalektomi operasyonundaki anestezi yönetimini ele almaktadır. Conn sendromu; hipertansiyon, hipopotasemi ve metabolik alkaloz ile karakterize olup, anestezi uygulamaları açısından yüksek risk taşımaktadır. Hastanın preoperatif sürecinde sürekli hipopotasemi ve hipertansiyon öyküsü mevcut olup, tıbbi tedavisine operasyon gününe kadar devam edilmiştir. İntraoperatif dönemde, invaziv arteriyel monitörizasyon eşliğinde remifentanil ve sevofluran kullanılarak hemodinamik stabilite sağlanmıştır. Ameliyat sırasında saptanan derin hipopotasemi (1.9 mmol L-1) ve hafif metabolik alkaloz, kontrollü potasyum klorür infüzyonu ile başarıyla düzeltilmiştir. Kas gevşetici olarak roküronyum, bloğun geri döndürülmesinde ise nöromüsküler komplikasyon riskini azaltmak amacıyla sugammadeks tercih edilmiştir. Postoperatif dönemde hastanın semptomları düzelmiş, potasyum ve kan basıncı değerleri normale dönmüştür. Sonuç olarak, bu nadir hastalıkta preoperatif hazırlık, yakın elektrolit takibi ve uygun ajan seçimi başarılı bir anestezi yönetimi için kritiktir.
This case report discusses the anesthetic management of a 29-year-old female patient with Conn syndrome, also known as primary hyperaldosteronism, undergoing laparoscopic right total adrenalectomy. Conn syndrome is characterized by hypertension, hypokalemia, and metabolic alkalosis, presenting high risks for anesthesia. The patient had a history of persistent hypokalemia and hypertension, with medical treatment continuing until the day of surgery. During the intraoperative period, hemodynamic stability was maintained using remifentanil and sevoflurane under invasive arterial monitoring. Deep hypokalemia (1.9 mmol L-1) and mild metabolic alkalosis detected during surgery were successfully corrected with controlled potassium chloride infusion. Rocuronium was used as the muscle relaxant, and sugammadex was preferred for reversal to minimize the risk of neuromuscular complications. Postoperatively, the patient's symptoms resolved, and potassium and blood pressure levels returned to normal. In conclusion, preoperative preparation, close electrolyte monitoring, and appropriate agent selection are critical for successful anesthetic management in this rare disease.
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