Obstrüktif Uyku Apne Sendromlu Morbid Obez Olgunun Nazal CPAP Destekli Anestezi Yönetimi
Özet
Dünya genelinde artan obezite prevalansı, zor havayolu ve obstrüktif uyku apne sendromu (OSAS) gibi komorbiditeler nedeniyle anestezi yönetiminde özel yaklaşımlar gerektirmektedir. Bu vaka sunumunda, vücut kitle indeksi 47.8 kg/m² olan ve ağır OSAS tanısı bulunan 46 yaşındaki erkek hastanın endoskopik ultrasonografi (EUS) işlemi altındaki anestezi yönetimi paylaşılmıştır. Zor havayolu öngörülen hastada, ev tipi nazal sürekli pozitif havayolu basıncı (N-CPAP) cihazı ve nazal kanül aracılığıyla uygulanan sevofluran kombinasyonuyla sedasyon idamesi sağlanmıştır. İndüksiyonda midazolam, ketamin ve propofol kullanılmış; işlem sırasında gelişen laringospazm ek propofol dozuyla başarıyla yönetilmiştir. Obez hastalarda yağ dokusunun anestezik ajanlar için rezerv görevi görmesi nedeniyle, derlenme sürecini hızlandırmak adına inhalasyon ajanlarının kullanımı avantaj sağlamıştır. Sonuç olarak, OSAS’lı morbid obez hastalarda N-CPAP desteği ve nazal sevofluran uygulamasının, üst havayolu kollapsını önleyerek ve oksijenasyonu optimize ederek güvenli bir alternatif sunduğu gösterilmiştir.
Increasing obesity prevalence worldwide necessitates specialized anesthesia management due to comorbidities such as difficult airway and obstructive sleep apnea syndrome (OSAS). This case report presents the anesthesia management of a 46-year-old male patient with a body mass index of 47.8 kg/m² and severe OSAS during endoscopic ultrasonography (EUS). In the patient, for whom a difficult airway was predicted, sedation maintenance was achieved using a combination of a home-type nasal continuous positive airway pressure (N-CPAP) device and sevoflurane administered via nasal cannula. Induction was performed with midazolam, ketamine, and propofol; a laryngospasm that developed during the procedure was successfully managed with an additional dose of propofol. Since adipose tissue acts as a reservoir for anesthetic agents in obese patients, the use of inhalation agents provided an advantage in accelerating the recovery process. Consequently, it has been demonstrated that N-CPAP support and nasal sevoflurane application in morbidly obese patients with OSAS offer a safe alternative by preventing upper airway collapse and optimizing oxygenation.
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