Girişimsel Nöroradyolojide Anestezi
Özet
Girişimsel nöroradyoloji (GNR), beyin ve omuriliğin damarsal hastalıklarını endovasküler yolla tedavi eden, multidisipliner yaklaşım gerektiren bir alandır. Bu süreçte anestezi yönetimi; hemodinamik stabiliteyi korumak, serebral perfüzyonu optimize etmek ve komplikasyonları önlemek açısından kritik öneme sahiptir. En sık uygulanan işlemler arasında anevrizma, arteriovenöz malformasyon (AVM) ve akut iskemik inme tedavileri yer alır. Anevrizma vakalarında rüptürü önlemek için tansiyon kontrolü hayatiyken, AVM ve AVF tedavilerinde kan akımını azaltmak amacıyla kontrollü hipotansiyon uygulanır. Akut iskemik inme vakalarında anestezi yöntemi (sedasyon veya genel anestezi), hastanın nörolojik durumuna ve hava yolu güvenliğine göre belirlenir. Genellikle kafa içi basıncı düşüren total intravenöz anestezi (TİVA) tercih edilir. Ameliyathane dışı bir ortamda gerçekleştirilen bu işlemlerde; yakın monitörizasyon, vücut ısısının korunması ve kontrast maddeye bağlı böbrek fonksiyonlarının takibi gereklidir. Trombotik olayları engellemek için heparin gibi antikoagülanlar kullanılırken, işlem sonrası nörolojik değerlendirme için hızlı derlenme hedeflenir. Başarılı bir sonuç için anestezist ve nöroradyolog arasında kesintisiz iletişim şarttır.
Interventional neuroradiology (INR) is a specialized field that treats vascular pathologies of the brain and spinal cord through endovascular routes, requiring a multidisciplinary approach. Anesthesia management is critical for maintaining hemodynamic stability, optimizing cerebral perfusion, and preventing complications. Common procedures include treatments for aneurysms, arteriovenous malformations (AVM), and acute ischemic stroke. In aneurysm cases, blood pressure control is vital to prevent rupture, while controlled hypotension is applied in AVM and AVF treatments to reduce blood flow. In acute ischemic stroke, the anesthesia method (sedation or general anesthesia) is determined based on the patient's neurological status and airway safety. Total intravenous anesthesia (TIVA) is generally preferred as it lowers intracranial pressure. These procedures, performed in out-of-operating room settings, require close monitoring, maintenance of body temperature, and tracking of renal functions due to contrast media. Anticoagulants like heparin are used to prevent thrombotic events, while rapid emergence is targeted for post-operative neurological assessment. Continuous communication between the anesthesiologist and neuroradiologist is essential for a successful outcome.
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