İntraoperatif Radyoterapi Sırasında Anestezi
Özet
İntraoperatif radyoterapi (IORT), cerrahi esnasında tümör yatağına doğrudan ve yüksek dozda radyasyon uygulanarak sağlıklı dokuların maksimum düzeyde korunmasını hedefleyen çok disiplinli bir tedavi yöntemidir. Bu süreçte anesteziyologlar; preoperatif değerlendirme, anestezi yönetimi ve işlem boyunca hastanın vital bulgularının izlenmesi gibi kritik sorumluluklar üstlenmektedir. IORT uygulamalarında, hastanın hareketsizliğini sağlamak ve hedef hacmin radyasyon dozunu korumak amacıyla genellikle trakeal entübasyon ile genel anestezi tercih edilirken, total intravenöz anestezi (TIVA) alternatifleri de değerlendirilebilir. Cerrahi süreç genel olarak konvansiyonel yöntemlerle benzerlik gösterse de, ameliyat süresinin uzaması, hasta nakli veya pozisyon değişiklikleri ile ışınlama esnasında personelin odayı terk etmesi gibi IORT'ye özgü perioperatif zorluklar mevcuttur. Özellikle radyasyon verilirken hastanın kapalı devre kamera sistemleri ve uzaktan izleme enstrümanları ile takip edilme zorunluluğu, anestezi yönetimi açısından stresli ve dikkat gerektiren en kritik aşamayı oluşturmaktadır. Sonuç olarak, IORT anestezi yönetiminin başarısı; risklerin azaltılması adına kapsamlı bir preoperatif değerlendirmeye, radyasyondan korunma önlemlerinin eksiksiz uygulanmasına ve multidisipliner ekiple yakın bir işbirliğine dayanmaktadır.
Intraoperative radiotherapy (IORT) is a multidisciplinary treatment modality that delivers high doses of radiation directly to the tumor bed during surgery, minimizing exposure to surrounding healthy tissues. Within this complex framework, anesthesiologists play a pivotal role, encompassing preoperative assessment, anesthesia administration, meticulous monitoring of vital parameters, and immediate intervention during emergencies. To ensure complete immobility and prevent any displacement of the target volume during irradiation, conventional general anesthesia with tracheal intubation is routinely preferred, although total intravenous anesthesia (TIVA) remains a viable option. While the anesthetic procedure aligns closely with standard surgeries, it presents unique perioperatif challenges, such as prolonged surgical durations, potential patient transport, positional adjustments, and the mandatory evacuation of medical staff during radiation delivery. The most critical phase for the anesthesia team involves the remote management of the patient via closed-circuit monitors and specialized audio systems while the operating room is isolated. Ultimately, achieving optimal outcomes in IORT requires thorough preoperative evaluation to mitigate acute radiation risks, robust radiation protection workflows including lead shielding, and precise collaborative execution across the multidisciplinary oncological team.
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