Uyanık Video Yardımlı Torakoskopi Yapılan Olguda Anestezi Yönetimi
Özet
Günümüzde minimal invaziv tekniklerin kullanımının gittikçe artmasıyla spontan solunumla uyanık olarak uygulanan video yardımlı toraks cerrahisi olgularının sayısı da her geçen gün artmaktadır. Uyanık video yardımlı torakoskopi (VATS)’nin tercih edilmesindeki en önemli nedenler genel anesteziye ait risklerden başlıca entübasyona bağlı travma, pnömoni, ventilatöre bağlı akciğer hasarı, nöromüsküler bloke edici ajanların etkileri ve postoperatif bulantı ve kusma gibi potansiyel risklerle ilişkili yan etkilerden kaçınmaktır. Daha fazla hasta memnuniyeti ve hemşirelik bakımında tasarruf, daha az ağrı, erken mobilizasyon, düşük morbidite oranı, daha az hastanede yatış süresi, başlıca avantajları arasında görülür. Uyanık VATS ameliyatlarının başarısı uygun hasta seçimi anestezistin ve cerrahın deneyimi hastaya uygun anestezi seçimi ve ekibin koordinasyonu gereğinde hasta güvenliği açısından genel anesteziye geçilecek şekilde pozisyon alınmalıdır.
Today, with the increasing use of minimally invasive techniques, the number of video-assisted thoracic surgery cases performed while awake with spontaneous breathing is increasing day by day. The most important reasons for choosing awake VATS are to avoid the risks associated with general anesthesia, such as side effects related to potential risks such as intubation-related trauma, pneumonia, ventilator-related lung damage, effects of neuromuscular blocking agents, and postoperative nausea and vomiting. More patient satisfaction and savings in nursing care, less pain, early mobilization, low morbidity rate, and shorter hospital stay are among the main advantages. For the success of awake VATS surgeries, appropriate patient selection, experience of the anesthesiologist and surgeon, selection of anesthesia suitable for the patient and coordination of the team, a position should be taken to switch to general anesthesia for patient safety.
Referanslar
Irons J F, Martinez G. Anaesthetic considerations for non-intubated thoracic surgery J Vis Surg. 2016; 2: 61.
Morgan GE, Mikhail MS, Murray MJ. Anesthesia for thoracic surgery. In: Morgan GE, Mikhail MS, Murray MJ, eds. Clinical Anesthesiology. 4th ed. New York: McGraw-Hill, 2006:585-613.
Benumof JL, Alfery DD. Anesthesia for thoracic surgery. In: Miller RD (ed). Anesthesia. 5th ed. Philadelphia: Churchill-Livingstone, 2000; 1665-1752.
Benumof JL. Separation of the two lungs (double-lumen tube and bronchial blocker intubation). In: Benumof JL (ed). Anesthesia for Thoracic Surgery. 2nd ed. Philadelphia: W.B. Saunders Company, 1995; 330-389.
Vale R. Selective brochial blocking in a small child. Case report. Br J Anaesth 1969; 41: 453-4.
Hogg CE, Lorhan PH. Pediatric bronchial blocking. Anesthesiology 1970; 33: 560-2.
Cay DL, Csenderits LE, Lines V, et al. Selective bronchial blocking in children. Anaesth Intensive Care 1975; 3: 127-30.
Ginsberg RJ. New technique for one-lung anesthesia using an endobronchial blocker. J Thorac Cardiovasc Surg 1981; 82: 542-6.
Park HP, Bahk JH, Park JH, Oh YS. Use of a Fogarty catheter as a bronchial blocker through a single-lumen endotracheal tube in patients with subglottic stenosis. Anaesth Intensive Care 2003; 31: 214-6.
Dalens B, Labbé A, Haberer JP. Selective endobronchial blocking vs. Anesthesiology 1982; 57: 555-6.
Cohen E. Methods of lung separation. Minerva Anestesiol 2004; 70: 313-8.
Campos JH. Progress in lung separation. Thorac Surg Clin 2005; 15: 71-83.
Sazak HG, Taşdelen M, Sıcakkan A, Çetin MC, Şavkılıoğlu E. Ankilozan Spondilit Hastasında Tek Akciğer Ventilasyonu. Olgu sunumu. Türk Anest Rean Der Dergisi 2009; 37(5): 314-317.
Rocco G, Martucci N, La Manna C, et al. Tenyear experience on 644 patients undergoing single port (uniportal) video-assisted thoracoscopic surgery. Ann Thorac Surg 2013; 96: 434-8.
F Hameed, A Raza, J Saleem, et al. VATS without general anesthesia: initial experience of 18 cases. Anaesth Pain & Intensive Care. 2016; 20 Suppl 1: 150-3.
Pompeo E, Mineo D, Rogliani P, et al. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg 2004; 78: 1761-8.
Pompeo E, Tacconi F, Mineo D, et al. The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. J Thorac Cardiovasc Surg 2007; 133: 786-90.
Pompeo E, Tacconi F, Mineo TC. Comparative results of non-resectional lung volume reduction performed by awake or non-awake anesthesia. Eur J Cardiothorac Surg 2011; 39: 51-8.
Noda M, Okada Y, Maeda S, et al. Is there a benefit of awake thoracoscopic surgery in patients with secondary spontaneous pneumothorax? J Thorac Cardiovasc Surg 2012; 143: 613-6.
Pompeo E, Rogliani P, Tacconi F, et al. Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery. J Thorac Cardiovasc Surg 2012; 143: 47-54.
Pompeo E, Dauri M. Awake Thoracic Surgery Research Group. Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis? J Thorac Cardiovasc Surg 2013; 146: 495-7.
Chen JS, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg 2011; 254: 1038-43.
Wu CY, Chen JS, Lin YS, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg 2013; 95: 405-11.
Mineo TC, Sellitri F, Tacconi F, et al. Quality of life and outcomes after nonintubated versus intubated videothoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study. J Palliat Med 2014; 17: 761-8.
Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov 2015; 22: 123-30.
Gonzalez-Rivas D, Bonome C, Fieira E, et al. Entübe olmayan video destekli torakoskopik akciğer rezeksiyonları: göğüs cerrahisinin geleceği? Eur J Cardiothorac Surg 2016; 49: 721-31.
Jorgensen H, Wetterslev J, Møiniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 2000. CD001893.
Marret E, Remy C, Bonnet F, Postoperative Pain Forum Group. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007;94:665e73.
Loick HM, Schmidt C, Van Aken H, et al. High thoracic epidural anesthesia,but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg 1999;88:701e9.
Referanslar
Irons J F, Martinez G. Anaesthetic considerations for non-intubated thoracic surgery J Vis Surg. 2016; 2: 61.
Morgan GE, Mikhail MS, Murray MJ. Anesthesia for thoracic surgery. In: Morgan GE, Mikhail MS, Murray MJ, eds. Clinical Anesthesiology. 4th ed. New York: McGraw-Hill, 2006:585-613.
Benumof JL, Alfery DD. Anesthesia for thoracic surgery. In: Miller RD (ed). Anesthesia. 5th ed. Philadelphia: Churchill-Livingstone, 2000; 1665-1752.
Benumof JL. Separation of the two lungs (double-lumen tube and bronchial blocker intubation). In: Benumof JL (ed). Anesthesia for Thoracic Surgery. 2nd ed. Philadelphia: W.B. Saunders Company, 1995; 330-389.
Vale R. Selective brochial blocking in a small child. Case report. Br J Anaesth 1969; 41: 453-4.
Hogg CE, Lorhan PH. Pediatric bronchial blocking. Anesthesiology 1970; 33: 560-2.
Cay DL, Csenderits LE, Lines V, et al. Selective bronchial blocking in children. Anaesth Intensive Care 1975; 3: 127-30.
Ginsberg RJ. New technique for one-lung anesthesia using an endobronchial blocker. J Thorac Cardiovasc Surg 1981; 82: 542-6.
Park HP, Bahk JH, Park JH, Oh YS. Use of a Fogarty catheter as a bronchial blocker through a single-lumen endotracheal tube in patients with subglottic stenosis. Anaesth Intensive Care 2003; 31: 214-6.
Dalens B, Labbé A, Haberer JP. Selective endobronchial blocking vs. Anesthesiology 1982; 57: 555-6.
Cohen E. Methods of lung separation. Minerva Anestesiol 2004; 70: 313-8.
Campos JH. Progress in lung separation. Thorac Surg Clin 2005; 15: 71-83.
Sazak HG, Taşdelen M, Sıcakkan A, Çetin MC, Şavkılıoğlu E. Ankilozan Spondilit Hastasında Tek Akciğer Ventilasyonu. Olgu sunumu. Türk Anest Rean Der Dergisi 2009; 37(5): 314-317.
Rocco G, Martucci N, La Manna C, et al. Tenyear experience on 644 patients undergoing single port (uniportal) video-assisted thoracoscopic surgery. Ann Thorac Surg 2013; 96: 434-8.
F Hameed, A Raza, J Saleem, et al. VATS without general anesthesia: initial experience of 18 cases. Anaesth Pain & Intensive Care. 2016; 20 Suppl 1: 150-3.
Pompeo E, Mineo D, Rogliani P, et al. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg 2004; 78: 1761-8.
Pompeo E, Tacconi F, Mineo D, et al. The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. J Thorac Cardiovasc Surg 2007; 133: 786-90.
Pompeo E, Tacconi F, Mineo TC. Comparative results of non-resectional lung volume reduction performed by awake or non-awake anesthesia. Eur J Cardiothorac Surg 2011; 39: 51-8.
Noda M, Okada Y, Maeda S, et al. Is there a benefit of awake thoracoscopic surgery in patients with secondary spontaneous pneumothorax? J Thorac Cardiovasc Surg 2012; 143: 613-6.
Pompeo E, Rogliani P, Tacconi F, et al. Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery. J Thorac Cardiovasc Surg 2012; 143: 47-54.
Pompeo E, Dauri M. Awake Thoracic Surgery Research Group. Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis? J Thorac Cardiovasc Surg 2013; 146: 495-7.
Chen JS, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg 2011; 254: 1038-43.
Wu CY, Chen JS, Lin YS, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg 2013; 95: 405-11.
Mineo TC, Sellitri F, Tacconi F, et al. Quality of life and outcomes after nonintubated versus intubated videothoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study. J Palliat Med 2014; 17: 761-8.
Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov 2015; 22: 123-30.
Gonzalez-Rivas D, Bonome C, Fieira E, et al. Entübe olmayan video destekli torakoskopik akciğer rezeksiyonları: göğüs cerrahisinin geleceği? Eur J Cardiothorac Surg 2016; 49: 721-31.
Jorgensen H, Wetterslev J, Møiniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 2000. CD001893.
Marret E, Remy C, Bonnet F, Postoperative Pain Forum Group. Meta-analysis of epidural analgesia versus parenteral opioid analgesia after colorectal surgery. Br J Surg 2007;94:665e73.
Loick HM, Schmidt C, Van Aken H, et al. High thoracic epidural anesthesia,but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting. Anesth Analg 1999;88:701e9.
