İnterstisiyel Akciğer Hastalığı Olan TUR-M Yapılan Hastada Anestezi Yönetimi
Özet
İnterstisyel akciğer hastalığı olan ve ek patolojiler nedeniyle cerrahi gereken hastalarda rejyonel anestezi yöntemleri güvenle uygulanmaktadır. Mesane kanseri erkeklerde sık görülmekle beraber ileri yaş ve ek hastalığı olan hastalarda hematüri birlikteliği ile görülmektedir. Tanı ve tedavi için sistoskopi eşliğinde saptanan tümörlerin tamamen ve yeterli derinlikte rezeksiyonu temel yaklaşımdır. Mesanenin yan duvarına yerleşen tümörlerin transüretral mesane tümörü rezeksiyonu (TUR-MT) sırasında sinirin uyarılmasına bağlı adduktor kas spazmı oluşabilmektedir. TUR-MT sırasında sinirin uyarılmasına bağlı adduktor kas spazmı gelişebilir. Kas gevşeticilerin kullanıldığı genel anestezi uygulaması adduktor kas spazmının önlese de hastaya postoperatif getireceği yükler nedeniyle spinal anesteziye ek olarak uygulanan obturatuar blok ile hastalar güvenli bir şekilde opere olabilmektedir. İnterstisyel akciğer hastalığı tanısı olan ve oksijen konsantratörü ile evinde tedavisi devam eden hastada mesane tümörü ön tanısı konmuş ve TUR-MT planlanmıştır. Hasta ameliyat öncesinde mönitörize edildiğinde periferik oksijen satürasyonu (SpO2): %78 olduğu non invaziv kan basıncı (KB):145/85 mmHg, kalp atım hızı (KAH):105 atım dk-1 olduğu görüldü. L3-L4 aralığından 12,5 mg bupivakain ile spinal anestezi uygulandı. Daha sonra ultrasonografi (USG) eşliğinde obturator blok uygulandı. Transüretral mesane rezeksiyonu (TUR-M) operasyonu komplikasyonsuz olarak tamamlandı. Postoperatif herhangi bir komplikasyon gelişmedi.
Olguların, tümör evrelemesinde kas invazyon varlığı önemlidir. Bu nedenle mesane kanseri tanısı ve tedavisinde TUR-M değerlidir. Obturator sinirin mesane arka duvarına komşu olarak seyretmesi nedeniyle rezeksiyon uygulamalarında oluşabilen adduktör kas kasılması mesane duvarında perforasyon gibi majör komplikasyonlara neden olabilir. Obturator sinirin uyarılmasını önlemede obturator sinir bloğu (OSB) uygulaması son yıllarda ultrasonografinin de kullanılmasıyla genel anestezi uygulamalarına alternatif olabilir.
Patients with interstitial lung disease and those needing surgery for other illnesses can safely employ regional anaesthesia techniques. While bladder cancer is more common in men, patients with advanced age and comorbidities are more likely to experience haematuria. The primary method of diagnosis and therapy involves the thorough and thorough removal of tumours found during cystoscopy. The stimulation of the nerves during transurethral resection (TUR-MT) of tumours on the bladder wall may cause adductor muscle spasm. During transurethral resection (TUR-MT), nerve stimulation may cause adductor muscle spasm. Patients can be successfully operated on with obturatory block applied in addition to spinal anaesthesia, even though general anaesthesia with muscle relaxants avoids adductor muscle spasm due to the postoperative burden on the patient. A bladder tumour was tentatively identified in a patient with interstitial lung disease receiving home oxygen therapy, and transurethral resection was scheduled. Preoperative monitoring revealed the following: Spo2:78, ta:145/85, and pulse: 105. 12.5 mg of bupivacaine was used for spinal anaesthesia at the L3–L4 interval. USG guided obturator block was then used. The TUR-M procedure was carried out without incident. No postoperative complications occurred. Muscle invasion has a significant role in the staging of tumours.
As a result, transurethral bladder resection (TUR-M) is useful for both bladder cancer detection and treatment. The adductor muscle contraction that may happen during resection could result in serious consequences such bladder wall perforation since the obturator nerve travels close to the posterior wall of the bladder. With the use of ultrasonography in recent years, obturator nerve block (ONB) to inhibit stimulation of the obturator nerve may be an option to general anaesthesia.
Referanslar
Pratter MR, Curley FJ, Dubois J. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 1989;149:2277-82.
Walsh CP. Surgical treatment of bladder cancer. In: Retik BA, Vaughan DE, Wein AJ, eds. Campbell’s Urology. 9th ed. Philadelphia: WB Saunders 2007; 2819-23.
Akata T, Murakami J, Yoshinaga A. Life-threatening haemorrhage fol lowing obturator artery injury during transurethral bladder surgery: a se quel of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand. 1999;43(7):784
Shah NF, Sofi KP, Nengroo SH. Obturator nerve block in transurethral re section of bladder tumor: a comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique. Anesth Essays Res. 2017;11(2):411-5
Prentiss RJ, Harvey GW, Bethard WF, Boatwright DE, Pen nington RD. Massive Adductor Muscle Contraction In Transurethral Surgery: Cause And Prevention; Develop ment Of New Electrical Circuitry. Trans Am Assoc Genito urin Surg 1964;56:64–72.
Prentiss RJ, Harvey GW, Bethard WF, Boatwright DE, Pennington RD. Massive adductor muscle contraction in transurethral surgery: cause and prevention; development of electrical circuitry. J Urol. 1965;93:263-71. [Crossref]]
Teymourian H, Khorasanizadeh S, Razzaghi MR et al. Combination of spinal anesthesia and obturator nerve block in transurethral re section of bladder tumor, comparison between nerve stimulator and ultrasonography. J Clin Med Sci. 2018;2(1):1-5
Wassef MR. Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth 1993;18(1):13–7.
So PC. Two case reports of obturator nerve block for trans urethral resection of bladder tumour. Hong Kong Med J 2004;10(1):57–9.
Labat G. Regional anesthesia, its technic and clinical appli cation. Philadelphia: WB Saunders 1928:286–7.
Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fif teen years of ultrasound guidance in regional anaesthesia: Part 2-recent developments in block techniques. Br J An aesth 2010;104(6):673–83.
Kuo JY. Prevention of obturator jerk during transurethral resection of bladder tumor. JTUA. 2008;19(1):27-31.
Patel D, Shah B, Patel BM. Contribution of the obturator nerve block in the trans-urethral resection of bladder tumours. Indian J Anaesth. 2004;48(1):47-9.
Erbay G, Akyol F, Karabakan M, Celebi B, Keskin E, Hirik E. Effect of ob turator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and re currence of the disease. Kaohsiung J Med Sci. 2017;33(2):86-90.
Referanslar
Pratter MR, Curley FJ, Dubois J. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 1989;149:2277-82.
Walsh CP. Surgical treatment of bladder cancer. In: Retik BA, Vaughan DE, Wein AJ, eds. Campbell’s Urology. 9th ed. Philadelphia: WB Saunders 2007; 2819-23.
Akata T, Murakami J, Yoshinaga A. Life-threatening haemorrhage fol lowing obturator artery injury during transurethral bladder surgery: a se quel of an unsuccessful obturator nerve block. Acta Anaesthesiol Scand. 1999;43(7):784
Shah NF, Sofi KP, Nengroo SH. Obturator nerve block in transurethral re section of bladder tumor: a comparison of ultrasound-guided technique versus ultrasound with nerve stimulation technique. Anesth Essays Res. 2017;11(2):411-5
Prentiss RJ, Harvey GW, Bethard WF, Boatwright DE, Pen nington RD. Massive Adductor Muscle Contraction In Transurethral Surgery: Cause And Prevention; Develop ment Of New Electrical Circuitry. Trans Am Assoc Genito urin Surg 1964;56:64–72.
Prentiss RJ, Harvey GW, Bethard WF, Boatwright DE, Pennington RD. Massive adductor muscle contraction in transurethral surgery: cause and prevention; development of electrical circuitry. J Urol. 1965;93:263-71. [Crossref]]
Teymourian H, Khorasanizadeh S, Razzaghi MR et al. Combination of spinal anesthesia and obturator nerve block in transurethral re section of bladder tumor, comparison between nerve stimulator and ultrasonography. J Clin Med Sci. 2018;2(1):1-5
Wassef MR. Interadductor approach to obturator nerve blockade for spastic conditions of adductor thigh muscles. Reg Anesth 1993;18(1):13–7.
So PC. Two case reports of obturator nerve block for trans urethral resection of bladder tumour. Hong Kong Med J 2004;10(1):57–9.
Labat G. Regional anesthesia, its technic and clinical appli cation. Philadelphia: WB Saunders 1928:286–7.
Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fif teen years of ultrasound guidance in regional anaesthesia: Part 2-recent developments in block techniques. Br J An aesth 2010;104(6):673–83.
Kuo JY. Prevention of obturator jerk during transurethral resection of bladder tumor. JTUA. 2008;19(1):27-31.
Patel D, Shah B, Patel BM. Contribution of the obturator nerve block in the trans-urethral resection of bladder tumours. Indian J Anaesth. 2004;48(1):47-9.
Erbay G, Akyol F, Karabakan M, Celebi B, Keskin E, Hirik E. Effect of ob turator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and re currence of the disease. Kaohsiung J Med Sci. 2017;33(2):86-90.
