Addison Hastalığı Olan Hastada Minimal İnvaziv Koroner Arter Bypass Greft Ameliyatı ve Anestezi Yönetimi
Özet
Primer adrenal yetmezliğin en sık sebebi, artan 21-hidroksilaz antikor seviyesiyle ilişkili olan Addison hastalığıdır. Bu hastalık bilateral adrenal bezlerin hasarı sonucu meydana gelir; kortizol, aldosteron ve androjenler gibi adrenokortikal hormonların azlığı ile seyreder (1). Kortizol vücudun stres yanıtında önemli role sahiptir ve küçük bir adrenal yetmezlik bile kritik hastalık ve majör cerrahide adrenal krize yol açabilir (2). Adrenal kriz bir endokrinolojik acil olup kısa sürede tanısı koyularak tedaviye başlanmalıdır. Tedavide amaç fizyolojik glukokortikoid ve mineralokortikoid düzeylerini sağlamaktır (1). Özellikle majör kardiyak cerrahilerde adrenal krizin klinik tablosu kalp cerrahisiyle ilişkili komplikasyonları taklit edebilir. Yapılan bir çalışma kardiyak cerrahi sırasında meydana gelen büyük hacim değişikliklerinin adrenal disfonksiyona yol açabileceğini göstermiştir (3). Bu nedenle teorik olarak pompasız cerrahilerde pompalı cerrahilere göre adrenal yetmezlik olasılığı daha düşüktür. Biz bu olguda minimal invaziv yöntemle koroner arter bypass greft ameliyatı yapılan Addison hastasındaki anestezi yönetimimizi sunduk.
Referanslar
Munir S, Quintanilla Rodriguez BS, Waseem M. Addison Disease. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023.
D’Silva C, Watson D, Ngaage D. A strategy for management of intraoperative Addisonian crisis during coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2012 Apr;14(4):481–2.
Henzen C, Kobza R, Schwaller-Protzmann B, Stulz P, Briner VA. Adrenal function during coronary artery bypass grafting. European Journal of Endocrinology. 2003 Jun;148(6):663-8. doi: 10.1530/eje.0.1480663.
Choudhury S, Meeran K. Glucocorticoid replacement in Addison disease. Nature Reviews Endocrinology. Nature Publishing Group; 2018. p. 562.
Zhao R, Luo S, Wang S, Wen Y, Xiong F. Coronary artery disease in a patient with Addison’s disease: a case report and literature review. BMC Cardiovasc Disord. 2023 Dec 1;23(1).
Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative Steroid Management: Approaches Based on Current Evidence. Vol. 127, Anesthesiology. Lippincott Williams and Wilkins; 2017. p. 166–72.
Woodcock T, Barker P, Daniel S, Fletcher S, Wass JAH, Tomlinson JW, et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May 1;75(5):654–63.
White A, Patvardhan C, Falter F. Anesthesia for minimally invasive cardiac surgery. Vol. 13, Journal of Thoracic Disease. AME Publishing Company; 2021. p. 1886–98.
Debono M, Sheppard L, Irving S, Jackson P, Butterworth J, Brookes ZLS, et al. Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery. Eur J Endocrinol. 2011 Mar 1;164(3):413–9.
Seo KH. Perioperative glucocorticoid management based on current evidence. Vol. 16, Anesthesia and Pain Medicine. Korean Society of Anesthesiologists; 2021. p. 8–15.
Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. Journal of Clinical Endocrinology and Metabolism. 2010;95(9):4338–44.
Di Filippo A, Baldini G. Thoracic wall block for minimally invasive thoracic surgery: enough analgesic advantages to improve functional outcomes? Vol. 90, Minerva Anestesiologica. Edizioni Minerva Medica; 2024. p. 478–81.
Referanslar
Munir S, Quintanilla Rodriguez BS, Waseem M. Addison Disease. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023.
D’Silva C, Watson D, Ngaage D. A strategy for management of intraoperative Addisonian crisis during coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2012 Apr;14(4):481–2.
Henzen C, Kobza R, Schwaller-Protzmann B, Stulz P, Briner VA. Adrenal function during coronary artery bypass grafting. European Journal of Endocrinology. 2003 Jun;148(6):663-8. doi: 10.1530/eje.0.1480663.
Choudhury S, Meeran K. Glucocorticoid replacement in Addison disease. Nature Reviews Endocrinology. Nature Publishing Group; 2018. p. 562.
Zhao R, Luo S, Wang S, Wen Y, Xiong F. Coronary artery disease in a patient with Addison’s disease: a case report and literature review. BMC Cardiovasc Disord. 2023 Dec 1;23(1).
Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative Steroid Management: Approaches Based on Current Evidence. Vol. 127, Anesthesiology. Lippincott Williams and Wilkins; 2017. p. 166–72.
Woodcock T, Barker P, Daniel S, Fletcher S, Wass JAH, Tomlinson JW, et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May 1;75(5):654–63.
White A, Patvardhan C, Falter F. Anesthesia for minimally invasive cardiac surgery. Vol. 13, Journal of Thoracic Disease. AME Publishing Company; 2021. p. 1886–98.
Debono M, Sheppard L, Irving S, Jackson P, Butterworth J, Brookes ZLS, et al. Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery. Eur J Endocrinol. 2011 Mar 1;164(3):413–9.
Seo KH. Perioperative glucocorticoid management based on current evidence. Vol. 16, Anesthesia and Pain Medicine. Korean Society of Anesthesiologists; 2021. p. 8–15.
Sato H, Carvalho G, Sato T, Lattermann R, Matsukawa T, Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. Journal of Clinical Endocrinology and Metabolism. 2010;95(9):4338–44.
Di Filippo A, Baldini G. Thoracic wall block for minimally invasive thoracic surgery: enough analgesic advantages to improve functional outcomes? Vol. 90, Minerva Anestesiologica. Edizioni Minerva Medica; 2024. p. 478–81.
