Anestezi Derinliği Monitörizasyonunun Doğru Yorumlanmasının Klinik Önemi: Lomber Stabilizasyon Cerrahisi Sırasında “Alpha Dropout” Gelişen Bir Olgu
Özet
Lomber disk hernisi ve instabilite nedeniyle L3-L5 seviyelerine posterior vida-rod stabilizasyonu planlanan 58 yaşındaki kadın hastaya, cerrahi sırasında nöromonitörizasyon uygulanacak olması nedeniyle total intravenöz anestezi (TİVA) ve anestezi derinliği monitörizasyonu ile anestezi yönetimi planlandı. Anestezi indüksiyonunun ardından propofol ve remifentanil infüzyonu ile anestezi idamesi sağlandı. Cerrahi insizyon sırasında EEG üzerinde alpha dropout (alfa kaybı) örüntüsünün geliştiği izlendi. Bu örüntü, yetersiz antinosiseptif yanıt göstergesi olarak değerlendirilerek remifentanil infüzyon dozu artırıldı ve kısa sürede EEG görüntüsünün normalize olduğu gözlendi. Yaklaşık 2.5 saat süren operasyonun ardından stabil hemodinamik ve EEG örüntüleri ile anestezi sonlandırıldı. Postoperatif dönemde düşük ağrı skorları, minimal opioid gereksinimi olan ve bilişsel fonksiyonlarda bozulma izlenmeyen hasta, postoperatif 3. gün komplikasyonsuz olarak taburcu edildi.
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