Maligniteye Bağlı Üst Hava Yolu Obstrüksiyonunda Hava Yolu Yönetimi: Transtrakeal Blok ile Uyanık Trakeostomi
Özet
Üst hava yolu obstrüksiyonuna bağlı solunum yetmezliği, acil servislerde karşılaşılan en kritik durumlardan biridir. Endotrakeal entübasyonun mümkün olmadığı ya da başarısız olduğu durumlar, “entübe edilemeyen – oksijenize edilemeyen” (CICO) vakaları olarak tanımlanır ve acil cerrahi hava yolu açılmasını gerektirir. Ancak, bu tür hastalarda acil cerrahi girişim yapılsa dahi, anestezi yönetimi konusunda net bir konsensusa varılamamıştır. Bu vaka sunumunda, ileri evre larinks kanserine bağlı olarak gelişen tam hava yolu tıkanıklığı ve buna bağlı bilinç değişikliği gelişen bir hastada, entübasyon denemesi yapılmaksızın, transtrakeal blok ve sedasyon eşliğinde uygulanan acil trakeostomi ile hava yolunun başarıyla sağlandığı bir olgu sunulmaktadır.
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