Laparoskopik Sleeve Gastrektomi Uygulanan Obstrüktif Uyku Apneli Olguda Anestezi Yönetimi
Özet
Obstrüktif uyku apnesi (OSA), uyku sırasında üst hava yolunda tekrarlayan tıkanıklık ataklarıyla karakterize bir hastalıktır ve temel anormallik, üst hava yolunu genişleten kasların, inspirasyon sırasında üst hava yolunda oluşan negatif kuvvetlere direnç gösterememesidir (1). Obstrüktif uyku apneli hastalar, anestezistler için içerdiği peroperatif ve postoperatif riskler nedeniyle büyük önem taşımaktadır. Havayolu yönetiminin zorluğu, hipnotik ve sedatif ajanlara bağlı artmış hava yolu kollapsı ve santral respiratuar inhibisyon, opioid ilişkili respiratuar depresyon, artmış postoperatif rezidüel nöromüsküler blokaj riski bunlardan bazılarıdır. Obezite (VKİ>30 kg m-2) ile OSA arasında pozitif bir korelasyon mevcuttur (2). Obezite tedavisinde en sık uygulanan ve en etkin bariyatrik cerrahi yöntemlerden birisi Laparoskopik Sleve Gastrektomidir (3). Olgumuzda obezite nedeniyle genel anestezi altında gerçekleştirilen laparoskopik sleeve gastrektomi uygulanan OSA’lı apneli hastada preoperatif değerlendirme, intraoperatif anestezi yönetimi, multimodal analjezi prosedürleri, postoperatif takip ve tedavi ilkelerini vurgulamayı amaçladık.
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