GKD Anest Yoð Bak Dern Derg. 2021; 27(1): 51-58 | DOI: 10.5222/GKDAD.2021.49403

Trakeal Stenoz Cerrahisinde Nöromuskuler Blok Yönetimi; Retrospektif Deðerlendirme

Sedat Saylan, Ali Akdogan
Karadeniz Teknik Üniversitesi Týp Fakültesi, Anesteziyoloji Ve Reanimasyon Ad. Trabzon, Türkiye

Amaç: Trakeal stenozun cerrahi tedavisinde ister trakeal rezeksiyon-anastomoz gibi uzun iþlemler olsun, isterse rijid bronkoskopi ve dilatasyon gibi kýsa cerrahi giriþimler olsun, hasta konforunu saðlamak ve cerrahiyi kolaylaþtýrmak için derin nöromuskuler blok gerekebilir. Bu çalýþmada trakeal stenozun cerrahi tedavisi sýrasýnda sugammadeks kullanýlarak yapýlan nöromuskuler blok antagonizmasý incelenmiþtir. Çalýþmamýzýn amacý, postentübasyon trakeal stenoz ve posttrakeostomi trakeal stenoz olgularýnda uyguladýðýmýz nöromuskuler blokajýn sugammadeks ile antagonizmasýný, postoperatif rezidual blok, komplikasyonlar ve postoperatif solunum paternine etkisi yönünden deðerlendirmekti.
Yöntem: Kliniðimizde trakeal stenozun cerrahi tedavisi sýrasýnda uyguladýðýmýz anestezi yöntemleri ve nöromuskuler blok yönetimi prosedürlerinin etkinliðini deðerlendirmek için hasta dosyalarý, anestezi kayýt formlarý, erken postoperatif takip ve taburculuk süreci retrospektif olarak incelenmiþtir. Trakeal stenoz tanýsý alan 34 hastanýn bir çoðuna farklý zamanlarda birden fazla cerrahi iþlem uygulandýðý için toplamda 140 giriþimsel iþlem ve anestezi uygulamasý incelenmiþtir. Trakeal stenoz cerrahisi geçiren ve nöromuskuler blok antagonizmasý için sugammadeks kullanýlan hastalar çalýþmaya dahil edilmiþtir.
Bulgular: Hastalarýmýzýn 34’ü postentübasyon-posttrakeostomi trakeal stenoz olarak deðerlendirildi. Hastalara kýsa cerrahi iþlem olarak rijid bronkoskopi (n=78), balon dilatasyon (n=35) ve stent (n=5) uygulanýrken, 22 hastaya trakeal rezeksiyon-anastomoz cerrahisi uygulanmýþtýr. Kýsa ve uzun cerrahi iþlemlerde sugammadeks kullanýmý sonrasý, spontan solunuma baþlama zamanýnýn birbirine benzer olduðu görüldü. Sugammadekse baðlý herhangi bir komplikasyon tespit edilmedi.
Sonuç: Trakeal stenoz cerrahisinde anestezi derinliði ve kas gücünün monitörizasyonu altýnda sugammadeks kullanýmýnýn nöromuskuler blok antagonizmasýnda etkin ve güvenilir bir seçim olduðunu düþünmekteyiz.

Anahtar Kelimeler: trakeal stenoz, anestezi, nöromuskuler blok, sugammadeks

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Neuromuscular Block Management in Tracheal Stenosis Surgery; Retrospective Evaluation

Sedat Saylan, Ali Akdogan
Faculty Of Medicine, Department Of Anesthesiology, Karadeniz Technical University, Trabzon, Turkey

Objective: In the surgical treatment of tracheal stenosis, whether in long procedures such as tracheal resection-anastomosis or in short procedures such as rigid bronchoscopy and dilatation, performing a deep neuromuscular block to provide patient comfort and facilitate the surgery. In this study, neuromuscular block antagonism using sugammadex during the surgical treatment of tracheal stenosis was investigated. The aim of our study was to evaluate the antagonism of the neuromuscular block with sugammadex in cases of postintubation tracheal stenosis and posttracheostomy tracheal stenosis in terms of postoperative residual block, complications and its effect on postoperative respiratory pattern.
Method: In order to evaluate the effectiveness of the anesthesia methods and neuromuscular block management procedures applied during the surgical treatment of tracheal stenosis, patient files, anesthesia record forms, early postoperative follow-up and discharge process were retrospectively reviewed. Since most of the 34 patients diagnosed with tracheal stenosis underwent more than one surgical procedure at different times, a total of 140 interventional procedures and anesthesia applications were examined. Patients who underwent tracheal stenosis surgery and used sugammadex for neuromuscular block antagonism were included in the study.
Results: 34 patients were evaluated as postintubation- posttracheostomy tracheal stenosis. While rigid bronchoscopy (n = 78), balloon dilatation (n = 35) and stent (n = 5) were applied to the patients as short surgical procedures, 22 patients underwent tracheal resection-anastomosis surgery. After the use of sugammadex in short and long surgical procedures, the time to start spontaneous breathing was found to be similar. No complications related to sugammadex were identified.
Conclusion: We argue that the use of sugammadex under the monitoring of anesthesia depth and muscle strength in tracheal stenosis surgery is an effective and reliable choice for neuromuscular block antagonism.

Keywords: tracheal stenosis, anesthesia, neuromuscular blockade, sugammadex

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