GKD Anest Yoð Bak Dern Derg. 2011; 17(2): 42-48 | DOI: 10.5222/GKDAD.2011.042

Yüksek Riskli Arkus Aort Anevrizma Ameliyatýnda Üçlü Serebral Monitörizasyon

Tuðba Yiðit¹, Ümit Karadeniz¹, Özcan Erdemli¹, Aslý Demir¹, Þeref Küçüker^2
1Türkiye Yüksek Ýhtisas Eðitim Ve Arþ. Hastanesi, Anestezi Kliniði Ankara
²Türkiye Yüksek Ýhtisas Eðitim Ve Arþ. Hastanesi, Kalp Damar Cerrahi Kliniði Ankara

Daha önce 2 kez torasik aort anevrizmasý nedeniyle opere edilmiþ yüksek riskli hastada, arkus aorta anevrizma ameliyatýnda serebral korumaya yönelik üçlü monitörizasyonun önemini ve uygulamalarýmýzý sunduk.

Daha önce Tip 1 aort disseksiyonu (1999 yýlýnda) ve asendan aort anevrizmasý (2006 yýlýnda) nedeniyle ameliyat edilen Marfan Sendromlu erkek hasta, arkus aort anevrizmasý nedeni ile 3. kez ameliyata alýndý. Rutin monitorizasyonun yanýnda, serebralkortikalsinaptik aktivite deðiþiklikleri elektroensefalografi ve % 95 spektral “edge” frekans deðerleri ile, serebral oksijen satürasyonu “near-infraredspectroscopy” ile, orta serebral arter kan akým hýzlarý trans kranialdoppler ultrasonografi ile ölçüldü. 18°C derin hipotermiksirkülatuvararrest sýrasýnda 700 mL dak-1antegradselektifserebralperfüzyonla beyin kan akýmý saðlandý. Selektifperfüzyon sýrasýnda sað ve sol spektral “edge” frekans deðerleri 0-2, sað ve sol serebral oksijen satürasyon deðerleri % 72 - % 80 aralýðýnda, sol temporal percereden ölçülen orta serebral arter ortalama kan akým hýzlarý 10-23 cm sn-1 aralýðýnda devam etti. Hasta postoperatif 22. saatte ekstübe edildi ve 3. günde sorunsuz olarak servise çýkarýldý.

Yüksek risk taþýyan, uzun selektifserebralperfüzyon süresi öngörülen hastamýzda düþük akým sýrasýnda serebraloksijenasyonun ve perfüzyonun yeterliliðini 3’lü serebralmonitorizasyon ile takip ederek maksimum hasta güvenliði saðladýðýmýzý düþünüyoruz.

Anahtar Kelimeler: aortik ark cerrahisi, serebral koruma, derin hipotermikarrest

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Triple Cerebral Monitorization in a Highly Risky Arcus Aorta Aneurysm Repair

Tuðba Yiðit¹, Ümit Karadeniz¹, Özcan Erdemli¹, Aslý Demir¹, Þeref Küçüker^2
1Türkiye Yüksek Ýhtisas Education And Research Hospital, Anesthesiology Clinic, Ankara
²Türkiye Yüksek Ýhtisas Education And Research Hospital, Cardiovascular Surgery Clinic, Ankara

In this case we present the importance of triple cerebral monitorization and our experiences in a highly-riskypatient’saorticarc surgery.

A male patient with a Marfansyndrome had been operated for type 1 aortic dissection in 1999 and again for a orticaneurysm in 2006. Aorticarcus surgery was planned in elective conditions. Besides routine monitorization, cerebral cortical synapticactivity changes were monitored by electroencephalography and 95 % spectraledge frequency values, cerebral oxygen saturation were measured with near-infrared spectroscopy and flow velocity of middle cerebral artery was measured by transcranial Doppler ultrasound system. During deep hypothermiccirculatory arrest (18˚C), antegrade selective cerebral perfusion was performed at 700 mL min-1. During selective cerebral perfusion, right and left spectral edge frequency values were 0 to 2, right and left cerebral oxygen saturations were between 72 to 80 %, and middle cerebral arterial blood flow velocities werebetween 10 to 23 cm sec-1. The patient was extubated at postoperative 22. hour and discharged from intensive care unit at postoperative third day.

We think that we provided the maximum patient safety for our highly risky patient who was predicted to endureprolonged selective cerebral perfusion during lower cerebral oxygenation by ensuring a dequate cerebral oxygenation and perfusion by using triple cerebral monitorization during selective cerebral perfusion.

Keywords: aorticarcsurgery, cerebralprotection, deephipotermicarrest

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ATIF KOPYALA