Kardiyak Cerrahi Geçiren ve Monoamine Oksidaz Ýnhibitörü Kullanan Parkinson Hastasýnda Fentanil Reaksiyonu

Monoamino oksidaz inhibitörleri kullanan hastalarda kardiyak cerrahi yapýlmasý durumunda bu ilaçlarýn fentanil ile ortaya çýkabilecek etkileþimi yüzünden fentanil kullanýmý tartýþmalý bir konudur. Bu olgu sunumunda, monoaminooksidaz tip B inhibitörleri (rasajilin) ile birlikte selektif serotonin reuptake inhibitörü (paroxetin) de almakta olan, 57 yaþýnda, 45 kg. kadýn hastada, mitral yetmezlik nedeni ile mitral kapak deðiþimi cerrahisi sýrasýnda fentanil ile ilaç etkileþimi tanýmlanmýþtýr. Anestezi ve cerrahi normal seyrederken, kardiyopulmoner baypasýn ýsýnma ve kalbin uyanmasý sýrasýnda, hýzlý ventriküler yanýtlý supraventiküler taþikardi, hipertansiyon, terleme, kýzarma ve hipertermi gözlendi. Kardiyoversiyon ve beta bloker tedavisi ile taþikardi kontrol edildi. Isý, pompa aracýlýðý ile 37 oC de tutuldu. Fentanil infüzyonu kesildi. Hemodinamik stabilite saðlandýktan sonra kardiyopulmoner baypasdan ayrýlýndý. Toplam fentanil tüketimi 2,8 mg idi. Parkinson tedavisine post operatif 1. gün yeniden baþlandý. 7. gün taburcu edildi.

Fentanyl Reaction in a Parkinsonian Patient Receiving Monoamine Oxidase Inhibitor while Undergoing Cardiac Surgery

Use of fentanyl is a controversial issue because of possible adverse drug interactions in patients using monoamine oxidase inhibitors during cardiac surgery procedure. In this case report we described a drug interaction with fentanyl in a parkinsonian patient who was 57 years old, 45 kg weigh and required mitral valve replacement surgery while he was taking a selective inhibitor of monoamineoxidase type B (Rasajilin) with selective serotonin reuptake inhibitor (paroxetin). Despite anesthesia and surgery was continued normally, supraventricular tachycardia, hypertension, sweating, flushing and hypertermia was observed during warming of the heart and the weaning period of cardiopulmonary bypass. Tachycardias were treated by cardioversion and beta blocker therapy. The temparature was controlled at 37 oC by using pump perfusion. Fentanyl infusion was discontinued. After hemodynamic stability was achieved, cardiopulmonary bypass was terminated. Total fentanyl consumption was 2,8 mg. Parkinson’s therapy was resumed at the first day postoperatively. Patient was discharged at the 7th day.