GKD Anest Yoð Bak Dern Derg. 2018; 24(4): 152-159 | DOI: 10.5222/GKDAD.2018.96967

Endovasküler Giriþimlerde Anestezi Yönetimi ve Klinik Sonuçlarýnýn Retrospektif Deðerlendirilmesi

Sünkar Kaya¹, Özlem Turhan¹, Zerrin Sungur¹, Ömer Ali Sayýn², Ufuk Alpagut², Mert Þentürk^1
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalý, Ýstanbul
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Kalp Damar Cerrahisi Ana Bilim Dalý, Ýstanbul

GÝRÝÞ ve AMAÇ: Endovasküler aort onarýmý hýzlý derlenme ve kýsa hastanede kalýþ süresi gibi avantajlarýyla sýk uygulanan güvenilir bir yöntemdir. Çalýþmanýn amacý anestezi tipinin yoðun bakým ve hastanede kalýþ süreleri ve perioperatif komplikasyonlar üzerine etkilerinin araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Retrospektif çalýþmamýza 2004-2014 yýllarý arasýnda endovasküler aort onarýmý yapýlan hastalar dahil edildi. Genel anestezi (GGA), rejyonal anestezi (spinal veya epidural) (GSE) ve lokal anestezi (GLA) olmak üzere üç grup oluþturuldu. Hastalarýn yoðun bakým ve hastanede kalýþ süreleri ile hastalarda geliþen postoperatif komplikasyonlar takip edildi.
BULGULAR: Çalýþmaya alýnan 86 hastanýn 25’i GGA, 37’si GSE ve 24’ü GLA grubundadýr. Altmýþ beþ hastaya abdominal 21 hastaya torasik anevrizma onarýmý yapýlmýþtýr. GLA grubundaki hastalarýn yaþlarý diðer gruplarla karþýlaþtýrýldýðýnda belirgin yüksektir. (p: 0.025) Operasyon süresi GGA grubunda diðer gruplara kýyasla anlamlý yüksek bulundu. (p: 0.0147) Yoðun bakýmda kalýþ süresi de GGA grubunda GSE ve GLA grubuna kýyasla daha uzundu.(GGA 3,08±3 gün, GSE 1,05±0,4 gün, GLA 1,08±0,4 gün; p<0.001) Hastanede kalýþ süreleri de benzer þekildeydi. Uzamýþ hastanede kalýþ (>10 gün) 16 hastada görüldü. Lojistik regresyon analizinde preoperatif kronik böbrek yetersizliði (KBY) uzamýþ hastanede kalýþ ile iliþkili bulundu.
TARTIÞMA ve SONUÇ: Endovasküler aort anevrizma onarýmlarýnda rejyonal ve lokal anestezi tekniklerinin her ikisi de kýsa yoðun bakýmda kalýþ gerektirdiðinden endovasküler aort anevrizma onarýmlarýnda tercih edilebilir. Ancak hastanede kalýþ süresi üzerine anestezi tekniðinin etkisi yoktur. Lokal anestezi iþlem sýrasýnda hemodinamik stabilite saðlanmasý açýsýnda daha güvenlidir. Postoperatif dönemdeki sistemik komplikasyonlar tüm gruplarda benzerdir. KBY uzamýþ hastanede kalýþ ile büyük ölçüde iliþkilidir. Endovasküler iþlemlerde daha hýzlý derlenme saðlamalarý nedeniyle rejyonal ve lokal anestezi teknikleri ön planda deðerlendirilebilir.

Anahtar Kelimeler: endovasküler aort onarýmý, genel anestezi, nöroaksiyel anestezi, lokal anestezi

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Evaluation of Anesthesia Management and Clinical Outcomes in Endovascular Interventions Retrospectively

Sünkar Kaya¹, Özlem Turhan¹, Zerrin Sungur¹, Ömer Ali Sayýn², Ufuk Alpagut², Mert Þentürk^1
1Department of Anesthesiology ve Reanimation, Ýstanbul Faculty of Medicine, Ýstanbul University,Ýstanbul, Turkey
²Department of Cardiovascular Surgery, Ýstanbul Faculty of Medicine, Ýstanbul University,Ýstanbul, Turkey

INTRODUCTION: Endovascular aortic repair (EVAR) is widely used as a safe method with reduced hospital stay and faster recovery. The aim of this study is to investigate effects of type of anesthesia on patients’ outcome with ICU and hospital stays and perioperative complications.
METHODS: Patients undergoing EVAR were included in this retrospective study (2004-14). Study groups were enrolled as general anesthesia (GGA), regional anesthesia (spinal or epidural) (GSE) and local (GLA). Patient outcomes were evaluated with ICU or hospital stay with postoperative complications.
RESULTS: Eighty-six patients were enrolled for this study with 25 patients in GGA, 37 in GSE and 24 in GLA. Sixty-five had abdominal aneurysm whereas 21 had thoracic. Patients in GLA were significantly older compared to other groups (p: 0.025). Operation time was significantly longer than in GGA compared to GSE and GLA (p: 0.0147). ICU stay was longer in GGA compared to GSE and GLA (GGA 3,08±3days, GSE 1,05±0,4 day, GLA 1,08±0,4 day; p<0.001). Hospital stay was similar. Prolonged hospital stay (>10 days) was seen in sixteen patients. Preoperative chronic renal failure (CRF) was found to be associated with prolonged hospital stay in logistic regression.
DISCUSSION AND CONCLUSION: Both regional and local anesthesia techniques were preferable for reduced ICU stay; whereas hospital stay was not affected by the type of anesthesia. Local anesthesia seemed safer in terms of hemodynamic stability during surgery. Postoperative systemic complications were similar between groups. CRF was significantly associated with prolonged hospitalization. Regional or local anesthesia techniques might be initially considered in endovascular procedures to ensure faster recovery.

Keywords: endovascular aortic repair, general anesthesia, neuroaxial anesthesia, local anesthesia

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