Y�ksek Riskli Hastalarda Torakal Epidural Anestezi ile Uyan�k Torasik Cerrahi: �� Olgu Sunumu ve Klinik ��kar�mlar

Kesici, Sevgi; Uysal, Figen; Sancak, Nur Betul; Kaya, Celal; Derdiyok, Onur; Temel, Ugur; Cinar, Ayse Surhan; Oba, Sibel

Cilt : 58 Say� : 3 Y�l : 2024

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Y�ksek Riskli Hastalarda Torakal Epidural Anestezi ile Uyan�k Torasik Cerrahi: �� Olgu Sunumu ve Klinik ��kar�mlar [Med Bull Sisli Etfal Hosp]

Med Bull Sisli Etfal Hosp. Kabul Yaz�lar: SETB-70962 | DOI: 10.14744/SEMB.2024.70962

Y�ksek Riskli Hastalarda Torakal Epidural Anestezi ile Uyan�k Torasik Cerrahi: �� Olgu Sunumu ve Klinik ��kar�mlar

Sevgi Kesici¹, Figen Uysal², Nur Betul Sancak³, Celal Kaya⁴, Onur Derdiyok⁵, Ugur Temel⁵, Ayse Surhan Cinar¹, Sibel Oba¹
¹T�rkiye Sa�l�k Bilimleri �niversitesi, �i�li Hamidiye Etfal E�itim ve Ara�t�rma Hastanesi, Anesteziyoloji ve Reanimasyon Klini�i, �stanbul
²T�rkiye Sa�l�k Bilimleri �niversitesi, Kanuni Sultan S�leyman E�itim ve Ara�t�rma Hastanesi, Anesteziyoloji ve Reanimasyon Klini�i, �stanbul
³Tekman �ehit Piyade �avu� Muhammet Binici Devlet Hastanesi, Anesteziyoloji ve Reanimasyon Klini�i, Erzurum
⁴T�rkiye Sa�l�k Bilimleri �niversitesi, Taksim E�itim ve Ara�t�rma Hastanesi, Anesteziyoloji ve Reanimasyon Klini�i, �stanbul
⁵T�rkiye Sa�l�k Bilimleri �niversitesi, �i�li Hamidiye Etfal E�itim ve Ara�t�rma Hastanesi, G��s Cerrahisi Klini�i, �stanbul

Torasik epidural anestezi kullan�larak yap�lan uyan�k torasik cerrahi, �zellikle komorbiditesi olan hastalarda genel anesteziye g�re �nemli avantajlar sunmaktad�r. Bu olgu raporunda, torasik epidural anestezi alt�nda uyan�k torasik cerrahi ge�iren �� kritik hasta sunulmaktad�r. �lk vaka, mezotelyoma i�in torakotomi ile dekortikasyon yap�lan ileri kronik obstr�ktif akci�er hastal�� olan 81 ya��ndaki erkek hastad�r. �kinci vaka, hipertansiyon, koroner arter baypas greft cerrahisi, laringeal kanser ve akci�er t�m�r� i�in video yard�ml� torasik cerrahi yap�lan kal�c� trakeostomi �yk�s� olan 73 ya��nda bir erkek hastad�r. Son olarak ��nc� vaka hipertansiyon, t�beroz skleroz, epilepsi ve interstisyel akci�er hastal�� yk�s� olan 41 ya��nda bir kad�n hastad�r. T�m hastalara epidural anestezi ve bilin�li sedasyon uyguland�; perioperatif hemodinami stabil �ekilde ve ek opioidlere ihtiya� duyulmadan etkili a�r� kontrol� ile sonu�land�. Bu vakalar, y�ksek riskli hastalarda a�r�s�z ve komplikasyonsuz torasik cerrahi i�in torasik epidural anestezinin etkinli�ini ve g�venli�ini vurgulamakta olup se�ilmi� vakalarda genel anesteziye iyi bir alternatif oldu�unu g�stermektedir. (SETB-2024-09-159)

Anahtar Kelimeler: Torasik epidural anestezi, torasik cerrahi, a�r� y�netimi, perioperatif t�p

Awake Thoracic Surgery with Thoracic Epidural Anesthesia in High-Risk Patients: Three Case Reports and Clinical Insights

Sevgi Kesici¹, Figen Uysal², Nur Betul Sancak³, Celal Kaya⁴, Onur Derdiyok⁵, Ugur Temel⁵, Ayse Surhan Cinar¹, Sibel Oba¹
¹Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
²Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
³Department of Anesthesiology and Reanimation, Tekman Sehit Piyade Cavus Muhammet Binici State Hospital, Erzurum, T�rkiye
⁴Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Taksim Training and Research Hospital, Istanbul, Türkiye
⁵Department of Thoracic Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye

Awake thoracic surgery utilizing thoracic epidural anesthesia has shown significant advantages over general anesthesia, especially in patients with comorbidities. This case report presents three cases of critically ill patients who successfully underwent awake thoracic surgery using thoracic epidural anesthesia. The first case involved an 81-year-old male with advanced Chronic obstructive pulmonary disease who underwent thoracotomy with decortication for mesothelioma. The second case involved a 73-year-old male with a history of hypertension, coronary artery bypass graft surgery, laryngeal cancer, and permanent tracheostomy who underwent video-assisted thoracic surgery for the lung tumor. Finally, the third case involved a 41-year-old female with a history of hypertension, tuberous sclerosis, epilepsy, and interstitial lung disease. All patients were managed with epidural anesthesia and conscious sedation, resulting in perioperative hemodynamic stability and effective pain control without the need for additional opioids. These cases highlight the efficacy and safety of thoracic epidural anesthesia for facilitating pain-free, uneventful thoracic surgeries in high-risk patients, suggesting that thoracic epidural anesthesia is a viable alternative to general anesthesia in selected cases.

Keywords: Thoracic epidural anesthesia, thoracic surgery, pain management, perioperative medicine

Sorumlu Yazar: Sevgi Kesici
Makale Dili: �ngilizce

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