  Spinal
cerrahi tanımı ile medulla spinalise
veya ondan çıkan köklere bası yapan
anatomik oluşumlara yönelik cerrahi girişim
kastedilmektedir. Spinal cerrahide
uygulanacak anestezi tipi genel, epidural ya
da spinal anestezi olabilir.
  Spinal
cerrahide rejyonel anestezinin genel
anesteziye göre daha az kan kaybı daha az
tromboembolik komplikasyonlara neden
olması ve de daha erken barsak motilitesinin
geri dönmesi gibi avantajları olduğu
bilinmesine karşın prone pozisyonu sık
kullanılan bir teknik değildir.
  Seydişehir
Devlet Hastanesinde
 
Kasım 2012- Eylül 2013 tarihleri arasında
spinal cerrahi operasyonu geçiren toplam 84
hastayı retrospektif olarak inceledik.
  Olguların 21 spinal stenoz,
 
29 vaka disk hernisi,
 
34 vakada da kombine veya
laminektomi,stabilizasyon operasyonları idi.
  84
hastaya (50 kadın, 34 erkek) spinal
anestezi uygulandı
  Hastaların
33 hasta ASA 1,
48 hasta ASA 2 ,
5 hasta ASA3 idi
  77
YAŞINDA BAYAN HASTA
  BEL, BACAK AĞRISI, YÜRÜYEMEME ŞİKAYETİ
İLE BAŞVURDU.
  ÖZGEÇMİŞİNDE DM, HT, KOAH
  10-15 YILDIR BU ŞİKAYETİ OLAN HASTA
POLİKLİNİĞİMİZE BAŞVURDU.
  NÖROLOJİK
MUAYENESİNDE
YÜRÜME ANTALJİK VE FLEKSÖR POSTÜRDE
SAĞ ELİNDE BASTON YARDIMI İLE YÜRÜYORDU.
LASEQUE TESTİ (-)
FGT (-)
  MOTOR
MUAYENESİNDE BİLATERAL AYAK
BAŞPARMAK VE AYAK BİLEĞİ DORSAL
FLEKSİYONU 4/5 KAS GÜCÜNDEYDİ.
  BİLATERAL L4-5 HİPOESTEZİK.
  AŞİL REFLEKSİ (-/-)
  YÜRÜME MESAFESİ 20 METRE
(NÖROJENİK KLODİKASYO İZLENDİ.
  URGENCY İNKONTİNANS
  ANAL TONUS ZAYIFTI.
 
SAĞ DİZ ARTROPLASTİ OPERASYONU (7 YIL
ÖNCE) HİKAYESİ VARDI.
  HASTANIN
BİOKİMYASAL TETKİKLERİ
NORMALDİ.
wbc: 5.71,
hb:12.7,
htc: 37.0,
plt: 207
A Rh(-)
  HASTAYA
ÇEKİLEN PREOP LOMBER MRG VE
DİREKT GRAFİLERİNDE LOMBER SPONDİLOZ
ZEMİNİNDE L4-5 SPİNAL STENOZ İZLENDİ.
  HASTA
PREOP KARDİOLOJİ İLE KONSULTE
EDİLDİ.
  MUAYENESİNDE EF %65, HAFİF AY-MY, TA:
170/90 mmHg, EKG SİNDE SOL DAL BLOĞU İLE
UYUMLU OLARAK BELİRTİLDİ.
  PREOP ÖNERİ OLARAK ANTİ HİPERTANSİF(CA
KANAL BLOKERİ VE ANJ 2 RESEPTÖR
ANTAGONİSTİ) TEDAVİSİNE EK OLARAK
CLEXANE 04.1X1 SC ÖNERİLDİ.
  GÖĞÜS
HASTALIKLARI KONSULTASYONU
SONRASI SFT İLE DEĞERLENDİRİLDİĞİNDE
(FEV1 %69, PEF %77, FVC % 65,
FEF 25-75 %115)
PREOP
-PREDNOL
-ULCURAN
-TEOBAG VERİLMESİ ÖNERİLDİ.
  ASA
3 İLE OPERASYONA ALINAN HASTA
KOMBİNE SPİNAL ANESTEZİ (MARCAİNE 12.5
mg, fentanil 25 MCG) VE SEDASYON(ZOLAMID
1 MG) İLE OPERASYONA ALINDI.
  OPERASYONA ANESTEZİDEN 15 DAKİKA SONRA
SUPİNE POZİSYONDA BAŞLANDI.
  OPERASYON
  L4-5
SÜRESİ 2.20 SAAT SÜRDÜ.
STABİLİZASYON VE L4 TOTAL
LAMİNEKTOMİ İLE FLAVEKTOMİ VE BİL.
FORAMİNOTOMİ YAPILDI.
  PEROP KOMPLİKASYON GELİŞMEDİ.
  POSTOP KAN TRANSFÜZYONU YAPILMADI.
(PEROP 150 CC KANAMA OLDU.)
  PEROP TA ORT. 140/80 MMHG, NABIZ 90 DK
  Postop.yoğun
bakım ünitesine alındı.
  Operasyonun 3.ssatinde %10 lidokain 2 cc
test dozu sonraso 2 cc %10 aritmal ve ½
sodyumbikarbonat uygulandı.
  Postop analjezi 6 saat aralıklarla uygulanan 8
cc serum fizyolojik volum içinde 1 cc %0.5
markain ve 100 mcg ile sağlandı.
  POSTOP
1 GÜN MOBİLİZE OLAN HASTANIN 2.
GÜN DRENİ ÇEKİLDİ.
  POSTOP 3 GÜN TABURCU EDİLDİ.
  1.Rejyonel
anestezi endikasyonu koyarken
operasyon süresi
  2.Hastanın durumu göz önüne alınmalıdır.
  3. Pozisyona bağlı komplikasyonların daha az
gözlenmesi bu operasyonlarda rejyonel
anestezinin en büyük avantajı sayılabilir.
  4. Tek veya çift seviye laminektomilerde
rejyonel anestezi etkin ve güvenli olarak
kullanılabilir.
  5. Spinal cerrahi deneyim sürenin
kısalmasında en büyük etkendir.
 
Masui. 2012 Aug;61(8):837-9.
 
[Anesthetic management of a morbidly obese patient in prone position for lumbar laminectomy].
 
Niwa Y1, Shimada N, Negishi Y, Kai M, Inoue S, Takeuchi M.
Abstract
 
 
A 22-year-old man weighing 188.7kg, 170cm tall (body mass index 65.2 kg x m(-2)) with bladder
and rectal disturbances due to lumbar disc hernia (L4/5 and L5/S1) was scheduled for L4-5
laminectomy under general anesthesia. Awake fiberoptic intubation was attempted to prevent
airway obstruction because we predicted difficult airway. During fiberoptic tracheal intubation,
we easily succeeded in the insertion of the fiberscope itself into the trachea, and we succeeded in
placing the reinforced tube into the trachea. Fentanyl and sugammadex were calculated with
total body weight, but, remifentanil, propofol, and rocuronium were re-calculated with ideal body
weight. They were given intravenously. Anesthesia was maintained with sevoflurane (1.5 to 2.0%),
the fraction of inspiratory oxygen (about 0.6), remifentanil (0.1 to 0.4 microg x kg(-1) x min(-1)),
and fentanyl (100 to 150 microg) as needed. After turning to prone position, severe physiological
abnormal signs were not recognized. We concluded that awake fiberoptic intubation was useful
and safe; moreover, anesthetic agents were administrated appropriately for morbid obesity.
 
PMID: 22991806 [PubMed - indexed for MEDLINE]
 
Asian J Endosc Surg. 2013 May;6(2):130-3. doi: 10.1111/ases.12004.
 
Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly
patient with spinal canal stenosis, herniated nucleus pulposus and pulmonary comorbidities.
 
Kitahama Y1, Sairyo K, Dezawa A.
Abstract
 
A 70-year-old man with severe pulmonary comorbidities was referred to our institution for
treatment of a right L5 nerve impingement. He had suffered from spinal canal stenosis and
herniated nucleus pulposus (HNP) at the level of L4-L5 for more than a year and had been treated
conservatively. However, the pain could not be alleviated, and his primary care physician
scheduled posterior decompression surgery. During this procedure, the anesthesiologist refused to
induce general anesthesia because of the patient's very poor pulmonary condition. Subsequently,
the patient was referred to us. We used a transforaminal approach with percutaneous endoscopic
discectomy, with the patient under local anesthesia. First, herniated nucleus pulposus fragments
at the disc level were removed. With a trephine drill, the upper part of the L5 pedicle was
removed, which allowed for the extraction of dorsally migrated fragments. Following complete
removal of the herniated nucleus pulposus fragments, osseous decompression was performed. The
osseous endplate of L5 (anterior part of the lateral recess) was removed to enlarge the lateral
recess so that decompression of the L5 nerve root was possible. The patient's lower back pain and
right leg pain subsided following surgery. Percutaneous endoscopic discectomy is useful for
patients with severe comorbidities as it can be done with local anesthesia
 
Neuroradiol J. 2011 Aug 31;24(4):620-6. Epub 2011 Sep 2.
 
mild(®) Lumbar Decompression for the Treatment of Lumbar Spinal Stenosis.
 
 
Schomer DF1, Solsberg D, Wong W, Chopko BW. 1
Radiology Imaging Associates; Denver, CO, USA - [email protected]
 
Abstract
 
More than 1.2 million people are undergoing treatment for lumbar spinal stenosis (LSS) in the
United States. Yet, therapeutic options for these patients are limited to either conservative
treatments or highly invasive surgeries. A new image-guided interlaminar decompression
procedure, mild(®), offers significant relief for many of these patients by debulking dorsal
element hypertrophy while preserving structural stability. mild can be performed without general
anesthesia and offers a short recovery period. A meta-analysis of four clinical patient series from
multiple institutions in the United States evaluated over 250 patients for safety and clinical
efficacy of the mild procedure. Clinical efficacy was evaluated at baseline and at three-month
follow-up using validated patient reported outcomes (PRO) instruments including the ten-point
Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Acute safety and patient
outcomes was compared to the Spine Patient Outcomes Research Trial (SPORT). No device or
procedure-related serious adverse events (SAEs) have been recorded with the mild procedure.
Outcome metrics for patients treated with mild demonstrated statistically significant symptomatic
improvement over baseline. When compared to open surgery, mild efficacy results compare
favorably, and complication rates are much lower. mild is a safe and effective procedure that
decompresses LSS in a minimally invasive manner while preserving the structural stability of the
spine.
  Surg
Neurol Int. 2013 Aug 19;4:105. doi:
10.4103/2152-7806.116683.
  General anesthesia versus combined
epidural/general anesthesia for elective
lumbar spine disc surgery: A randomized
clinical trial comparing the impact of the two
methods upon the outcome variables.
  Khajavi MR, Asadian MA, Imani F, Etezadi
F, Moharari RS, Amirjamshidi A.
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