Mide Hastalıklarında Anestezi Uygulamaları
Özet
Mide hastalıkları cerrahisinde anestezi yönetimi, preoperatif değerlendirmeden postoperatif bakıma kadar uzanan tüm perioperatif süreci kapsamaktadır. Güvenli bir anestezi planı oluşturmak adına, hastaların fiziksel durumları ve ek hastalıkları Amerikan Anesteziyoloji Derneği’nin (ASA) sınıflaması kullanılarak titizlikle değerlendirilir. Mide ameliyatlarında insizyon yerinin diyafragmaya yakınlığı nedeniyle postoperatif akciğer komplikasyonu riski yüksek olduğundan, ameliyat öncesinde verilen solunum eğitimleri büyük önem taşır. Operasyon sırasında kan basıncı, EKG, nabız oksimetre ve kapnografi gibi standart non-invaziv monitörizasyon yöntemlerinin yanı sıra, cerrahinin büyüklüğüne göre invaziv takipler de sürece dahil edilir. Girişimlerde en çok genel anestezi tercih edilmekte, epidural veya gövde blokları gibi rejyonel tekniklerle süreç desteklenmektedir. Özellikle mide kanseri cerrahisinde TIVA (Total İntravenöz Anestezi) uygulamasının ve hedefe yönelik sıvı tedavisinin hastanede kalış süresini azalttığı ve sağkalımı olumlu etkilediği görülmüştür. Postoperatif dönemde ise anastomoz kaçağı ve ileus gibi ciddi komplikasyonların önlenmesi, etkin ağrı yönetimi ve bulantı-kusma profilaksisi kritik rol oynar. Bu süreçte torakal epidural analjezi (TEA) ve multimodal analjezi yöntemleri öne çıkmaktadır. Ayrıca, perioperatif mortalite ve morbiditeyi azaltmayı hedefleyen ERAS (Hızlandırılmış İyileşme) protokolleri ile endoskopik girişimlerde uygulanan sedasyon düzeyleri anestezi yönetiminin temel bileşenleridir.
Anesthesia management in gastric disease surgery encompasses the entire perioperative period, ranging from preoperative evaluation to postoperative care. To establish a safe anesthesia plan, patients' physical statuses and comorbidities must be meticulously evaluated using the American Society of Anesthesiologists (ASA) classification. Due to the proximity of the incision to the diaphragm, the risk of postoperative pulmonary complications is inherently high; therefore, preoperative respiratory training is of paramount importance. During surgery, standard non-invasive monitoring methods such as blood pressure, ECG, pulse oximetry, and capnography are utilized, along with invasive monitoring based on the scale of the operation. General anesthesia is predominantly preferred in gastric surgery, often supported by regional techniques like epidural or trunk blocks. Particularly in gastric cancer surgery, the implementation of TIVA (Total Intravenous Anesthesia) and goal-directed fluid therapy has been shown to reduce hospital stay and improve long-term survival rates. In the postoperative phase, preventing severe complications such as anastomotic leakage and ileus, along with effective pain management and nausea-vomiting prophylaxis, plays a critical role. Thoracic epidural analgesia (TEA) and multimodal analgesia stand out in this regard. Furthermore, ERAS (Enhanced Recovery After Surgery) protocols aimed at reducing perioperative mortality and morbidity, along with various sedation levels applied during endoscopic procedures, constitute the core components of anesthesia management.
Referanslar
Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. British journal of anaesthesia. 1996;77(2):217-22.
Mitchell CK, Smoger SH, Pfeifer MP, Vogel RL, Pandit MK, Donnelly PJ, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Archives of Surgery. 1998;133(2):194-8.
McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. American journal of respiratory and critical care medicine. 2005;171(5):514-7.
Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. American Review of Respiratory Disease. 1984;130(1):12-5.
Huang Y-H, Lee M-S, Lou Y-S, Lai H-C, Yu J-C, Lu C-H, et al. Propofol-based total intravenous anesthesia did not improve survival compared to desflurane anesthesia in breast cancer surgery. Plos one. 2019;14(11):e0224728.
Huang N-C, Lee M-S, Lai H-C, Lin H-T, Huang Y-H, Lu C-H, et al. Propofol-based total intravenous anesthesia improves survival compared to desflurane anesthesia in gastric cancer surgery: A retrospective analysis. Medicine. 2020;99(25).
Voldby AW, Brandstrup B. Fluid therapy in the perioperative setting—a clinical review. Journal of intensive care. 2016;4(1):1-12.
Raghunathan K, Singh M, Lobo DN. Fluid management in abdominal surgery: what, when, and when not to administer. Anesthesiology clinics. 2015;33(1):51-64.
Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds M, Bennnett D. Early goal directed therapy reduces morbidity and length of hospital stay following high-risk surgery. Critical Care. 2005;9(1):1-.
Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews. 2012(6).
Pierre S, Whelan R. Nausea and vomiting after surgery. Continuing Education in Anaesthesia, Critical Care & Pain. 2013;13(1):28-32.
Fawcett WJ, Baldini G. Optimal analgesia during major open and laparoscopic abdominal surgery. Anesthesiology clinics. 2015;33(1):65-78.
Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy. Journal of British Surgery. 2014;101(10):1209-29.
Abad-Motos A, Ripollés-Melchor J, Bruna-Esteban M, Ferrando-Ortolá C, Paseiro-Crespo G, Abad-Gurumeta A, et al. Postoperative Outcomes Within an Enhanced Recovery after surgery protocol in gastric surgery for cancer (POWER. 4): Study protocol for a prospective, multicentre, observational cohort study. Revista Española de Anestesiología y Reanimación (English Edition). 2020;67(3):130-8.
Gross JB, Bailey PL, Connis RT, Coté CJ, Davis F, Epstein B, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004-17.
Amornyotin S, Chalayonnavin W, Kongphlay S. Recovery pattern and home-readiness after ambulatory gastrointestinal endoscopy. Medical journal of the Medical Association of Thailand. 2007;90(11):2352.
