KBB ve Baş-Boyun Cerrahisinde Anestezi
Özet
Kulak burun boğaz (KBB) ve baş-boyun cerrahisinde anestezi uygulamaları, cerrah ile anestezistin aynı çalışma alanını paylaşması nedeniyle özel bir uyum ve yaklaşım gerektirir. Bu cerrahilerde hem lokal hem de genel anestezi yöntemleri, operasyonun niteliğine ve hastanın durumuna göre kombine edilerek de sıklıkla tercih edilir. Lokal anestezikler esterler ve amidler olarak ikiye ayrılır; en sık kullanılan amid grubu ajan lidokain iken, en uzun etkili olanı bupivakaindir. Lokal anestezi uygulamalarında en kritik komplikasyon, intravasküler enjeksiyon veya doz aşımı sonucu gelişen sistemik toksisitedir. Genel anestezide ise hava yolu yönetimi, RAE, spiralli veya lazer cerrahisine özel tüpler gibi spesifik ekipmanlarla sağlanır. İnhalasyon anesteziklerinden sevofluran ve desfluran hızlı indüksiyon özellikleri nedeniyle günümüzde öne çıkarken, azot protoksit orta kulak ve sinüs cerrahisinde basınç artışına yol açabileceği için tercih edilmez. İntravenöz ajanlar arasında propofol, hızlı derlenme ve antiemetik etkileriyle KBB ameliyatlarında yoğun olarak kullanılır. Farklı KBB prosedürlerinde kanamayı azaltmak amacıyla kontrollü hipotansiyon ve baş elevasyonu uygulanırken; OSAS hastalarında postoperatif riskler, kanser cerrahilerinde hava yolu tıkanıklıkları ve lazer vakalarında yangın riskine karşı multimodal önlemler alınmalıdır.
Anesthesia in ear, nose, throat (ENT) and head-neck surgery requires precise coordination between the surgeon and the anesthesiologist due to their shared operative field. Both local and general anesthesia techniques are utilized, often in combination, depending on the specific procedural requirements. Local anesthetics are categorized into esters and amides; lidocaine is the most frequently used amide, while bupivacaine offers the longest duration. The most critical complication of local anesthesia is systemic toxicity resulting from accidental intravascular injection or overdose. In general anesthesia, airway management is maintained using specialized equipment such as RAE, armored, or laser-resistant endotracheal tubes. Among inhalation agents, sevoflurane and desflurane are preferred for rapid induction, whereas nitrous oxide is avoided in middle ear and sinus surgeries due to potential pressure-induced tissue injury. For intravenous anesthesia, propofol is widely favored in ENT procedures because of its rapid recovery profile and antiemetic properties. Controlled hypotension and head elevation are implemented across various ENT surgeries to minimize mucosal bleeding; furthermore, specific precautions must be taken regarding postoperative risks in OSAS patients, airway obstruction in oncological resections, and airway fire hazards during laser interventions.
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