Optik Sinir Kılıf Çapı Ölçümünün Anestezide Kullanım Alanları
Özet
İntrakraniyal basınç (İKB) artışının tespitinde altın standart invaziv yöntemler olsa da kanama ve enfeksiyon riski nedeniyle ultrasonografi eşliğinde optik sinir kılıfı çapı (OSKÇ) ölçümü gibi non-invaziv ve güvenilir teknikler ön plana çıkmaktadır. OSKÇ ölçümü, hasta sırtüstü pozisyonda başı 20-30 derece kaldırılmış durumdayken yüksek frekanslı lineer ultrason probu ile göz küresinin 3 mm arkasından transvers ve sagital düzlemlerde yapılan dört ayrı ölçümün ortalaması alınarak gerçekleştirilir. Yetişkinlerde 5,0 ile 5,9 mm arasındaki eşik değerler artmış İKB'ye işaret ederken, pediatrik grupta yaşa göre farklı eşik değerler tanımlanmıştır. OSKÇ ölçümü genel klinikte idiyopatik intrakraniyal hipertansiyon, intrakraniyal hipotansiyon, epidural kan yamasının başarısının değerlendirilmesi, menenjit, ensefalit, mantar zehirlenmesine bağlı ensefalopati, hidrosefali ve preeklamptik gebelerde İKB takibinde başarıyla kullanılmaktadır. Ayrıca kardiyak arrest sonrasında hipoksik iskemik ödemin nörolojik prognozu ve mortaliteyi tahmin etmede etkili bir parametredir. İntraoperatif alanda ise kraniosinostoz ameliyatlarında, ortopedik vakalarda turnike indirilmesini takiben salınan karbondioksite bağlı İKB artışlarında ve laparoskopik cerrahide karbondioksit pnömoperitonyumu ile Trendelenburg pozisyonunun yol açtığı İKB değişimlerinin izlenmesinde postoperatif morbiditeyi azaltmak için seri ölçümlerle tercih edilmektedir. Sonuç olarak OSKÇ ölçümü hasta başı, hızlı, radyasyonsuz ve emniyetli bir izlem olanağı sunar.
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