Visoka torakalna epiduralna anestezija kod bolesnika sa istovremenom karotidnom endarterektomijom i off-pump revaskularizacijom miokarda
Sažetak
Uvod/Cilj. Najnovije preporuke ukazuju da je kod bolesnika planiranih za hiruršku revaskularizaciju miokarda koji imaju značajnu bilateralnu i/ili simptomatsku stenozu karotidnih arterija potrebno uraditi karotidnu endarterektomiju (CEA) pre revaskularizacije miokarda. Ovim bi se moglo postići sniženje rizika od nastanka perioperativnog cerebrovaskularnog inzulta (CVI). Najbolji rezultati su postignuti u studijama sa malim brojem bolesnika, kod kojih je urađena sinhrona operacija CEA i revaskularizacija miokarda bez ekstrakorporalne, cirkulacije, off-pump (OPCAB). Ovde je prikazana grupa od 16 uzastopnih bolesnika kod kojih je urađena sinhrona operacija CEA i OPCAB koji su bili anestezirani visokom torakalnom epiduralnom anestezijom (TEA), kombinovanom sa opštom anestezijom, sa ciljem da se ocene efekti ovakvog anesteziološkog pristupa. Metode. Ukupno 16 uzastopnih bolesnika kod kojih je bila indikovana sinhrona operacija CEA i OPCAB, bez kontraindikacije za TEA, bili su uključeni u studiju. Svi bolesnici anestezirani su kombinovanom TEA i opštom anestezijom. Rana ekstubacija planirana je kod svih bolesnika sa ciljem da se rano proceni postoperativna neurološka funkcija. Kod ispitivanih bolesnika praćeni su sledeći parametri: demografske karakteristike, komorbiditet, kvalitet postoperativnog oporavka, dužina mehaničke ventilacije, uspešnost rane ekstubacije, ishod, kao i dužina boravka u jedinici intenzivnog lečenja i bolnici. Rezultati. Samo dva bolesnika nisu ispunila kriterijume za ranu ekstubaciju. Prosečno trajanje mehaničke ventilacije rano ekstubiranih bolesnika bilo je 87,9 ± 85,0 min (0–255 min). Pet (31,25%) bolesnika ekstubirano je na kraju operacije u operacionoj sali. Nije bilo smrtnih ishoda. Nije bilo neuroloških komplikacija vezanih za TEA. Sedam (43,7%) bolesnika imalo je bar jednu od postoperativnih komplikacija koje su praćene. Nijedan bolesnik nije imao CVI. Nijedan rano ekstubiran bolesnik nije bio reintubiran, niti imao respiratornu insuficijenciju. Zaključak. Rezultati naše studije ukazuju da je kombinacija TEA i opšte anestezije dobar izbor anestezije za bolesnike sa sinhronom operacijom CEA i OPCAB. Osnovne prednosti su mogućnost rane ekstubacije i rane procene neurološke funkcije. Potrebne su studije sa većim brojem bolesnika da bi se pokazale sve prednosti i uticaj na kratkoročne i dugoročne rezultate sinhrone operacije CEA i OPCAB.
Ključne reči:
endarterektomija; aa. carotis; aa. coronariae, premošćavanje; komorbiditet; anestezija, epiduralna; postoperativne komplikacije.
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