Spinal cerrahide anestezi

Anestezinin Sonland›r›lmas›

Spinal cerrahi anestezisinin, nerede ve ne flekilde sonland›r›laca-

¤› genellikle ameliyat öncesi hastan›n genel durumuna ve uygulana-

cak cerrahiye göre planlanmaktad›r. Ço¤unlukla, hasta operasyon

sonunda ameliyat odas›nda ekstübe edilmekte ve ay›lma odas›nda k›-

sa süreli bir takibin ard›ndan odas›na ç›kar›lmaktad›r. Genellikle

ameliyat öncesi medikal/kardiyovaskuler kondüsyonu kötü olan has-

talar ile intraoperatif beklenmeyen olaylar (uzam›fl ameliyat, masif ka-

nama, hipotermi) geliflen hastalar ameliyat sonras› dönemde yo¤un

bak›ma nakledilmektedirler. 

Hastan›n derlenmesini takiben, iyi bir analjezik kontrolünün sa¤-

lanmas›, sekresyonlar›n öksürerek etkili bir flekilde at›lmas› ve h›zl› bir

flekilde rehabilitasyona bafllanmas› için de çok önemlidir.

bolum19.qxp  4/9/11  7:09 PM  Page 198

---

199

Dr. Feyzi ARTUKO⁄LU - Doç. Dr. Juan Francisco ASENJO

1-

Pandey CK, Navkar DV, Giri PJ, et al: Evaluation of the optimal

preemptive dose of gabapentin for postoperative pain relief after

lumbar diskectomy: A randomized, double-blind, placebo 

controlled study. J Neurosurg Anesthesiol 17(2):65-8, 2005.

2-

Standards for basic anesthetic monitoring. October 2005. 

3-

Martyn JA, Richtsfeld M: Succinylcholine-induced hyperkalemia

in acquired pathologic states: Etiologic factors and molecular 

mechanisms. Anesthesiology 104(1):158-69, 2006.

4-

Edgcombe H, Carter K, Yarrow S: Anaesthesia in the prone 

position. BJA 100 (2):165-83, 2008.

5-

Lumb AB, Nunn JF: Respiratory function and ribcage contribution

to ventilation in body positions commonly used during 

anesthesia. Anesth Analg 73:422-6, 1991.

6-

Miller RD: Anesthesia. In Miller RD (ed). Churchill Livingstone, 

Elsevier, (7th ed) USA 2010, pp 2255.

7-

Stevens WR, Glazer PA, Kelley SD, et al: Ophthalmic 

complications after spinal surgery. 

Spine 22(12):1319-1324, 1997.

8-

Roth S, Nunez R, Schreider BD: Unexplained visual loss after 

lumbar spinal fusion. J Neurosurg Anesth 9(4):346-348, 1997.

9-

Beiner JM, Grauer J, Kwon BK, et al: Postoperative wound 

infections of the spine. Neurosurg Focus 15(3):E14, 2003.

10- Fang A, Hu SS, Endres N, et al: Risk factors for infection after 

spinal surgery. Spine 30(12):1460-1465, 2005.

11- Kanayama M, Hashimoto T, Shigenobu K, et al: Effective 

prevention of surgical site infection using a Centers for Disease

Control and Prevention guideline-based antimicrobial 

prophylaxis in lumbar spine surgery. J Neurosurg 

Spine 6(4):327-329, 2007.

12- North American Spine Surgery: Evidence-based clinical 

guidelines for multidisciplinary spine care. Antithrombotic 

therapies for spine surgery, 2009.

13- Mangano DT, Tudor IC, Dietzel C: Multicenter study if 

perioperative ischemia research group Ischemia Research and 

Education Foundation: The risk associated with aprotinin in 

cardiac surgery. N Engl J Med 354:353-65, 2006.

14- Elwatidy S, Jamjoom Z, Elgamal E, et al: Efficacy and safety of

prophylactic large dose of tranexamic acid in spine surgery. 

Spine 33(24):2577-2580, 2008.

15- Neilipovitz DT: Tranexamic acid for major spinal surgery, review

article. Eur Spine J 13 (Suppl 1):S62-S65, 2004.

16- Wong J, El Beheiry H, Rampersaud YR, et al: Tranexamic acid 

reduces perioperative blood loss in adult patients having spinal

fusion surgery. Anesth Analg 107(5):1479-1486, 2008.

17- Elwatidy S, Jamjoom Z, Elgamal E, et al: Efficacy and safety of

prophylactic large dose of tranexamic acid in spine surgery: A 

prospective, randomized, double-blind, placebo-controlled 

study. Spine 33(24):2577-2580, 2008.

18- Sum DC, Chung PC, Chen WC: Deliberate hypotensive anesthe

sia with labetolol in reconstructive surgery for scoliosis. Acta 

Anesth Sinica 34(4):203-207, 1996.

19- Taniguchi M, Nadstawek J, Pechstein U, et al: Total intravenous

anesthesia for improvement of intraoperative monitoring of 

somatosensory evoked potentials during aneurysm surgery. 

Neurosurgery 31(5):891-897, 1992.

20- Ornstein E, Berko R: Anesthesia techniques in complex spine 

surgery. Neurosurg Clin N Am 17:191-203, 2006.

21- Johansen JW, Sebel PS: Development and clinical application of

electroencephalographic bispectrum monitoring. 

Anesthesiology 93:1336-1344, 2000.

22- Johansen JW: Update on bispectral index monitoring. Best Pract

Res Clin Anaesth 20(1):81-99, 2006.

23- Lubicky JP, Spadaro JA, Yuan HA, et al: Variability of 

somatosensory cortical evoked potential monitoring during 

spinal surgery. Spine 14:790-798, 1989.

24- Gundanna M, Eskenazi M, Bendo J, et al: Somatosensory 

evoked potential monitoring of lumbar pedicle screw placement

for in situ posterior fusion. The Spine Journal 3:370-376, 2003.

25- Nishiyama M, Ito M: Effects of isoflurane, sevoflurane and 

enflurane on median nerve somatosensory evokd potentials in 

humans. Masui 42(3):339-43, 1993. Peterson DO, Drummond

JC, Todd MM: Effects of halothane, enflurane, isoflurane, and 

nitrous oxide on somatosensory evoked potentials in humans. 

Anesthesiology 65(1):35-40, 1986.

26- Yu CL, Wong CH, Chuah EC, et al: Intrathecal morphine’s effect

on somatosensory impulses transmission-studied with posterior 

tibial nerve SSEP. Ma Zui Xue Za Zhi 28(2):191-6, 1990. 

(Goodarzi M, Shier NH, Grogan DP: Effect of intrathecal 

opioids on somatosensory-evoked potentials during spinal 

fusion in children. Spine21(13):1565-1568, 1996.)

27- Schubert A, Licina MG, Lineberry PJ: The effect of ketamine on 

human somatosensory evoked potentials and its modification by

nitrous oxide. Anesthesiology 72(1):33-39, 1990.

28- Koht A, Schutz W, Schmidt G, et al: Effects of etomidate, 

midazolam and thiopenthal on median nerve somatosensory 

evoked potentials and the additive effects of fentanyl and nitrous

oxide. Anesth Analg 67(5):435-441, 1988.

29- Klasen J, Thiel A, Detsch O, et al: The effect of epidural and 

intravenous lidocaine on somatosensory evoked potentials after

stimulation of the posterior tibialis nerve. 

Anesth Analg 81(2):332-337, 1995.

30- Nuwer MR, Dawson EG, Carlson LG, et al: Somatosensory 

evoked potential spinal cord monitoring reduces neurologic 

deficits after scoliosis surgery: Results of a large multicenter 

survey. Electroencephalography & Clinical 

Neurophysiology 96(1):6-11,1995.

KAYNAKLAR

bolum19.qxp  4/9/11  7:09 PM  Page 199