Entübasyon Sonrası Gelien Trakeal StenozunAnestezi Yönetimi ve Cerrahi Prosedürü
Yükleniyor...
Dosyalar
Tarih
2013
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Endotrakeal tüp veya trakeostomi kanüllerinin kafları fazla volümde hava ile i irildikleri takdirde temas halinde oldukları hava yollarına basınç uygulayarak mukozada travmaya yol açmaktadırlar. Sonuçta bu bölgede çember eklinde nekroz alanı ve skatris-striktür olu ması ile ciddi bir klinik durum olan semptomatik trakeal stenozlar meydana gelmektedir. Yirmi dört ya ında erkek olgu nefes darlı ı ve hırıltılı solunum ikâyetleri ile acil servise ba vurdu. Anamnezde yakın zamanda yüksekten dü me nedeniyle yo un bakım ünitesinde entübe olarak takip ve tedavi edildi i ö renilen olgunun fizik muayenesinde inspiratuvar wheezing ve stridor tespit edildi. Arter kan gazında pH: 7.31 ve pO2: 68.7 mmHg idi. Anterior-posterior ve lateral boyun grafilerinde trakeal stenoz alanı görüldü. Bilgisayarlı tomografide trakeanın ba langıcında 22 mm uzunlu unda ve en dar yerinde 3,5 mm çapında olan stenotik segment izlendi. Olguya kollar insizyon ile stenotik segment rezeksiyonu ve uç uca anastomoz uygulandı. Postoperatif dönemde komplikasyon geli meyen olgu 7. gün taburcu edildi. Klinik, radyolojik ve bronkoskopik olarak tam iyile me gözlenen olgu 1 yıllık takibin sonunda halen asemptomatiktir. Uzun süreli entübasyonlarda yüksek kaf basıncına ba lı olarak geli en trakeal stenozlar ciddi solunum sıkıntısı ve ya am kalitesinde bozulmaya yol açmaktadırlar. Cerrahi olarak yapılan stenotik segmentin rezeksiyonu ve uç uca anastomoz tekni i etkili bir anestezi yönetimi ve postoperatif bakımla birle tirildi inde ba arılı sonuçlar alınabilmektedir.
The cuffs of endotracheal tube or tracheostomy cannulas cause mucosal trauma by applying pressure on to the airways when inflated with high volume. Eventually, symptomatic tracheal stenoses which are serious clinical cases occur with circular necrotic area and stricture. A 24 year-old male patient was admitted due to complaints including dyspnea and wheezy breathing. Hospitalization in intensive care unit due to fall off was learned from his history. Inspiratory wheezing and stridor was detected in physical examination. Arterial blood gas analysis showed pH: 7.31 and pO2 : 68.7 mmHg. Tracheal stenosis area was seen on anterior-posterior and lateral neck graphics. Computed tomography showed the stenotic segment 22 mm in length and 3.5 mm in narrowest diameter in the beginning of the trachea. The case was undergonestenotic segment resection and end to end anastomosis via collar incision. Any postoperative complication did not observed and the patient was discharged on 7th day. The patient is still asymptomatic after 1 year follow-up with complete clinical, radiological and bronchoscopic recovery. Tracheal stenoses due to high cuff pressure in prolonged intubations cause severe shortness of breath and deterioration in life quality. Surgery including stenotic segment resection and end to end anastomosis gives successful results when combined with an effective anesthesia management and postoperative care.
The cuffs of endotracheal tube or tracheostomy cannulas cause mucosal trauma by applying pressure on to the airways when inflated with high volume. Eventually, symptomatic tracheal stenoses which are serious clinical cases occur with circular necrotic area and stricture. A 24 year-old male patient was admitted due to complaints including dyspnea and wheezy breathing. Hospitalization in intensive care unit due to fall off was learned from his history. Inspiratory wheezing and stridor was detected in physical examination. Arterial blood gas analysis showed pH: 7.31 and pO2 : 68.7 mmHg. Tracheal stenosis area was seen on anterior-posterior and lateral neck graphics. Computed tomography showed the stenotic segment 22 mm in length and 3.5 mm in narrowest diameter in the beginning of the trachea. The case was undergonestenotic segment resection and end to end anastomosis via collar incision. Any postoperative complication did not observed and the patient was discharged on 7th day. The patient is still asymptomatic after 1 year follow-up with complete clinical, radiological and bronchoscopic recovery. Tracheal stenoses due to high cuff pressure in prolonged intubations cause severe shortness of breath and deterioration in life quality. Surgery including stenotic segment resection and end to end anastomosis gives successful results when combined with an effective anesthesia management and postoperative care.
Açıklama
Anahtar Kelimeler
Genel ve Dahili Tıp
Kaynak
Tıp Araştırmaları Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
11
Sayı
2
