Sitoredüktif Cerrahi ve HİPEK’te Anestezi ve Perioperatif Bakım

  • Dilek Kalaycı
  • Özlem Şen
  • Mustafa Arslan Gazi Üniversitesi Tıp Fakültesi

Abstract

Hipertermik intraperitoniyal kemoterapi ve sitoredüktif cerrahi seçilmiş peritoniyal karsinomatozisli olgularda popülaritesi gittikçe artan, etkili multimodal tedavi seçeneklerindendir. Sitoredüktif cerrahi, cerrahi alanın büyük olduğu, kan ve sıvı kaybının fazla olduğu, sıvı şiftlerinin görüldüğü, koagülasyon değişikliklerinin meydana geldiği hipertermik intraperitoniyal kemoterapi öncesi uygulanan fazdır ve süre olarak da uzundur. Hipertermik intraperitoniyal kemoterapifazı ise önemli hematolojik, hemodinamik ve metabolik değişikliklerin görüldüğü fazdır. Bu cerrahi prosedür anestezistler içinde oldukça zor bir süreçtir. Anestezistin görevi her fazda meydana gelen patofizyolojik değişiklikleri bilmek ve buna göre perioperatif dönemde önlem almaktır. Bu hastalar intraoperatif ve postoperatif yakın izlem gerektirir. Primer hastalığın yanı sıra cerrahinin büyüklüğü, anestezik yönetim, verilen sıvı miktarı ve kan transfüzyonu sonuçları etkileyebilir. Bu konuda ileri çalışmalara ihtiyaç vardır. Gittikçe artan sıklıkla yapılmasına rağmen anestezi uygulaması ile ilgili oluşmuş bir görüş birliği bulunmamaktadır. Bu yazıda sitoredüktif cerrahi ve hipertermik intraperitoniyal kemoterapide perioperatif anestezik yaklaşım anlatılmaktadır.

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Published
2016-12-26
Section
Literature Review With Cases