Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Kardiyak Kateterizasyon Uygulanan Pediatrik Hastalarda Prosedürel Sedasyonun Etkinliğinin Kesitsel İncelenmesi
Cross-Sectional Study of the Effectiveness of Procedural Sedation in Pediatric Patients Undergoing Cardiac Catheterization
Hilal ZENGİNa , Nadide ÖRS YILDIRIMb
aSağlık Bilimleri Üniversitesi Gülhane Eğitim Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon ABD, Ankara, Türkiye
bSincan Eğitim Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Anest Reanim. 2024;22(2):39-46
doi: 10.5336/anesthe.2024-104113
Article Language: TR
Full Text
ÖZET
 Amaç: Minimal invaziv kardiyak kateterizasyon (KK) işlemleri daha fazla tercih edilmektedir. Bu işlemlerde uygulanan prosedürel sedasyon ve analjezi (PSA) uygulamalarını değerlendirerek seçilmiş vakalarda genel anestezi (GA)'nin yerine kullanılabilirliğini göstermek istedik. Gereç ve Yöntemler: Etik kurul onamı alınan 18 yaşın altındaki çocuklarda, kardiyak hemodinamik görüntüleme ve işlem labaratuvarında, KK işlemlerinde, GA, ketamin ve propofol infüzyonu ile PSA uygulanan hastaların dosyalarından, ASA skoru, yaş, istenmeyen olaylar, yapılan işlem ve süresi, retrospektif olarak kayıt altına alındı. Bulgular: Çalışmaya 297 hasta dahil edildi. İşlemlerin %30,3'ü GA, %69,7'si PSA ile yapılmıştı. GA grubunda %63,3 oranı ile kız çocuklar fazla idi (p=0,031). Gruplar arasında ASA sınıflamasında fark bulunmadı (p=0,285). Hastaların ortalama yaşı 11,22 [standart sapma (SS) 4,54], en küçük yaş 1 ve en büyük yaş 18'di. İşlem süresi GA grubunda ortalama 106,56 dak. (SS 46,335) olup PSA grubunda 108,38 dak. (SS 47,566) idi. En kısa işlem 15, en uzun işlem 240 dakikaydı. Gruplar arasında süre açısından fark bulunmadı (p=0,760). Hastaların %11,8'inde (n=35) patent duktus arteriosus, %12,8'inde (n=38) atriyal septal defekt (ASD), %24,2'si (n=72) supraventriküler taşikardi, %42,8'inde (n=127) diğer ritim bozuklukları ve %2'sinde (n=6) ventriküler septal defekt (VSD) tanısı vardı. Transözofageal ekokardiyografi (TÖE) eşliğinde, ASD kapatılmasında %90, VSD'nin tamamında GA tercih edildi. Hastaların tanılarına göre seçilen tedavi yöntemleri arasındaki fark iki grupta anlamlıydı (p<0,001). PSA esnasında istenmeyen durumlar görülmedi. Sonuç: İşlem süreleri ve ASA skorları arasında fark olmayan gruplarda hastaların tanılarına göre anestezi yöntemi seçildiği görüldü. TÖE ile yapılan işlemlerde GA, çok uzun süren kardiyak elektrofizyolojik işlemlerde ise PSA ile işlem yaptırılabildi.

Anahtar Kelimeler: Prosedürel sedasyon analjezi; genel anestezi; kardiyak kateterizasyon işlemleri; pediatrik hasta
ABSTRACT
 Objective: Minimally invasive cardiac catheterization (CC) procedures are increasingly preferred. Prosedürel sedation and analgesia (PSA) are replacing general anesthesia (GA) in selected procedures. We aimed to show that PSA could be used as an alternative to GA in CC procedures. Material and Methods: In patients under 18 years of age who received ethical committee approval, data (ASA scores, age, advers events, procedures and durations) was retrospectively collected from the files of those undergoing PSA (with ketamine and propofol) and GA. Results: The study included 297 patients. While 30.3% of the procedures were performed under GA, 69.7% were performed with PSA. There was no significant difference between the ASA scores of the groups (p=0.285). The average age of the patients was 11.22 years [median 12, standard deviation (SD) 4.54], with the youngest being 1 year old and the oldest 18 years old. The average procedure time was 106.56 minutes (SD 46.335) for the GA group and 108.38 minutes (SD 47.566) for the PSA group. The shortest procedure lasted 15 minutes, and the longest lasted 240 minutes. No significant difference in procedure times was found between the groups (p=0.760). Among the patients, 11.8% (n=35) had patent ductus arteriosus, 12.8% (n=38) had atrial septal defects, 24.2% (n=72) had supraventricular tachycardia, 42.8% (n=127) had other rhythm disorders, and 2% (n=6) had ventricular septal defects. GA was preferred in 90% of TEE-guided ASD closures and all VSD closures. The differences in treatment methods based on diagnoses were significant in both groups (p<0.001). No undesirable events were observed during PSA. Conclusion: It was determined that the choice of anesthesia method was based on the diagnoses of patients rather than the duration of procedures.PSA may be preferred in cardiac electrophysiological procedures lasting longer than 60 minutes.

Keywords: Procedural sedation and analgesia; general anesthesia; cardiac catheterization procedures; pediatric patient
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