GLUKOZ-6-FOSFAT DEHİDROGENAZ EKSİKLİĞİ OLAN HASTADA LATERAL SAGİTTAL İNFRAKLAVİKÜLER BLOK

LATERAL SAGITTAL INFRACLAVICULAR BLOCK IN A PATIENT WITH GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY

Özet

Glukoz-6-fosfat dehidrogenaz (G6PD) eksikli¤i en s›k görülen enzim yetersizli¤idir. G6PD eksikli¤i olan hastalarda perioperatif dönemde cerrahi stres, baz› ilaçlar ve a¤r› hemolitik krizlere yol açabilece¤inden anestezi plan› dikkatli yap›lmal›d›r. Bu sunuda, ulna k›r›¤› nedeniyle üç gün arayla iki kez operasyona al›nan G6PD eksikli¤i ve gut hastal›¤› olan 56 yafl›ndaki erkek hastaya ultrasonografi (US) eflli¤inde baflar›yla gerçeklefltirdi¤imiz lateral sagittal infraklaviküler blok (LS‹B) uygulamas›n› irdelemeyi amaçlad›k. Malign hipertermi ve akut hemolitik kriz geliflme riskini engellemek amac›yla genel anesteziden kaç›n›ld›. Premedikasyon midazolam ve fentanil ile sa¤land›. Methemoglobinemiye yol açabilmeleri nedeniyle prilokain ve lidokainden kaç›n›ld›. US eflli¤inde LS‹B bupivakain kullan›larak yap›ld›. Postoperatif analjezi parasetamol ile sa¤land›. Sonuç olarak, G6PD eksikli¤inde hemolitik krize yol açabilecek ilaçlardan kaç›n›larak ve güvenli oldu¤u bildirilmifl ilaçlar kullan›larak premedikasyon, anestezi ve postoperatif analjeziyi içeren güvenli bir anestezi yönetimi planlanmal›d›r. Uygun cerrahi prosedürler için US eflli¤inde LS‹B’in etkili ve güvenli bir yöntem olaca¤› kanaatindeyiz.

Abstract

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency. Anesthesia plan should be done carefully in a patients with G6PD deficiency because surgical stress, many drugs and pain may lead to hemolytic crisis in the perioperative period. In this present, we aimed to investigate the application of Ultrasound (US)- guided lateral sagittal infraclavicular block (LSIB), which we successfully performed in a 56 year old male patient with G6PD deficiency and gout disease who was operated twice for three days due to ulna fracture. General anesthesia was avoided in order to prevent the risk of developing malignant hyperthermia and acute hemolytic crisis. Premedication was provided with midazolam and fentanyl. Prilocaine and lidocaine were avoided because they could lead to methemoglobinemia. US-guided LSIB was performed using bupivacaine. Postoperative analgesia was provided with paracetamol. As a result, safe anesthesia management including premedication, anesthesia, and postoperative analgesia, should be planned using drugs that are reported to be safe and avoided from drugs that may lead to haemolytic crisis in G6PD deficiency. For the appropriate surgical procedures, we believe that US-guided LSIB is an effective and safe method.