Haydarpasa Numune Med J. 2019; 59(1): 54-59 | DOI: 10.14744/hnhj.2018.85547

Anesthetic Management of Patients with Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome

Bedih Balkan¹, Mustafa Çelik², Kamil Hakan Kaya², Arzu Karaman Koç², Halil Çetingök³, Gülsüm Oya Hergünsel^1
1Department of Anesthesiology and Reamination, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
²Department of Otorhinolaryngology, Head and Neck Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
³Department of Anesthesiology and Reamination, Bagcilar Training and Research Hospital, Istanbul, Turkey

INTRODUCTION: The objective of this study was to evaluate patients who underwent transoral robotic surgery (TORS) due to obstructive sleep apnea syndrome (OSAS) with regard to anesthetic management.
METHODS: A total of 72 patients (20 females and 52 males) were included in this study. Their mean age was 46.94±9.02 years (range: 27–67 years). The Epworth Sleepiness Scale, body mass index (BMI), apnea–hypopnea index, and the neck circumference were calculated for all patients included in the study. These patients were evaluated in terms of demographic information, TORS, anesthesia, peroperative findings, and complications.
RESULTS: Evaluation of the patients with regard to ASA scores demonstrated that 14 patients (19.4%) were detected as ASA-1, 50 patients (69.4%) as ASA-2, and eight patients (11.2%) as ASA-3. The mean duration of the operations was 131.93±33.67 min (range: 64–210 min). The mean quantity of fluids used throughout the operation was 1.516.94±226.99 ml (range: 1.100–2.200 ml). None of the patients had a history of hemorrhage requiring blood transfusion. None of the patient underwent tracheostomy. All patients were subjected to prolonged intubation and followed up in the intensive care unit for 24 h postoperatively. No statistically significant difference was found between the duration of surgery of the male and female patients and the amount of fluids used during surgery (p=0.264 and p=0.113). It was demonstrated that there was no statistically significant difference between patients with BMI < and >30 kg/m², during the operation (p=0.122). The quantity of fluid used for patients with BMI <30 kg/m² was found to be statistically higher than of those with BMI values of >30 kg/m² (p=0.006).
DISCUSSION AND CONCLUSION: OSAS surgery with the TORS method under anesthesia is of utmost importance. We suggest that TORS interventions should be performed in accordance with basic endolaryngeal surgical principles of anesthesia. We are convinced that reports associated with the use of anesthesia experiences related to this subject would increase widespread use of the technique.

Keywords: Anesthesia, intubation; obstructive apnea syndrome; robotic surgery.

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Týkayýcý uyku apne sendromunda transoral robotik cerrahi uygulanan olgularýn anestezi yönetimi.

Bedih Balkan¹, Mustafa Çelik², Kamil Hakan Kaya², Arzu Karaman Koç², Halil Çetingök³, Gülsüm Oya Hergünsel^1
1Bakýrköy Dr.Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reaminasyon Kliniði, Ýstanbul, Türkiye.
²Bakýrköy Dr.Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Kulak Burun Boðaz Baþ ve Boyun Cerrahisi Kliniði, Ýstanbul, Türkiye.
³Baðcýlar Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reaminasyon Kliniði, Ýstanbul, Türkiye.

GÝRÝÞ ve AMAÇ: Týkayýcý uyku apnesi sendromu (TUAS) nedeniyle transoral robotik cerrahi (TORC) uygulanan olgularýn anestezi yönetimi açýsýndan deðerlendirmek.
YÖNTEM ve GEREÇLER: Bu çalýþmaya toplamda 72 olgu ( 20 kadýn 52 erkek; ortalama yaþ 46.94± 9.02 yýl, aralýk 27-67 yýl) dahil edildi. Çalýþmaya dahil edilen olgularýn Epwort uyku skalasý (ESS), vücut kitle indeksi (VKÝ), apne-hipopne indeksi(AHÝ) ve boyun çevresi hesaplandý. Bu hastalar demografik bilgileri, TORC cerrahileri, anestezisi, peroperative bulgular ve komplikasyonlarý açýsýndan deðerlendirildi.
BULGULAR: Olgularýn ASA skorlarý deðerlendirildiðinde, 14 olgu (%19.4) ASA-1, 50 olgu ( %69.4) ASA-2 ve 8 olgu (%11.2) ASA-3 idi. Ortalama operasyon süreleri 131.93± 33.67 dk (aralýk 64-210 dk) idi. Operasyon boyunca ortalama kullanýlan sývý miktarý 1.516,94 ± 226,99 ml (aralýk 1.100-2.200 ml) idi. Olgularýn hiçbirinde kan transfüzyonu gerektirecek kanama olmamýþtýr. Hiçbir olguya trakeotomi açýlmadý. Tüm olgulara uzamýþ entübasyon uygulanarak 24 saat postoperatif yoðun bakým ünitesinde takip edildi. Kadýn ve erkek olgularýn ameliyat süresi ve ameliyatlarda kullanýlan sývý miktarlarý arasýnda istatistiksel olarak anlamlý farklýlýk saptanmadý (p=0.264, p=0.113). Ameliyat sürelerinde VKI 30 kg/m²' un altýnda olan ve üzerinde olan olgular arasýnda istatistiksel olarak anlamlý farklýlýk olmadýðý saptandý (p=0,122). Kullanýlan sývý miktarlarýnýn VKI 30 kg/m²' un altýnda ola olgularda VKI 30 kg/m²' un üzerinde olan olgulara göre istatistiksel olarak daha yüksek olduðu saptandý (p=0,006).
TARTIÞMA ve SONUÇ: TORC ile TUAS cerrahisi anestezi yönetimi oldukça önem arz etmektedir. TORC giriþimlerinde temel endolaryngeal cerrahi anestezik ilkeler doðrultusunda hareket edilmesi gerektiðini düþünüyoruz. Bu konu ile ilgili anestezi deneyimlerin bildirilmesi tekniðin yaygýn olarak kullanýlmasý ile daha da artacaðý kanaatindeyiz

Anahtar Kelimeler: robotik cerrahi, obstrüktif apne sendromu, anestezi, entübasyon.

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