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Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları

Yıl 2022, Cilt: 5 Sayı: 1, 65 - 70, 01.01.2022
https://doi.org/10.19127/bshealthscience.1009012

Öz

Serebral palsili çocuklar sıklıkla var olan nörolojik hasar nedeniyle çiğneme ve yutma güçlüğü yaşamaktadır. Bu nedenle malnütrisyon için önemli bir risk grubunu oluştururlar. Fiziksel malformasyonları ve ek hastalıkları nedeniyle anestezi yönetimi diğer çocuk hastalara göre daha zordur. Çalışmamızda serebral palsili çocuklara yapılan perkütan endoskopik gastrostomi işlemleri sırasında ameliyathane dışı prosedüral sedasyon uygulamalarını değerlendirmeyi amaçladık. Mayıs 2017 ile Haziran 2021 tarihleri arasında ameliyathane dışında endoskopi ünitesinde prosedüral sedasyon ile perkütan endoskopik gastrostomi işlemlerinin gerçekleştirildiği 0-18 yaşları arasındaki hastalar retrospektif olarak değerlendirildi. Toplam 21 serebral palsili hasta ve 30 girişim değerlendirildi. Tüm hastalarda perkütan endoskopik gastrostomi uygulamasının temel endikasyonunu yutma güçlüğü ve malnütrisyon oluşturuyordu. Hastaların %26,6’sı (n=8) ASA skoru 2, %73,3’ü ise (n=22) ASA skoru 3 risk grubu olarak değerlendirildi. Hastaların %73,3’ünün (n=22) vücut ağırlığı <3 persentil idi. İki hastanın trakeostomisi bulunmaktaydı. Hastaların preoperatif laboratuvar değerleri normal sınırlar içindeydi. Hastaların %90,0’ında (n=27) tek başına veya ek hastalıklarına eşlik eden epilepsisi mevcuttu. İşlem sırasında en sık görülen komplikasyon bradikardi idi (n=5). Serebral palsili pediatrik hastaların perkütan endoskopik gastrostomi işlemlerinin, ameliyathane dışı ünitelerde prosedüral sedasyon altında, bu konuda deneyimli merkezler ve ekipler tarafından yapılabileceğini düşünmekteyiz.

Kaynakça

  • Ateş O, Kart Y, Hakgüder G, Mustafa Olguner M, Nur Aslan N, Yeşim Öztürk Y, Feza M. Akgür FM. 2006. Percutaneous endoscopic gastrostomy: Our experiences. Çocuk Cer Derg, 20(3): 170-173.
  • Aytuluk HG. 2020. Evaluation of advanced behavior guidance techniques used in dentistry: sedation and general anesthesia. Osmangazi Tıp Derg, 42(5): 466-473.
  • Azar AR, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. 2014. Percutaneous endoscopic gastrostomy: Indications, technique, complications and manageent. World J Gastroenterol, 20(24): 7739-7751.
  • Bawazir UA. 2020. Percutaneous endoscopic gastrostomy in children less than 10 kilograms: A comparative study. Saudi J Gastroenterol, 26(2): 105-110.
  • Butler MG, Hayes BG, Hathaway MM, Begleiter ML. 2000. Specific genetic diseases at risk for sedation/anesthesia complications. Anesth Analg, 91: 837-55.
  • Chong SK. 2001. Gastrointestinal problems in the handicapped child. Curr Opin Pediatr, 13(5): 441-446.
  • Chung HK, Lightdale JR. 2016. Sedation and monitoring in the pediatric patient during gastrointestinal endoscopy. Gastrointest Endosc Clin N Am, 26: 507–525.
  • Cudny ME, Wang NE, Bardas SL. 2013. Adverse events associated with procedural sedation in pediatric patients in the emergency department. Hosp Pharm, 48: 134-142.
  • Durakbaşa ÇU, Okur H, Mutuş HM, Baş A, Sert M, Tosyalı AN. 2008. Çocuklarda perkütan endoskopik gastrostomi (PEG) uygulamalarının endikasyonları, komplikasyonları ve sonuçlarına ilişkin bir derleme Çocuk Cer Dergi, 22(3): 122-126.
  • Enever GR, Nunn JH, Sheehan JK. 2000. A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities. Int J Paediatr Dent, 10(2): 120-125.
  • Erkin G, Kacar S, Özel S. 2005. Serebral palsili hastalarda gastrointestinal sistem ve beslenme problemleri. Turk J Phys Med Rehab, 51(4): 150-155.
  • Gamlı M, Pala Y, Selçuk A, Özcan M, Horasanlı E. 2005. İleri derecede kifoskolyozlu femur kırığı olgusunda unilateral spinal anestezi. Gazi Tıp Derg, 16: 37-41.
  • Gross WL. 2015. Non-operating room anaesthesia. In: Miller RD, editor. Miller's Anaesthesia. 8th ed. Elsevier, Philadelphia, US, pp. 3112.
  • Hausman LM, Reich DL. 2008. Providing safe sedation/analgesia: An anesthesiologist’s perspective. Gastrointest Endosc Clin N Am, 18: 707-716.
  • Kuperminc MN, Stevenson RD. 2008. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev, 14: 137-146.
  • Kurihara M, Kumagai K, Nakae Y, Kurihara K. 2001. Latex allergy in patients with severe motor and intellectual disabilities syndrome. No To Hattatsu, 33: 241-245.
  • Lightdale JR, Mahoney LB, Schwarz SM, Liacouras CA. 2007. Methods of sedation in pediatric endoscopy: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr, 45: 500-502.
  • Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T. 2015. Independent predictors of delay in emergence from general anesthesia. Anesth Prog, 62: 8–13.
  • Maranhao MV. 2005. Anesthesia and cerebral palsy. Rev Bras Anestesiol, 55: 680-702.
  • Mason KP, Seth N. 2019. The pearls of pediatric sedation: polish the old and embrace the new. Minerva Anestesiol, 85: 1105-1117.
  • McSweeney ME, Kerr J, Jiang H, Lightdale JR. 2015. Risk factors for complications in infants and children with percutaneous endoscopic gastrostomy tubes. J Pediatr, 166: 1514-1519.
  • Nolan J, Chalkiadis GA, Low J, Olesch CA, Brown TC. 2000. Anesthesia and pain management in cerebral palsy. Anesthesia, 55: 32-41.
  • Nugud A, Alhoot S, Agabna M, Babiker MOE, El Bashir H. 2021. Analgesia and sedation modalities used with botulinum toxin injections in children with cerebral palsy: a literature review. Sudan J Paediatr, 21(1): 6-12.
  • Ouchi K, Sugiyama K. 2015. Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study. BMC Anesthesiol, 15: 34.
  • Sankar C, Mundkur N. 2005. Cerebral palsydefinition, classification, etiology and early diagnosis. Indian J Pediatr, 72: 865-868.
  • Serdaroğlu A, Cansu A, Ozkan S, Tezcan S. 2006. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol, 48: 413–416.
  • Sipes M, Matson JL, Belva B, Turygin N, Kozlowski AM, Horovitz M. 2011. The relationship among side effects associated with anti-epileptic medications in those with intellectual disability. Res Dev Disabil, 32(5): 1646-1651.
  • Sit M, Kahramansoy N, Tekelioglu UY, Ocak T. 2013. Our experience in percutaneous endoscopic gastrostomy. JAREM, 3: 66-68.
  • Souter KJ, Davies JM. 2012. Diversification and specialization in anesthesia outside the operating room. Curr Opin Anaesthesiol, 25: 450-452.
  • Wang YC, Lin IH, Huang CH, Fan SZ. 2012. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan, 50: 122-125.
  • Wongprasartsuk P, Stevens J. 2002. Cerebral palsy and anesthesia. Paediatr Anaesth, 12: 296-303.
  • Yılbaş AA, Ayhan B, Akıncı SB, Sarıcaoğlu F, Aypar Ü. 2013. The effect of different end-tidal desflurane concentrations on bispectral ındex values in normal children and children with cerebral palsy. Turk J Anaesth Reanim, 41: 200-205.

Procedural Sedation Practices during Percutaneous Endoscopic Gastrostomy in Patients with Cerebral Palsy

Yıl 2022, Cilt: 5 Sayı: 1, 65 - 70, 01.01.2022
https://doi.org/10.19127/bshealthscience.1009012

Öz

Children with cerebral palsy often have chewing and swallowing difficulties due to the neurological impairment. Therefore, they constitute an important risk group for malnutrition. Anesthesia management in children with cerebral palsy is more difficult than other pediatric patients due to their physical malformations and comorbidities. In our study, we aimed to evaluate non-operating room procedural sedation practices during percutaneous endoscopic gastrostomy procedures performed on children with cerebral palsy. Between May 2017 and June 2021, patients aged 0-18 years who underwent percutaneous endoscopic gastrostomy with procedural sedation in the endoscopy unit outside the operating room were evaluated retrospectively. A total of 21 patients with cerebral palsy and 30 interventions were evaluated. Swallowing difficulties and malnutrition were the main indications for percutaneous endoscopic gastrostomy. Of the patients 26.6% (n=8) were considered as ASA score 2 and 73.3% (n=22) as ASA score 3 risk group. The weight were below the third percentile in 73.3% (n=22) of the patients. Two patients had tracheostomy. Preoperative laboratory values of the patients were within normal limits. 90.0% (n=27) of the patients had epilepsy. The most common complication during the procedure was bradycardia (n=5). We think that percutaneous endoscopic gastrostomy procedures of pediatric patients with cerebral palsy can be performed in non-operating room units under procedural sedation by experienced centers and teams.

Kaynakça

  • Ateş O, Kart Y, Hakgüder G, Mustafa Olguner M, Nur Aslan N, Yeşim Öztürk Y, Feza M. Akgür FM. 2006. Percutaneous endoscopic gastrostomy: Our experiences. Çocuk Cer Derg, 20(3): 170-173.
  • Aytuluk HG. 2020. Evaluation of advanced behavior guidance techniques used in dentistry: sedation and general anesthesia. Osmangazi Tıp Derg, 42(5): 466-473.
  • Azar AR, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. 2014. Percutaneous endoscopic gastrostomy: Indications, technique, complications and manageent. World J Gastroenterol, 20(24): 7739-7751.
  • Bawazir UA. 2020. Percutaneous endoscopic gastrostomy in children less than 10 kilograms: A comparative study. Saudi J Gastroenterol, 26(2): 105-110.
  • Butler MG, Hayes BG, Hathaway MM, Begleiter ML. 2000. Specific genetic diseases at risk for sedation/anesthesia complications. Anesth Analg, 91: 837-55.
  • Chong SK. 2001. Gastrointestinal problems in the handicapped child. Curr Opin Pediatr, 13(5): 441-446.
  • Chung HK, Lightdale JR. 2016. Sedation and monitoring in the pediatric patient during gastrointestinal endoscopy. Gastrointest Endosc Clin N Am, 26: 507–525.
  • Cudny ME, Wang NE, Bardas SL. 2013. Adverse events associated with procedural sedation in pediatric patients in the emergency department. Hosp Pharm, 48: 134-142.
  • Durakbaşa ÇU, Okur H, Mutuş HM, Baş A, Sert M, Tosyalı AN. 2008. Çocuklarda perkütan endoskopik gastrostomi (PEG) uygulamalarının endikasyonları, komplikasyonları ve sonuçlarına ilişkin bir derleme Çocuk Cer Dergi, 22(3): 122-126.
  • Enever GR, Nunn JH, Sheehan JK. 2000. A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities. Int J Paediatr Dent, 10(2): 120-125.
  • Erkin G, Kacar S, Özel S. 2005. Serebral palsili hastalarda gastrointestinal sistem ve beslenme problemleri. Turk J Phys Med Rehab, 51(4): 150-155.
  • Gamlı M, Pala Y, Selçuk A, Özcan M, Horasanlı E. 2005. İleri derecede kifoskolyozlu femur kırığı olgusunda unilateral spinal anestezi. Gazi Tıp Derg, 16: 37-41.
  • Gross WL. 2015. Non-operating room anaesthesia. In: Miller RD, editor. Miller's Anaesthesia. 8th ed. Elsevier, Philadelphia, US, pp. 3112.
  • Hausman LM, Reich DL. 2008. Providing safe sedation/analgesia: An anesthesiologist’s perspective. Gastrointest Endosc Clin N Am, 18: 707-716.
  • Kuperminc MN, Stevenson RD. 2008. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev, 14: 137-146.
  • Kurihara M, Kumagai K, Nakae Y, Kurihara K. 2001. Latex allergy in patients with severe motor and intellectual disabilities syndrome. No To Hattatsu, 33: 241-245.
  • Lightdale JR, Mahoney LB, Schwarz SM, Liacouras CA. 2007. Methods of sedation in pediatric endoscopy: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr, 45: 500-502.
  • Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T. 2015. Independent predictors of delay in emergence from general anesthesia. Anesth Prog, 62: 8–13.
  • Maranhao MV. 2005. Anesthesia and cerebral palsy. Rev Bras Anestesiol, 55: 680-702.
  • Mason KP, Seth N. 2019. The pearls of pediatric sedation: polish the old and embrace the new. Minerva Anestesiol, 85: 1105-1117.
  • McSweeney ME, Kerr J, Jiang H, Lightdale JR. 2015. Risk factors for complications in infants and children with percutaneous endoscopic gastrostomy tubes. J Pediatr, 166: 1514-1519.
  • Nolan J, Chalkiadis GA, Low J, Olesch CA, Brown TC. 2000. Anesthesia and pain management in cerebral palsy. Anesthesia, 55: 32-41.
  • Nugud A, Alhoot S, Agabna M, Babiker MOE, El Bashir H. 2021. Analgesia and sedation modalities used with botulinum toxin injections in children with cerebral palsy: a literature review. Sudan J Paediatr, 21(1): 6-12.
  • Ouchi K, Sugiyama K. 2015. Required propofol dose for anesthesia and time to emerge are affected by the use of antiepileptics: prospective cohort study. BMC Anesthesiol, 15: 34.
  • Sankar C, Mundkur N. 2005. Cerebral palsydefinition, classification, etiology and early diagnosis. Indian J Pediatr, 72: 865-868.
  • Serdaroğlu A, Cansu A, Ozkan S, Tezcan S. 2006. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol, 48: 413–416.
  • Sipes M, Matson JL, Belva B, Turygin N, Kozlowski AM, Horovitz M. 2011. The relationship among side effects associated with anti-epileptic medications in those with intellectual disability. Res Dev Disabil, 32(5): 1646-1651.
  • Sit M, Kahramansoy N, Tekelioglu UY, Ocak T. 2013. Our experience in percutaneous endoscopic gastrostomy. JAREM, 3: 66-68.
  • Souter KJ, Davies JM. 2012. Diversification and specialization in anesthesia outside the operating room. Curr Opin Anaesthesiol, 25: 450-452.
  • Wang YC, Lin IH, Huang CH, Fan SZ. 2012. Dental anesthesia for patients with special needs. Acta Anaesthesiol Taiwan, 50: 122-125.
  • Wongprasartsuk P, Stevens J. 2002. Cerebral palsy and anesthesia. Paediatr Anaesth, 12: 296-303.
  • Yılbaş AA, Ayhan B, Akıncı SB, Sarıcaoğlu F, Aypar Ü. 2013. The effect of different end-tidal desflurane concentrations on bispectral ındex values in normal children and children with cerebral palsy. Turk J Anaesth Reanim, 41: 200-205.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Nermin Kılıçarslan 0000-0002-5855-9099

Hande Gürbüz 0000-0002-3562-9517

Ayşe Neslihan Balkaya 0000-0001-8031-6264

Derya Karasu 0000-0003-1867-9018

Kaan Demirören 0000-0003-1137-1715

Mehmet Gamlı 0000-0002-5618-2734

Yayımlanma Tarihi 1 Ocak 2022
Gönderilme Tarihi 13 Ekim 2021
Kabul Tarihi 1 Kasım 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 5 Sayı: 1

Kaynak Göster

APA Kılıçarslan, N., Gürbüz, H., Balkaya, A. N., Karasu, D., vd. (2022). Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları. Black Sea Journal of Health Science, 5(1), 65-70. https://doi.org/10.19127/bshealthscience.1009012
AMA Kılıçarslan N, Gürbüz H, Balkaya AN, Karasu D, Demirören K, Gamlı M. Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları. BSJ Health Sci. Ocak 2022;5(1):65-70. doi:10.19127/bshealthscience.1009012
Chicago Kılıçarslan, Nermin, Hande Gürbüz, Ayşe Neslihan Balkaya, Derya Karasu, Kaan Demirören, ve Mehmet Gamlı. “Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları”. Black Sea Journal of Health Science 5, sy. 1 (Ocak 2022): 65-70. https://doi.org/10.19127/bshealthscience.1009012.
EndNote Kılıçarslan N, Gürbüz H, Balkaya AN, Karasu D, Demirören K, Gamlı M (01 Ocak 2022) Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları. Black Sea Journal of Health Science 5 1 65–70.
IEEE N. Kılıçarslan, H. Gürbüz, A. N. Balkaya, D. Karasu, K. Demirören, ve M. Gamlı, “Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları”, BSJ Health Sci., c. 5, sy. 1, ss. 65–70, 2022, doi: 10.19127/bshealthscience.1009012.
ISNAD Kılıçarslan, Nermin vd. “Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları”. Black Sea Journal of Health Science 5/1 (Ocak 2022), 65-70. https://doi.org/10.19127/bshealthscience.1009012.
JAMA Kılıçarslan N, Gürbüz H, Balkaya AN, Karasu D, Demirören K, Gamlı M. Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları. BSJ Health Sci. 2022;5:65–70.
MLA Kılıçarslan, Nermin vd. “Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları”. Black Sea Journal of Health Science, c. 5, sy. 1, 2022, ss. 65-70, doi:10.19127/bshealthscience.1009012.
Vancouver Kılıçarslan N, Gürbüz H, Balkaya AN, Karasu D, Demirören K, Gamlı M. Serebral Palsili Hastalarda Perkütan Endoskopik Gastrostomi Sırasında Uygulanan Prosedüral Sedasyon Uygulamaları. BSJ Health Sci. 2022;5(1):65-70.