Seyfi KARTAL, Esra KONGUR, Seyhan Sümeyra AŞÇI, Hasan Rıza AYDIN, Pınar DUMAN AYDIN, AHMET ŞEN

Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients

Objective: Spinal anesthesia is frequently used in many surgical procedures. Although both median and paramedianapproaches are used in spinal anesthesia, the conventional median approach is preferred. Reportedly, degenerativechanges in elderly patients are less affected by the paramedian approach during spinal anesthesia. In this study, we aimto determine which of the two methods is superior in elderly patients.Method: This study, patients were treated with the median approach or paramedian approach during spinal anesthesiaafter appropriate procedural preparation.Results: Overall, 103 patients were included in the study. The success rate was 90.5% in the paramedian approach and79.1% in the median approach. The duration of the procedure was shorter in the paramedian approach than in the medianapproach (14.4 ± 8.2 versus 28.4 ± 24.9, p = 0.004). During the procedure, the repetition from another interval was morein the median approach than in the statistically insignificant level due to the contact with the spinal bones and failure.The average age of the patients with the procedure duration was

Yaşlı Hastalardaki Spinal Anestezide Median ve Paramedian Yaklaşımın Değerlendirilmesi

Giriş: Spinal anestezik pek çok cerrahi işlemde sıklıkla kullanılır. Spinal anestezide median ve paramedian yaklaşım kullanılmasına rağmen, geleneksel median yöntem daha çok tercih edilir. Spinal anestezideki paramedian yaklaşım yaşlılardaki dejeneratif değişikliklerden daha az etkilenmektedir. Bu çalışmada yaşlılarda iki yöntemden hangisinin üstün olduğunu değerlendirmeyi amaçlamaktayız. Yöntemler: Bu çalişmada hastalara uygun hazırlık sonrası median ve paramedian yaklaşım ile spinal anestezik uygulandı. Bulgular: Çalişmaya toplam 103 hasta dahil edildi. Başarı oranı paramedian yaklaşımda %90,5 iken median yaklaşımda %79,1 olarak bulundu. İşlem süresi paramedian yaklaşımda median yaklaşımdan daha kısa idi (14.4±8.2’e karşın 28.4±24.9, p=0.004). İşlem esnasında spinal kemiklere değme ve başarısızlık nedeniyle başka aralıktan deneme istatistiksel olarak anlamlı düzeyde olmasa da median yaklaşımda daha fazla idi. İşlem süresi 30 sn den az olanların yaş ortalaması, 30 sn den fazla olanlara göre daha yüksek idi. Sonuç: Yaşlı hastalarda paramedian yaklaşımda, ilk girişimde ve tekrarlayan denemelerdeki başarı oranı yüksek, işlem süresi kısa, fleksiyon pozisyonundan bağımsız olarak spinal kemiklere değmeden hasta için daha konforlu şekilde işlem yapılabilmektedir. Bu nedenle yaşlı hastalarda median yaklaşıma göre paramedian yaklaşım hızlı, güvenli ve daha başarılı şekilde uygulanabilen bir yöntem olduğu kanısındayız.

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