TY  - JOUR
T1  - Elektrokonvülsif terapi uygulamalarında anestezi.
TT  - Anesthesia in electroconvulsive therapy.
AU  - Kılınç, Gökhan
AU  - Atik, Bülent
AU  - Mete, Aslı
PY  - 2019
DA  - January
Y2  - 2018
DO  - 10.31362/patd.414652
JF  - Pamukkale Medical Journal
JO  - Pam Tıp Derg
PB  - Pamukkale University
WT  - DergiPark
SN  - 1308-0865
SP  - 189
EP  - 197
VL  - 12
IS  - 1
LA  - tr
AB  - Elektrokonvülsif terapi (EKT), farmakolojikyaklaşıma yanıt vermeyen ağır depresyonlarda uygulanan, temeli elektrikseluyarı yoluyla yaygın konvülsiyon oluşturmaya dayanan etkin ve yaşam kurtarıcıbir yöntemdir. Günümüzde EKT'de seçilecek anestezi yönteminin bellikuralları yoktur. Ancak genel görüş, bu uygulamada uzman bir anestezi doktorugözetiminde eğitimli bir anestezi ekibinin psikiyatri ekibine eşlik etmesigerektiği doğrultusundadırKonvülsiyon sırasında kırık ve çıkıkla sonuçlanantravmalar, solunum sorunları ve fizyolojik yanıtların ortaya çıkması zamaniçinde işlemin genel anestezi altında yapılmasını gerektirmiştir. EKThastasının uygun anestezi yönetimi modern EKT'nin terapötik sonucunu etkiler.İndüksiyon ajanlarını hastanın bireysel ihtiyaçlarına göre seçmek gereklidir.Uygulama öncesinde hastalar eşlik eden sorunlar vekullandıkları ilaçlar yönünden değerlendirilmeli, uygun anestezi yöntemiseçilmeli, hemodinami ve oksijenlenme yönünden izlenmelidir. EKT’nin güvenli veetkin olmasında anestezi ve psikiyatri doktorlarının işbirliği önemtaşımaktadır. .Anesteziklerin ‘ideal’ olarak tanımlanması için hızlıindüksiyon ve derlenme sağlamaları, etki sürelerinin kısa, yan etkilerinin azolması ve EKT’nin etkinliğini azaltmamaları gerekmektedir. Anesteziklerin pekçoğu antikonvülsan etkiye sahip olduğundan doza bağlı olarak konvülsiyonsüresini kısaltmaktadır. Görüldüğü gibi ideal bir konvülsiyon süresisağlamakla, yeterli bir anestezi derinliği sağlamak arasında çok duyarlı birdenge vardır. Adjuvan ilaçlar gerektiğinde eklenebilir. Standardizehiperventilasyon teknikleri ve anestezi-EKT zaman aralığı (ASTI) dadüşünülmelidir. Gelecekteki araştırmalar, klinik uygulamaları yönlendiren tümbu değişkenleri standartlaştırmalıdır. Kısa etki süreli barbitüratlardanmetoheksital bu tanıma en yakın bulunduğu için dünyada ‘altın standart’ kabuledilmekle birlikte ülkemizde bulunmamaktadır.
KW  - Elektrokonvülzif terapi
KW  - genel anestezi
KW  - nöromuskuler blokerler
N2  - Electroconvulsivetherapy (ECT) is an effective and life-saving method based on the generation ofdiffuse convulsions through a baseline electrical stimulus applied in severedepressions that do not respond to the pharmacological approach.There is no certain rule for decision of anesthetic method for ECT. However, general view isthat a training anesthesist under the supervision of a specialistanesthesiologist should accompany the psychiatric team in this application.Fractures and dislocations resulting in trauma, respiratory problemsand physiological responses during convulsions necessitated it to be performedunder general anesthesia over time. The appropriate anesthesiamanagement of ECT patients affects the therapeutic outcome of modern ECT. It isnecessary to select induction agents according to the individual needs of thepatient.Patients should be evaluated interms of the problems they are associated with and the drugs they use,appropriate anesthesia should be selected, hemodynamics and oxygenation shouldbe monitored. The cooperation of anesthesia and psychiatry doctors is importantfor the safe and effective ECT.In order for anesthetics to be defined as 'ideal', should provide arapid induction and recovery, short duration of action, low side effects, andalso should not reduce the efficacy of ECT. Since most of theanesthetics have anticonvulsant effect, they shorten the duration ofconvulsions depending on the dose. As can be seen there is a very critical balance between providingan ideal duration of convulsion and adequate depth of anesthesia.Adjuvant medications can be added when needed. Standardized hyperventilationtechniques and anesthesia-ECT time interval (ASTI) should also be considered.Future research should standardize all these variables that guide clinicalpractice. Methohexital is the gold standard of short-acting barbiturates and isconsidered to be the 'gold standard' in the world, but it is not in ourcountry.
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UR  - https://doi.org/10.31362/patd.414652
L1  - https://dergipark.org.tr/en/download/article-file/628566
ER  -