Elektrokonvülsif terapi uygulamalarında anestezi.

Year 2019, , 189 - 197, 18.01.2019

Gökhan Kılınç , Bülent Atik , Aslı Mete

https://doi.org/10.31362/patd.414652

Abstract

Elektrokonvülsif terapi (EKT), farmakolojik
yaklaşıma yanıt vermeyen ağır depresyonlarda uygulanan, temeli elektriksel
uyarı yoluyla yaygın konvülsiyon oluşturmaya dayanan etkin ve yaşam kurtarıcı
bir yöntemdir.

Günümüzde EKT'de seçilecek anestezi yönteminin belli
kuralları yoktur. Ancak genel görüş, bu uygulamada uzman bir anestezi doktoru
gözetiminde eğitimli bir anestezi ekibinin psikiyatri ekibine eşlik etmesi
gerektiği doğrultusundadır

Konvülsiyon sırasında kırık ve çıkıkla sonuçlanan
travmalar, solunum sorunları ve fizyolojik yanıtların ortaya çıkması zaman
içinde işlemin genel anestezi altında yapılmasını gerektirmiştir. EKT
hastasının uygun anestezi yönetimi modern EKT'nin terapötik sonucunu etkiler.
İndüksiyon ajanlarını hastanın bireysel ihtiyaçlarına göre seçmek gereklidir.

Uygulama öncesinde hastalar eşlik eden sorunlar ve
kullandıkları ilaçlar yönünden değerlendirilmeli, uygun anestezi yöntemi
seçilmeli, hemodinami ve oksijenlenme yönünden izlenmelidir. EKT’nin güvenli ve
etkin olmasında anestezi ve psikiyatri doktorlarının işbirliği önem
taşımaktadır. .

Anesteziklerin ‘ideal’ olarak tanımlanması için hızlı
indüksiyon ve derlenme sağlamaları, etki sürelerinin kısa, yan etkilerinin az
olması ve EKT’nin etkinliğini azaltmamaları gerekmektedir. Anesteziklerin pek
çoğu antikonvülsan etkiye sahip olduğundan doza bağlı olarak konvülsiyon
süresini kısaltmaktadır. Görüldüğü gibi ideal bir konvülsiyon süresi
sağlamakla, yeterli bir anestezi derinliği sağlamak arasında çok duyarlı bir
denge vardır. Adjuvan ilaçlar gerektiğinde eklenebilir. Standardize
hiperventilasyon teknikleri ve anestezi-EKT zaman aralığı (ASTI) da
düşünülmelidir. Gelecekteki araştırmalar, klinik uygulamaları yönlendiren tüm
bu değişkenleri standartlaştırmalıdır. Kısa etki süreli barbitüratlardan
metoheksital bu tanıma en yakın bulunduğu için dünyada ‘altın standart’ kabul
edilmekle birlikte ülkemizde bulunmamaktadır. 

Keywords

Elektrokonvülzif terapi, genel anestezi, nöromuskuler blokerler

Anesthesia in electroconvulsive therapy.

Abstract

Electroconvulsive
therapy (ECT) is an effective and life-saving method based on the generation of
diffuse convulsions through a baseline electrical stimulus applied in severe
depressions that do not respond to the pharmacological approach.

There is no certain rule for decision of anesthetic method for ECT. However, general view is
that a training anesthesist under the supervision of a specialist
anesthesiologist should accompany the psychiatric team in this application.

Fractures and dislocations resulting in trauma, respiratory problems
and physiological responses during convulsions necessitated it to be performed
under general anesthesia over time. The appropriate anesthesia
management of ECT patients affects the therapeutic outcome of modern ECT. It is
necessary to select induction agents according to the individual needs of the
patient.

Patients should be evaluated in
terms of the problems they are associated with and the drugs they use,
appropriate anesthesia should be selected, hemodynamics and oxygenation should
be monitored. The cooperation of anesthesia and psychiatry doctors is important
for the safe and effective ECT.

In order for anesthetics to be defined as 'ideal', should provide a
rapid induction and recovery, short duration of action, low side effects, and
also should not reduce the efficacy of ECT. Since most of the
anesthetics have anticonvulsant effect, they shorten the duration of
convulsions depending on the dose. As can be seen there is a very critical balance between providing
an ideal duration of convulsion and adequate depth of anesthesia.
Adjuvant medications can be added when needed. Standardized hyperventilation
techniques and anesthesia-ECT time interval (ASTI) should also be considered.
Future research should standardize all these variables that guide clinical
practice. Methohexital is the gold standard of short-acting barbiturates and is
considered to be the 'gold standard' in the world, but it is not in our
country.

Keywords

Electroconvulsive therapy, general anesthesia, Neuromuscular blockers

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