Cerrahi Girişimlerde Psikotrop İlaç Yönetimi

Öz

Psikiyatrik hastalıkların toplumda giderek yaygınlaşması ve bu hasta grubuna uygulanan cerrahi girişim sayısının belirgin şekilde artması, perioperatif psikotrop ilaç yönetimini klinisyenler için kritik bir uygulama alanına dönüştürmüştür. Bu anlatısal derleme; antidepresanlar, antipsikotikler, duygudurum dengeleyiciler ve çeşitli psikotrop ajan gruplarının preoperatif, intraoperatif ve postoperatif dönemlerdeki yönetimine ilişkin güncel kanıtları kapsamlı biçimde ele almaktadır. Tedavinin ani kesilmesinin tetikleyebileceği nüks, yoksunluk sendromları ve anestezik ajanlarla ortaya çıkan farmakokinetik etkileşimler yer almaktadır. İlaç sürekliliği ile cerrahi güvenlik arasındaki dengenin nasıl sağlanacağı, bireysel risk-yarar analizinin hangi ölçütlere göre yapılacağı ve multidisipliner ekip iletişiminin perioperatif sürece nasıl yansıtılacağı bu derlemenin temel tartışmalarını oluşturmaktadır. Özellikle QT uzaması, serotonin sendromu ve kolinerjik blokaj gibi ilaç kaynaklı advers etkilerin perioperatif dönemde nasıl öngörülüp yönetileceği, anestezistler ve psikiyatristler arasında yapılandırılmış bir iletişim protokolünün gerekliliğini bir kez daha gündeme taşımaktadır. Aynı zamanda bu derleme, henüz yeterince standardize edilmemiş olan perioperatif psikotrop yönetim kılavuzlarının geliştirilmesine katkı sağlamayı ve klinisyenlere kanıta dayalı, uygulanabilir bir referans çerçevesi sunmayı hedeflemektedir. Eldeki veriler, psikotrop ilaçların büyük çoğunluğunun ameliyat süresince sürdürülmesi gerektiğine işaret etmekle birlikte, lityum gibi dar terapötik pencereye sahip ajanlar için cerrahi öncesinde özenli bir farmakolojik planlama yapılmasını zorunlu kılmaktadır.

Anahtar Kelimeler

• psikotroplar
• antipsikotik ilaçlar
• ilaç etkileşimleri

Management of Psychotropic Medications in Surgical Procedures

Öz

The increasing prevalence of psychiatric disorders in the general population and the substantial rise in surgical interventions performed on this patient group have rendered perioperative psychotropic medication management a critical area of clinical practice. This narrative review comprehensively addresses current evidence regarding the management of antidepressants, antipsychotics, mood stabilizers, and various other psychotropic agent classes across the preoperative, intraoperative, and postoperative periods. Topics covered include relapse triggered by abrupt discontinuation, withdrawal syndromes, and pharmacokinetic interactions arising with anesthetic agents. How to achieve the balance between medication continuity and surgical safety, the criteria by which individualized risk–benefit analysis should be conducted, and how multidisciplinary team communication should be integrated into the perioperative process constitute the central discussions of this review. In particular, anticipating and managing drug-induced adverse effects such as QT prolongation, serotonin syndrome, and cholinergic blockade in the perioperative setting further underscores the necessity of a structured communication protocol between anesthesiologists and psychiatrists. This review also aims to contribute to the development of perioperative psychotropic management guidelines that have yet to be sufficiently standardized, and to provide clinicians with an evidence-based, practical reference framework. The available data indicate that the majority of psychotropic medications should be maintained throughout the surgical period; however, agents with a narrow therapeutic window, such as lithium, necessitate meticulous pharmacological planning prior to surgery.

Anahtar Kelimeler

• psychotropics
• antipsychotics
• drug interactions

Kaynakça

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