Gökhan KILINÇ, Bülent ATİK, Aslı METE

Elektrokonvülsif terapi uygulamalarında anestezi

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.

Anesthesia in electroconvulsive therapy

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 anesthesiaECT 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.

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