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 doğrultusundadırKonvülsiyon 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.

Anahtar Kelimeler:

Elektrokonvülzif terapi, genel anestezi, nöromuskuler blokerler

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 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,

PDF

___

Simpson KH, Lynch L. Anaesthesia and electroconvulsive therapy ECT).Anaesthesia. 1998 Jul;53(7):615-617
Sakamoto A, Hoshino T, Suzuki N, Suzuki H, Kimura M, Ogawa R. Effects of propofol anesthesia on cognitive recovery of patients undergoing electroconvulsive therapy. Psychiatry Clin Neurosci. 1999 Dec;53(6):655-60.
Stek ML, Beekman AT, Verwey B (1997) Electroconvulsive therapy in late life depression: a review. Tijdschr Gerontol Geriatr, 28:106-112.
Lisanby SH, Morales O, Paayne N ve ark. (2003) New development in electroconvulsive therapy and magnetic seizure therapy. CNS Spectr, 8:529-536.
Rabheru K. The use of electroconvulsive therapy in special patient populations. Can J Psychiatry. 2001 Oct;46(8):710-719.
Brown NI, Mack PF, Mitera DM ve ark. (2003) Use of the ProsealTM laryngeal mask airway in a pregnant patient with difficult airway during electroconvulsive therapy. Br J Anaesth, 91:752-754
Hordynska E, Palinska D, Sobow T (2002) Electroconvulsive therapy in the treatment of depression in the elderly. Psychiatr Pol, 36(6 Suppl.):157-166.
Hick EM, Black JL (1999) AANA journal course: update for nurse anesthetists-anesthetic management during electroconvulsive therapy:effects on seizure duration and antidepressant efficacy. AANA J, 67:87-92.
Kadar AG, Ing CH, White PF ve ark. (2002) Anesthesia for electroconvulsive therapy in obese patients. Anesth Analg, 94:360-361
Ding Z, White PF (2002) Anesthesia for electroconvulsive therapy. Anesth Analg, 94:1351-1364.
Smith DL, Angst MS, Brock-Utne JG ve ark. (2003) Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy. Acta Anaesthesiol Scand, 47:1064-1066.
Malsch E, Ho L, Booth MJ, Allen E (1991) Survey of anesthetic coverege of electroconvulsive therapy in the state Pennsylvania, 1988. Convuls Ther, 7:262-274.
Mollenberg O (1997) Electroconvulive therapyanesthesiological procedures. Anasthesiol Intesivmed Notfallmed Schmerzther, 32:593-603.
Andersen FA, Arsland D, Holst-larsen H ve ark. (2001) Effects of combined methohexitone-remifentanil anaesthesia in electroconvulsive therapy. Acta Anaesthesiol Scand, 45:830-833
Swartz CM (1992) Propofol anesthesia in ECT. Convuls Ther, 8:262-266.
Folk JW, Kellner CH, Beale MD ve ark. (2000) Anesthesia for electroconvulsive therapy: a review. J ECT, 16:157-170.
Saito S, Kadoi Y, Nara T ve ark. (2000) The comparative effects of propofol versus thiopental on middle cerebral artery blood flow velocity during electroconvulsive therapy. Anesth Analg, 91:1531-1536.
Celebioglu B, Yigit H, Rezaki M ve ark. (1999) Anesthesia in electroconvulsive therapy. Annals of Saudi Medicine, 19:144-146.
Demirel CB, Kat› İ, Koçoğlu H ve ark. (2002) Elektrokonvülsif tedavide propofol ile propofol+alfentanil’in konvülsiyon süresi, hemodinamik yan›tlar ve derlenme üzerine etkileri. Anestezi Dergisi, 10:203-206.
K Tang, W & Ungvari, Gabor. (2001). Rehab Rounds: Electroconvulsive Therapy in Rehabilitation: The Hong Kong Experience. Psychiatric services (Washington, D.C.). 52. 303-306.
Otsuka H, Shikama H, Saito T ve ark. (2000) Asystole during electroconvulsive terapy in a patient with depression and myasthenia gravis. Masui, 49:893-895.
Mayur PM, Shree RS, Gangadhar BN ve ark. (1998) Atropine premedication and the cardiovascular response to electroconvulsive therapy. Br J Anaesth, 81:466-467.
Dinwiddie SH, Isenberg KE (1995) Combined alfentanilmethohexital anesthesia in electroconvulsive therapy. Convuls Ther, 11:170-176
Recart A, rawal S, White PF ve ark. (2003) The efect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy. Anesth Analg, 96:1047-1050
Nishihara F, Saito S (2002) Pre-ictal bispectral index has a positive correlation with seizure duration during electroconvulsive therapy. Anesth Analg, 94:1249-1252.
Karaca S, Köse Y, Ertan T (1995) Elektrokonvülsif tedavide (EKT) propofol ve tiyopenton’un hemodinamik ve derlenme aç›s›ndan karş›laşt›r›lmas›. Türk Anest Rean Cem Mecmuas› 23:185-188
Gürsoy MY, Özerdem A, Arkan A ve ark. (1998) Elektrokonvülsif tedavide tiyopenton ve propofolün hemodinamik yan›tlar ve derlenme üzerine etkileri. Türk Anest Rean Cem Mecmuas›, 26:197-201.
Kadoi Y, Saito S, Ide M ve ark. (2003) The comparative effects of propofol versus thiopentone on left ventricular function during electroconvulsive therapy. Anaesth Intensive Care, 31:172-175.
Zaidi NA, Khan FA (2000) Comparison of thiopentone sodium and propofol for electroconvulsive therapy (ECT). J Pak Med Assoc, 50:60-63.
Bailine SH, Petrides G, Doft M ve ark. (2003) Indications for use of propofol in electroconvulsive therapy. J ECT, 19:129-132.
Walder B, Seeck M, Tramer MR ve ark. (2001) Propofol versus methohexital for electroconvulsive therapy: a meta-analysis. J Neurosurg Anesthesiol, 13:93-98.
Geretsegger C, Rochowanski E, Kartnig C ve ark. (1998) propofol and methohexital as anesthetic agents for electroconvulsive therapy (ECT): a comparison of seizure-quality measures and vital signs. J ECT, 14:28-35.
Conca A, Germann R, König P ve ark. (2003) Etomidate vs. thiopentone in electroconvulsive therapy. Pharmacopsychiatry, 36:94-97.
Rasmussen KG, Jarvis MR, Zorumski CF (1996) Ketamine anesthesia in electroconvulsive thraphy. Convuls Ther, 12:217-223.
Auriacombe M, Reneric JP, Usandizaga D ve ark. (2000) PostECT agitation and plasma lactate concentrations. J ECT, 16:263- 267.
Dillard M, Webb J (1999) Administration of succinylcholine for electroconvulsive therapy after organophosphate poisining: a case study. AANA J, 67:513-517.
Cheam EW, Critchley LA, Chui PT ve ark. (1999) Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy. Can J Anaesth, 46:49-51.
Kadoi Y, Hoshi H, Nishida A, Saito S. Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy. J Anesth. 2011
Hoshi H, Kadoi Y, Kamiyama J, Nishida A, Saito H, Taguchi M, Saito S. Use of rocuronium-sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy. J Anesth. 2011 Apr;25(2):286-290.
Yalcin S, Aydogan H, Serdaroglu H. Rocuronium-sugammadex as an alternative to succinylcholine in electroconvulsive therapy. J Anesth. 2011 Aug;25(4):631; 632.