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Yıl:1998; Cilt: 3; Sayı: 2>> Özet
Ege Psikiyatri Sürekli Yayınları; 1998;3(2):333-352
Elektrokonvülsif Tedavi ve Anestezi
MY Gürsoy, E Sağıroğlu
Elektrokonvülsif tedavinin (EKT) depresif bozuklukların tedavisinde kullanımı giderek yaygınlaşmaktadır. Tedavi için kısa süreli bilinç kaybı yeterli olduğundan kısa etkili anestezik maddelerin kullanımı daha avantajlıdır. Hastanın güvenliği ve hoşnutluğunu sağlamak için, EKT anestezisini uygulayan birimin yeterli deneyim ve donanıma sahip olması gerekir. EKT'de mortalite ve ciddi morbidite nadirdir. Artan monitörizasyon düzeyi güvenliği daha da artırmaktadır. EKT anestezisinin standartları yakın dönemde ortaya çıkmaya başlamıştır. Geleneksel olarak EKT'nin hedefi en az 20-30 sn süren bir jeneralize tonik-klonik nöbet oluşturmaktır. Kümülatif nöbet süresinin EKT etkinliğinin ikinci bir ölçüsü olduğu bildirilmektedir. Ancak EKT'nin tedavi edici etkinliğinin belirli bir nöbet süresine dayandığı konusundaki dogma yakın dönemde sorgulanmaya başlanmıştır. Nöbet eşiği ve nöbet süresi birbirleriyle ters orantılıdır. Nöbet eşiğini yükselten anestezik maddeler, EKT ile oluşan nöbetin süresini kısaltabilirler. Bu nedenle anesteziklerin olanaklı olan en düşük dozda verilmeleri gerekir. Elektrikle oluşturulan nöbetler yeterli derecede amneziye yol açtığından, yalnızca oluşmamış ya da yetersiz nöbetler sırasında hastanın kas paralizisini hissetmemesine yetecek ölçüde bir hipnoz sağlanmalıdır. EKT'ye kardiyovasküler yanıt, otonom sinir sisteminin uyarılmasından kaynaklanmaktadır. Parasempatik ve sempatik etkinlikteki artış, dolaşımdaki katekolamin düzeylerinin artmasına yol açmaktadır. Düzenlemenin hedeflerinden biri de artan otonom sinir sistemi etkinliğine bağlı istenmeyen etkileri azaltmak olmalıdır. EKT'nin başarıyla uygulanabilmesi eğitimli anestezi hemşireleri, psikiyatristler, anestezistler, hastalar ve yakınlarının işbirliğini gerektirir.

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