Anahtar Kelimeler
antipsikotikler
duygudurum dengeleyiciler
ilaç etkileşimleri
perioperatif farmakoloji
Nasıl Atıf Yapılır
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.
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