Anafilaksi ve Benzeri Durumlarda Adrenalin ve Diğer Ajanların Kullanımı
Özet
Anafilaksi çok hızlı gelişebilen ve erken tanı ve tedavisi yapılamadığı zamanlarda ölümle sonuçlanabilen acil durumlardan biri olarak karşımıza çıkar. Vücudun yabancı maddelere karşı savunma amaçlı verdiği yanıtlar zaman zaman kontrolden çıkar ve basit bir cilt reaksiyonu olan ürtikerden fatal seyreden anaflaksi tablosuna kadar değişen tablolara yol açabilir. Buradaki patofizyolojiyi anlamak ve anaflaksi tablosunu erken tanımak erken tedavi açısından hayati önem taşır. Anafilaksideki ana ilaç adrenalin veya epinefrin olarak bilinmektedir ve mutlak kontraendikasyonu olmadan anafilaksi kriterlerini tam karşılamayan yüksek şüpheli hastalarda bile kullanımı önerilmektedir. Alerji durumlarında kullanılan antihistaminikler, steroid grubu ilaçlar, bronkodilatörler gibi ilave ilaçlar adrenalinin alternatifi değildir ve hastanın havayolu ödemi, kardiyovasküler kollapsı gibi ölümcül sonuçları geri çeviremezler. İntramusküler yapıldığında yan etki profili düşük olan adrenalin ihtiyaç halinde intravenöz infüzyon şeklinde de verilmelidir ve anafilaksi durumlarında ilk seçenek olarak tercih edilmesi gerekmektedir. Bununla birlikte bir diğer ciddi alerjik reaksiyon olan anjioödem tablolarında özellikle bradikinin aracılı olan türlerde cevabın yetersiz olabileceği bilinmeli ve spesifik tedavi ajanları kullanılmalıdır.
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