Girişimsel Sedasyon ve Analjezi
Özet
Prosedürel sedasyon ve analjezi (PSA), tanı ve tedavi işlemleri sırasında hastanın konforunu artırmak ve işleme uyumunu sağlamak amacıyla, bilinç düzeyini hafif-orta düzeyde baskılayan, hava yolu reflekslerini ve hemodinamik stabiliteyi koruyan farmakolojik bir tekniktir. PSA; kardiyoversiyon, kırık redüksiyonu ve laserasyon onarımı gibi birçok acil müdahalede sıkça uygulanır. Yaşlılar, obez bireyler, gebeler ve zor hava yolu riski taşıyan hastalar için dikkatli değerlendirme ve özel önlemler gereklidir. PSA’nın güvenli uygulanabilmesi için uygun hasta seçimi, dikkatli ilaç titrasyonu, sürekli monitörizasyon ve acil müdahale ekipmanlarının hazır bulundurulması esastır. Propofol ve etomidat gibi kısa etkili ajanlar sıklıkla tercih edilirken, ketamin ve ketofol gibi kombinasyonlar da avantajlar sunabilir. Lipofilik yapısı nedeniyle santral sinir sistemine hızla geçen midazolam, en yaygın kullanılan benzodiazepin olup fentanil gibi kısa etkili ve güçlü opioidlerle birlikte kısa süreli ancak derin sedasyon gerektiren endoskopi gibi durumlarda tercih edilebilir. İntranazal uygulamalar da belirli durumlarda alternatif olarak kullanılabilir. PSA sonrası güvenli taburculuk için hastanın klinik stabilitesi, semptom kontrolü ve eşlik eden kişinin varlığı önemlidir.
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