Yoğun Bakım Ünitesinde Entübasyona Hemodinamik Yanıtı Önlemede Remifentanil, Fentanil, Esmolol, Lidokain ve Amiodaronun Etkilerinin Karşılaştırılması ve Bir Olgu Sunumu
Özet
Laringoskopi ve endotrakeal entübasyon, özellikle yoğun bakım ünitesinde (YBÜ) kritik hastalarda belirgin sempatoadrenerjik aktivasyona yol açarak hipertansiyon, taşikardi ve kardiyak aritmilere neden olabilmektedir. Bu hemodinamik yanıt çoğu sağlıklı bireyde tolere edilebilirken; hipertansiyon, koroner arter hastalığı, serebrovasküler hastalık ve artmış intrakraniyal basıncı olan hastalarda ciddi komplikasyonlara yol açabilir. YBÜ’de entübasyon, hemodinamik instabilite ve hipovolemi gibi eşlik eden durumlar nedeniyle ameliyathane koşullarına kıyasla daha yüksek komplikasyon oranları ile ilişkilidir. Entübasyona bağlı hemodinamik yanıtın önlenmesinde refleks arkı temelinde üç yaklaşım uygulanmaktadır: afferent yolların lokal anesteziklerle blokajı, santral sempatik yanıtın opioid ve nöroleptiklerle baskılanması ve efferent yolların beta blokerler, kalsiyum kanal blokerleri ve vazodilatörlerle inhibisyonu. Bu bölümde, yoğun bakım koşullarında entübasyona hemodinamik yanıtı önlemede remifentanil, fentanil, esmolol, lidokain ve amiodaronun etkinlikleri karşılaştırılmış ve klinik bir olgu sunumu eşliğinde değerlendirilmiştir. Amaç, kritik hastalarda entübasyon güvenliğini artırmaya yönelik farmakolojik stratejilerin klinik uygulanabilirliğini ortaya koymaktır.
Laryngoscopy and endotracheal intubation provoke a pronounced sympathoadrenal response, particularly in critically ill patients in the intensive care unit (ICU), leading to hypertension, tachycardia, and cardiac arrhythmias. Although this response is generally transient and well tolerated in healthy individuals, it may result in serious complications in patients with hypertension, coronary artery disease, cerebrovascular disorders, or elevated intracranial pressure. Compared with operating room settings, intubation in the ICU is associated with higher complication rates due to hemodynamic instability, hypovolemia, and impaired physiological reserve. Strategies to attenuate the hemodynamic response are based on the reflex arc and include: blockade of peripheral afferent pathways with local anesthetics; suppression of central sympathetic activation using opioids and neuroleptic agents; and inhibition of efferent pathways and effector receptors with beta-blockers, calcium channel blockers, and vasodilators. This chapter compares the effects of remifentanil, fentanyl, esmolol, lidocaine, and amiodarone in preventing intubation-related hemodynamic responses in the ICU setting and presents a representative clinical case. The aim is to evaluate pharmacological strategies that enhance intubation safety in critically ill patients.
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