Güncel Anestezi Uygulamalarında Ketamin’in Yeri
Özet
Ketaminin güncel anestezi uygulamalarındaki yerini inceleyen bu çalışma, ilacın tarihçesinden başlayarak farmakolojik özelliklerini, sistemik etkilerini ve özellikle opioid kullanımını azaltmadaki kritik rolünü kapsamlı bir şekilde ele almaktadır. 1960'larda sentezlenen ve "dissosiyatif anestezi" terimiyle özdeşleşen ketamin, NMDA reseptör antagonizması yoluyla etki göstererek güçlü analjezik, anestezik ve amnestik özellikler sunar. Ketaminin en belirgin avantajı, çoğu anestezik ajanın aksine hemodinamik stabiliteyi koruması ve sempatik sistemi stimüle ederek kan basıncı ile kalp hızını desteklemesidir. Ayrıca, hava yolu direncini azaltan bronkodilatatör etkisi sayesinde astımlı hastalarda güvenle tercih edilir. Anti-inflamatuar ve nöroprotektif etkileriyle perioperatif süreçte sistemik inflamasyonu baskılar ve iskemiye karşı koruma sağlar. Günümüzde ketamin, özellikle ERAS protokolleri çerçevesinde multimodal analjezinin vazgeçilmez bir parçası haline gelmiştir. Preemptif uygulamaları, postoperatif opioid tüketimini %37 oranında azaltırken, bulantı ve kusma insidansını da düşürerek iyileşme sürecini optimize etmektedir.
This study examining the role of ketamine in current anesthesia practices provides a comprehensive overview starting from its history to its pharmacological properties, systemic effects, and particularly its critical role in reducing opioid consumption. Synthesized in the 1960s and identified with the term "dissociative anesthesia," ketamine provides potent analgesic, anesthetic, and amnestic properties by acting through NMDA receptor antagonism. The most prominent advantage of ketamine is that, unlike most anesthetic agents, it maintains hemodynamic stability and supports blood pressure and heart rate by stimulating the sympathetic system. Additionally, it is safely preferred in patients with asthma due to its bronchodilator effect, which reduces airway resistance. With its anti-inflammatory and neuroprotective effects, it suppresses systemic inflammation during the perioperative period and provides protection against ischemia. Today, ketamine has become an indispensable part of multimodal analgesia, especially within the framework of ERAS protocols. Preemptive applications reduce postoperative opioid consumption by 37% and optimize the recovery process by decreasing the incidence of nausea and vomiting.
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