Geriatrik Hastalarda Rejyonel Anestezi Yönetimi
Özet
Geriatrik popülasyondaki artışla birlikte, bu yaş grubunda cerrahi müdahale gerektiren hastalıkların görülme sıklığı da yükselmektedir. Yaşlı hastalarda kronik hastalıklar ve polifarmasi kullanımı, genel anestezi risklerini artırdığından rejyonel anestezi teknikleri modern tıpta stratejik bir öneme sahiptir. Rejyonel anestezi, merkezi etkili ilaçlara ve opioidlere duyarlı olan yaşlılarda sistemik yan etkileri azaltırken, cerrahi sonrası iyileşme (ERAS) protokollerini destekler. Yaşlanma ile birlikte gelişen anatomik değişiklikler, kardiyovasküler kapasitenin azalması ve ilaç metabolizmasındaki yavaşlama, anestezik yönetimini karmaşıklaştırır. Spinal ve epidural bloklar gibi nöroaksiyel tekniklerde, BOS hacmindeki azalma ve doku değişimleri nedeniyle ilaçların daha yüksek seviyelere yayılma riski ve hipotansiyon olasılığı mevcuttur. Ultrason rehberliğinde yapılan periferik sinir blokları ise daha stabil hemodinami ve düşük komplikasyon oranı ile öne çıkmaktadır. Sedasyon ve analjezi için kullanılan ilaç dozlarının geriatrik hastalarda %30-50 oranında azaltılması ve titizlikle ayarlanması kritiktir. Sonuç olarak, multidisipliner bir yaklaşım ve hastaya özgü teknik seçimi, geriatrik cerrahide başarıyı ve güvenliği belirleyen temel unsurlardır.
As the geriatric population grows, the prevalence of diseases requiring surgery in this age group also increases. Due to chronic conditions and polypharmacy, which heighten general anesthesia risks, regional anesthesia techniques hold strategic importance in modern medicine. Regional anesthesia reduces systemic side effects in elderly patients sensitive to centrally acting drugs and opioids, while supporting Enhanced Recovery After Surgery (ERAS) protocols. Anatomic changes, decreased cardiovascular capacity, and slower drug metabolism associated with aging complicate anesthetic management. In neuraxial techniques such as spinal and epidural blocks, there is a risk of medication spreading to higher levels and a possibility of hypotension due to reduced CSF volume and tissue changes. Conversely, ultrasound-guided peripheral nerve blocks stand out for their stable hemodynamics and lower complication rates. It is critical to reduce drug dosages for sedation and analgesia by 30-50% and carefully titrate them for geriatric patients. Consequently, a multidisciplinary approach and patient-specific technique selection are the fundamental elements determining success and safety in geriatric surgery.
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