Derlenme Ajitasyonu (Emergence Agitation)
Özet
Uyanma ajitasyonu (derlenme ajitasyonu), genel anesteziden uyanma sırasında ortaya çıkan; bilinç bulanıklığı, agresif davranışlar ve çevre algısında bozuklukla karakterize bir anestezi komplikasyonudur. Genellikle 1-15 dakika süren bu tablo, hastanın kendisine veya sağlık personeline zarar vermesi, kateterlerin çekilmesi ve cerrahi kanama gibi ciddi riskler taşıdığından klinik önemi yüksektir. Patofizyolojisi tam aydınlatılamasa da talamoregülatör sistemlerdeki işlevsel bozukluklar ve sempatik tonus artışının etkili olduğu düşünülmektedir. Çocuklarda okul öncesi çağ ve anksiyete; erişkinlerde ise yaş, cinsiyet ve anestezi tekniği gibi faktörler riski artırır. Tanı için PAED, RASS veya RSAS gibi ölçekler kullanılsa da bunlar öznel değerlendirmelerdir. Yönetiminde; riskli hastaların takibi, TIVA tercihi, yeterli analjezi sağlanması ve invaziv cihazların erken çıkarılması gibi stratejiler uygulanır. Ayrıca ketamin, opioidler ve dexmedetomidin gibi farmakolojik ajanların ajitasyonu azalttığı gösterilmiştir. Kesin tanı için nesnel biyobelirteçlere olan ihtiyaç sürmektedir.
Emergence agitation is an anesthesia complication characterized by confusion, aggressive behaviors, and impaired perception during recovery from general anesthesia. Usually lasting 1-15 minutes, this condition holds high clinical significance due to risks such as patients harming themselves or staff, removal of catheters, and surgical bleeding. Although its pathophysiology is not fully understood, thalamoregulatory dysfunction and increased sympathetic tone are thought to be influential. Risk factors include preschool age and anxiety in children, while age, gender, and anesthesia technique are prominent in adults. While scales like PAED, RASS, or RSAS are used for diagnosis, these involve subjective assessments. Management strategies include monitoring high-risk patients, preferring TIVA, ensuring adequate analgesia, and early removal of invasive devices. Furthermore, pharmacological agents such as ketamine, opioids, and dexmedetomidine have been shown to reduce agitation. The need for objective biomarkers for a definitive diagnosis remains.
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