Transseksüel Hastalarda Anestezi Yönetimi
Özet
Transseksüel bireylerde anestezi yönetimi; preoperatif, intraoperatif ve postoperatif dönemlerde hasta güvenliğini ve konforunu sağlamak adına ayrıntılı, hassas ve özgün bir değerlendirme gerektirmektedir. Cinsiyet uyum ameliyatları ve diğer tıbbi müdahalelerin sayısının artmasıyla birlikte, perioperatif süreçte kullanılan Cross-Sex Hormone Therapy (CSHT) tedavileri, ilaç etkileşimleri ve olası klinik riskler dikkatle ele alınmalıdır. Preoperatif aşamada, hastanın kendini güvende hissettiği kültürel olarak uygun bir ortam sağlanmalı, hastanın tercih ettiği ad ve cinsiyet kimliğine saygı gösterilmelidir. Hormon tedavisinin laboratuvar testleri üzerindeki biyokimyasal etkileri, artan venöz tromboembolizm (VTE) ve kardiyovasküler hastalık riskleri dikkate alınarak ameliyat öncesi hormonal tedavinin kesilme kararı cerrah ve endokrinolog iş birliğiyle belirlenmelidir. Ayrıca, vokal kord ve yüz cerrahilerine bağlı trakeal darlık gelişebileceğinden zor havayolu hazırlığı yapılmalı; HIV prevalansı, sigara kullanımı ve ruhsatsız dolgu/silikon uygulamalarının olası ciddi sistemik komplikasyonları detaylıca sorgulanmalıdır. İntraoperatif dönemde, anestezik ilaç dozlamalarında kullanılan ideal vücut ağırlığı hesaplamaları ve TCI algoritmaları gözden geçirilmeli, anestezi derinliğinin izleminde BIS gibi yöntemlerden yararlanılmalıdır. Postoperatif süreçte ise depresyon, anksiyete ve opioid bağımlılığı riski göz önünde bulundurularak ağrı yönetimi titizlikle yürütülmeli, östrojen kullanımına bağlı artan bulantı-kusma insidansı ile hastanın mahremiyet ihtiyacına özen gösterilmelidir.
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