Transseksüel Hastalarda Anestezi Yönetimi
Synopsis
Anesthesia management in transgender patients requires a detailed, sensitive, and individualized evaluation in order to ensure patient safety and comfort during the preoperative, intraoperative, and postoperative periods. With the increasing number of gender-affirming surgeries and other medical interventions, Cross-Sex Hormone Therapy (CSHT) treatments used in the perioperative process, drug interactions, and potential clinical risks must be carefully addressed. In the preoperative stage, a culturally appropriate environment where the patient feels safe should be provided, and respect must be shown for the patient's preferred name and gender identity. Considering the biochemical effects of hormone therapy on laboratory tests, as well as the increased risks of venous thromboembolism (VTE) and cardiovascular diseases, the decision to discontinue preoperative hormonal therapy should be made in collaboration between the surgeon and the endocrinologist. In addition, preparations for a difficult airway should be made due to potential tracheal stenosis and vocal cord damage resulting from vocal cord and facial surgeries; moreover, HIV prevalence, smoking history, and possible severe systemic complications of unlicensed filler/silicone injections must be thoroughly evaluated. During the intraoperative period, ideal body weight calculations and TCI algorithms used in anesthetic drug dosing should be reviewed, and methods such as BIS should be utilized for monitoring depth of anesthesia. In the postoperative phase, pain management should be conducted meticulously taking into account the risks of depression, anxiety, and opioid dependence, while paying special attention to the increased incidence of nausea and vomiting associated with estrogen use as well as the patient's need for privacy.
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