Katekolaminlere Dirençli Şokta Non-Adrenerjik Yaklaşım: Metilen Mavisi ve Perfüzyon Güvenliği

Eda Gödekmerdan Katırcıoğlu; Mehmet Burak Coşkun; Mahmut Köylü; Mihriban Yalçın

doi:10.5281/zenodo.19238729

Yazarlar

Eda Gödekmerdan Katırcıoğlu ordu devlet hastanesi https://orcid.org/0000-0003-0724-4051
Mehmet Burak Coşkun Sağlık Bakanlığı https://orcid.org/0000-0001-6748-575X
Mahmut Köylü Çukurova Üniversitesi https://orcid.org/0009-0004-2106-983X
Mihriban Yalçın Ordu Devlet Hastanesi https://orcid.org/0000-0003-4767-0880

DOI:

https://doi.org/10.5281/zenodo.19238729

Anahtar Kelimeler:

Vazoplejik Sendrom, metilen mavisi, Kardiyopulmoner Bypass, Nitrik Oksit, Perfüzyon Yönetimi

Özet

Kardiyopulmoner bypass (KPB) sonrası gelişen vazoplejik sendrom; düşük sistemik vasküler direnç, normal veya artmış kardiyak debi ve yüksek doz katekolaminlere yanıtsızlık ile karakterize, mortalitesi yüksek (%25) bir klinik tablodur. Bu bölüm, vazoplejinin patofizyolojisinde rol oynayan Nitrik Oksit (NO) ve siklik Guanozin Monofosfat (cGMP) yolağının aşırı aktivasyonunu ve bu yolağı hedef alan Metilen Mavisi'nin (MM) terapötik rolünü incelemektedir. MM, çözünür Guanilat Siklaz (sGC) ve indüklenebilir Nitrik Oksit Sentaz (iNOS) enzimlerini inhibe ederek, adrenerjik reseptörlerden bağımsız bir mekanizmayla vasküler tonusu restore eder.

Çalışmada ayrıca, MM kullanımının intraoperatif dönemde yarattığı spesifik monitörizasyon zorlukları detaylandırılmıştır. İlacın optik özellikleri nedeniyle pulse oksimetre (SpO2) ve serebral oksimetre (NIRS) cihazlarında gözlenen "psödo-desatürasyon" (yalancı düşüş) fenomeninin mekanizması ve perfüzyon güvenliği açısından yönetimi tartışılmıştır. Cerrahi açıdan; preoperatif risk faktörleri (ACE inhibitörü kullanımı, endokardit), zamanlama stratejileri (profilaktik vs. kurtarıcı) ve mutlak kontrendikasyonlar (G6PD eksikliği, Serotonin Sendromu riski) güncel literatür ışığında ele alınmıştır. Bu bölüm, kalp damar cerrahı, perfüzyonist ve farmakoloğun ortak perspektifiyle, dirençli vazopleji yönetiminde güvenli ve etkili bir klinik protokol oluşturmayı amaçlamaktadır

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