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Spinal Anestez i Uygulanan Sezaryenlerde Uterus Büyüklüğünün Hipotansiyona Etkisi

The Effect of the Size of the Uterus to Hypotension in Cesarean Sections Performed with Spinal Anesthesia

Journal Name:

  • Smyrna Tıp Dergisi

Publication Year:

  • 2016

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: To determine hypotension in the cesarean sections performed with spinal anesthesia, to investigate the relationship between the hypotension and the size of the uterus and the ephedrine requirement. Material and Methods: Study had been conducted on 50 patients that were taken into cesarean sections performed with spinal anesthesia who were 18 years old or older and ASA I-II. Data including the volume of the amniotic fluid (AFV), estimated fetal weight (EFW), the week of pregnancy (PW) had been collected with obstetric ultrasound before the operation. Length between the symphysis pubis and the uterine fundus (SPFL) of the patients had been measured in the operating room. By sitting down the patient, spinal anesthesia had been performed with 10 mg hyperbaric bupivacaine and 12,5 mcg fentanyl from L3-4 or L4-5 interspinous gap by 25 G Quincke spinal needle. After the patient was taken into supine and 15-degree tilt position and blood pressure had been measured, the level of sensory block was assessed and maximum block level was recorded. Results: It has been recognized that there was no correlation between SPFL and hypotension and the dose of ephedrine given in patients after spinal anesthesia. The correlation between SPFL and NBW, PW, BMI, EFW, AFV had been found statistically significant. The correlation between PW and BMI, and PW and EFW were statistically significant. The correlation between AFV and EFW had also been found statistically significant. Conclusion: It was concluded that there is no correlation between the size of the length between the symphysis pubis and the uterine fundus and hypotension, and ephedrine requirement.
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Abstract (Original Language): 
Amaç: Spinal anestezi uygulanan sezaryen operasyonlarında hipotansiyonu belirlemek, hipotansiyon ile uterus büyüklüğü ve efedrin gereksinimi arasındaki ilişkiyi araştırmak. Gereç ve yöntem: Çalışma ameliyathanede spinal anestezi uygulanarak sezaryen operasyonuna alınan 18 yaş ve üzeri, ASA I-II, 50 hastada yapılmıştır. Operasyon öncesi obstetrik ultrason ile amniyon mayi miktarı (AMM), tahmini fetal ağırlık (TFA), gebelik haftası (GH) verileri alınmıştır. Ameliyathanede hastaların simfizis pubis, uterin fundus arası mesafesi (SPFM) ölçülmüştür. Hasta oturtularak L3-4 veya L4-5 interspinöz aralıktan 25 G Quincke spinal iğne 10 mg hiperbarik bupivakain ve 12,5 mcg fentanil ile spinal anestezi uygulanmıştır. Hasta supin ve 15 derece sola tilt pozisyona alınıp kan basıncı ölçüldükten sonra duyusal blok seviyesi değerlendirilmiş ve maksimum blok seviyesi kaydedilmiştir. Bulgular: Spinal anestezi sonrasında hastalarda SPFM ile hipotansiyon ve verilen efedrin dozu arasında korelasyon olmadığı görülmüştür. SPFM ile yenidoğan doğum ağırlığı (YDA), GH, vücut kitle indeksi (VKİ), TFA, AMM arasındaki ilişki anlamlı bulunmuştur. GH ile VKİ arasındaki ve GH ile TFA arasındaki ilişki anlamlı bulunmuştur. AMM ile TFA arasındaki ilişkinin de anlamlı olduğu görülmüştür. Sonuç: Simfizis pubis fundus arası mesafenin büyüklüğü ile hipotansiyon ve efedrin ihtiyacı arasında ilişki olmadığı sonucuna varılmıştır.
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