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Elektif sezaryen uygulanan olgularda genel ve spinal anestezinin maternal ve fetal etkilerinin karşılaştırılması

Comparison of the maternal and fetal effects of general and spinal anesthesia in elective cesarean section

Journal Name:

  • Gülhane Tıp Dergisi

Publication Year:

  • 2008

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Abstract (2. Language): 
In our study we aimed to compare the maternal and fetal effects of two different anesthesia techniques (spinal and general) routinely performed in cases undergoing elective cesarean section. Fifty two cases undergoing elective cesarean section were divided into 2 groups. Spinal anesthesia was administered with 2-2.2 ml 0.5% bupivacaine at the L3-4 and L4-5 interspaces in the lateral position in cases in Group I (n=26). In cases in Group II (n=26), anesthesia induction was made with 2 mg/kg propofol and 0.6 mg/kg rocuronium. Fifty percent O2 + 50% N2O and sevoflurane were used for the maintenance of anesthesia. Maternal hemodynamic parameters (heart rate, mean arterial blood pressure) were recorded in both groups at every five minutes during 45 minutes after the initiation of anesthesia, and 6 ml of umbilical artery blood sample was taken from all the cases following delivery. Blood gases analysis, ALT, AST, creatin kinase and total cortisol levels were studied in the blood samples. Evaluation of the newborn was performed by a pediatrician, and APGAR scores at the first and 5th minutes were recorded. In our study, results of APGAR scores, fetal blood gases (pH, pO2 , pCO2 , HCO2 -, BE), creatin kinase and ALT levels, and maternal mean arterial blood pressure and heart rate values were similar in both groups. Although fetal AST and total cortisol levels were higher in Group II, these values were within normal ranges in both groups. We conclude that the two anesthesia techniques administered in elective cesarean sections are not superior to each other in terms of maternal hemodynamic parameters and fetal well-being. Choice of anesthetic technique which will be used should be made on the basis of advantages and disadvantages of both techniques, comorbidities present in the patient, urgency of the operation, experience of the anesthesiologist and patient's choice.
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Abstract (Original Language): 
Çalışmamızda elektif sezaryen olgularında rutin uygulanan farklı iki anestezi tekniğinin (spinal-genel anestezi) maternal ve fetal etkilerini karşılaştırmayı amaçladık. Elektif sezaryen uygulanan 52 olgu iki gruba ayrıldı. Grup I olgulara (n=26) sol yan pozisyon verilip, L3-4 veya L4-5 aralığından 2-2.2 ml %0.5 hipertonik bupivakain ile spinal anestezi uygulandı. Grup II olgulara (n=26) anestezi indüksiyonunda 2 mg/kg propofol ve 0.6 mg/kg rokuronyum uygulandı. Anestezi idamesi %50 O2 + %50 N2O ve sevofluran ile sağlandı. Her iki grupta anestezi başlangıcından sonra 45 dk süreyle 5 dk'da bir maternal hemodinamik parametreler (kalp atım hızı, ortalama arteriyel kan basıncı) kaydedildi ve tüm olgulardan doğumu takiben umbilikal arterden 6 ml kan örneği alındı. Alınan örneklerden kan gazı analizi, ALT, AST, kreatin kinaz ve total kortizol düzeyleri ölçümleri yapıldı. Yenidoğanın değerlendirilmesi bir çocuk sağlığı ve hastalıkları uzmanı tarafından yapıldı ve 1. ile 5. dk APGAR skorları kaydedildi. Çalışmamızda her iki gruba ait APGAR skorları, fetal kan gazı değerleri (pH, PO2, PCO2, HCO3-, BE), kreatin kinaz, ALT değerleri ile maternal ortalama arteriyel kan basıncı değerleri ve kalp atım hızları benzer bulundu. Grup II'de fetal AST ve total kortizol değerleri daha yüksek saptanmasına karşın, her iki gruptaki değerler normal sınırlarda idi. Sonuç olarak, elektif sezaryen operasyonlarında uygulanan her iki anestezik yöntemin, maternal hemodinami ve fetal iyilik açısından birbirine belirgin üstünlükleri bulunmadığı kanısına varıldı. Hangi anestezi yönteminin uygulanacağına her iki yöntemin avantaj ve dezavantajları, hastada mevcut olan patolojiler, operasyonun aciliyeti gibi faktörler, anestezistin deneyimi ve hastanın tercihi göz önünde bulundurularak karar verilmelidir.
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  • 2
91-97
  • Turkish

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