Spinal Anestezi Uygulanan Sezaryen Operasyonlarında Maternal Hipotansiyon Ve Bulantıyı Önleyecek Yöntemlerin Retrospektif Değerlendirilmesi

Öz

Giriş: Sezaryen operasyonlarında spinal anestezi uygulamalarına bağlı ortaya çıkan hipotansiyon ve bulantı-kusmayı önleyici ve tedavi edici yöntemleri ve anne-bebek üzerinde etkilerini ve başarı oranlarını karşılaştırmayı amaçladık. Yöntem: Spinal anestezi altında elektif veya acil sezaryen ASA II, 348 hasta çalışmaya dahil edildi. Spinal anesteziden hemen önce ve spinal anesteziden sonra operasyon boyunca sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), kalp atım hızı (KAH), periferik oksijen satürasyonu (SpO2) ölçülerek kaydedilmektedir. Yaş, kilo, boy, kullanılan ilaçlar ve sıvılar, kan ve kan ürünleri, operasyon süresi, Apgar skorları anestezi hasta takip formlarına kaydedilmektedir. Retrospektif olarak, spinal anestezi yapılmış olan hastaların sezaryen operasyonlarının anestezi takip formları çalışmamızda değerlendirildi. Bulgular: SKB, DKB, KAH değişiklikleri ilaç verilmemiş, adrenalin, efedrin ve granisetron verilmiş olan hasta gruplarında karşılaştırıldı. SKB, DKB ve KAH değişiklikleri paralel seyretti ve istatistiksel anlamlı fark bulunmadı. Spinal anestezi sonrası SKB, DKB, KAH, giriş değerine göre tüm zaman dilimlerinde azalmıştır. SKB değişikliklerinin ilaç uygulanmayan grupta diğer gruplara göre giriş ölçümlerine yakın değerlerde olduğu görülmektedir. Efedrin verilmiş olan hastalarda supin pozisyonda ve üçüncü dakika’da SKB’nın hızlı ve belirgin bir şekilde düştüğü görülmüştür, yirminci dk'larda giriş değerine yaklaşmıştır. Adrenalin verilmiş olan grupta SKB‘da düşme belirgin olmuş ve giriş değerlerinin altında seyretmiştir. Granisetron verilmiş olan hastalarda SKB‘nın ilaç verilmemiş olan hastalarla paralel seyrettiği görülmüştür. Gruplar arasında Apgar ölçümlerinde istatistiksel olarak anlamlı bir fark bulunamamıştır. Sonuç: Spinal anestezi sonrası ortaya çıkan bulantı kusmayı önlemek için verilen i.v. granisetronun, hipotansiyon ve bradikardi gelişmesini azalttığını, hemodinamik stabilizasyon sağladığını, efedrin ve adrenalin kullanımını azalttığı sonucuna ulaştık.

Anahtar Kelimeler

• Spinal anestezi
• Hipotansiyon
• Granisetron
• Efedrin.

Retrospectıve Evaluatıon Of Methods To Prevent Maternal Hypotensıon And Nausea In Caesarean Operatıons Usıng Spınal Anesthesıa

Abstract

Objective: We aimed to examine the causes of hypotension and nausea-vomiting that occur due to spinal anesthesia in cesarean section and to compare the effects of preventive and therapeutic methods on the mother-baby. Method: ASA II, 348 patients who elective or emergency cesarean section with spinal anesthesia were included in the study. Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), oxygen saturation(SpO2) were recorded before and after spinal anesthesia throughout the operation. Age, weight, height, medications, fluids, blood, operation time, Apgar scores are recorded on anesthesia forms. Anesthesia forms of cesarean section operations of patients were retrospectively evaluated in our study. Results: Changes in SBP, DBP and HR were compared in unmedicated, adrenaline, ephedrine and granisetron treated groups. SBP, DBP and HR were parallel and no statistically significant difference was found. SBP, DBP and HR decreased in all time periods after spinal anesthesia compared to baseline. It was observed that changes SBP in the unmedicated group were close to the baseline measurements compared to the other groups. In ephedrine-treated patients, it was observed that SBP decreased rapidly and significantly in the supine position and at the third minute, and approached the admission value at the twentieth minute. In the group administered adrenaline, the decrease in SDB was marked and remained below. In patients who were given granisetron, it was observed that SBP followed a parallel course with the patients who were not given any drug. There was no statistically significant difference between the groups in Apgar measurement. Conclusion: We concluded that iv.granisetron given to prevent nausea and vomiting after spinal anesthesia decreased hypotension and bradycardia, provided hemodynamic stabilization, and reduced the use of ephedrine and adrenaline.

Keywords

• Spinal anesthesia
• Hypotension
• Granisetron
• Ephedrine

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