Comparison of Maternal and Neonatal Effects of Different Inhalational Anaesthetics Used for Cesarean Operations

Abstract

Aim: The aim of this study is to evaluate the maternal and fetal effects of frequently used inhalational anaesthetic agents sevoflurane, isoflurane and desflurane in cesarean operations performed under general anaesthesia. Material and Methods: 75 ASA I-II parturients undergoing elective caesarean section were included in the study. Anesthesia induction was performed induction with propofol 2 mg/kg and rocuronium 0.6 mg/kg. In Group S, anesthesia maintenance was done with sevoflurane 1.5 % and N2O 50 % in oxygen inhalation while in Group D and Group I maintainance was done desflurane 3 % and isoflurane 1 % and N2O 50 % in oxygen inhalation respectively. Hemodynamic data were recorded before induction (baseline), at 1, 5, 10, 15, 20, 25 and 30 minutes following intubation. Anesthesia induction-delivery time, anesthesia emergence time and orientation time were recorded. Uterine tonus and blood loss were assessed. Venous blood sample for maternal complete blood count was collected before anaesthesia induction and at 30 minutes postoperatively. Neonatal blood samples for umbilical blood gas analysis were collected after the clamping of cord. A blinded observer to the study protocol evaluated the APGAR score at 1 and 5 minutes after the clamping of the umbilical cord. Same observer also evaluated the NACS at 2nd and 24th hours postoperatively. Results: Maternal demographic data and duration of anesthesia and surgery, anesthesia induction-delivery time, anesthesia emergence and orientation times were similar among groups. The hemodynamic parameters of Group S at 1st minute was higher when compared with the baseline values and Group D at 1st minute was higher when compared with baseline values and Group S and Group I. Estimated blood loss was similar in three groups. There was no difference between the groups in terms of APGAR scores, while the NAC scores at 2nd hour of Group I were lower than the other two Groups. Conclusion: In elective cesarean operations performed with general anaesthesia, sevoflurane and desflurane may be preferred instead of isoflurane in terms of neonatal effects. As desflurane cause a slight increase in maternal hemodynamic parameters, sevoflurane may be the preferred inhalational anaesthetic agent.

Keywords

• general anaesthesia
• cesarean operation
• inhalational anaesthetics

Sezaryen Operasyonlarında Kullanılan Farklı İnhalasyon Anesteziklerinin Maternal ve Neonatal Etkilerinin Karşılaştırılması

Abstract

Amaç: Bu çalışmada amaç, elektif sezaryen girişimlerinde sık kullanılan inhalasyon ajanlarından sevofluran, desfluran ve izofluranın yenidoğan üzerine ve maternal etkilerini karşılaştırmaktır. Gereç ve yöntem: Genel anestezi altında elektif sezaryen ameliyatı planlanan, miadında ASA I-II grubunda 75 gebe çalışmaya dahil edildi. Tüm hastalara intravenöz 2 mg/kg propofol, 0,6 mg/kg roküronyum bromür ile indüksiyon sağlandıktan sonra hastalar rastgele üç gruba ayrılarak idame, %50 N2O-O2 karışımı içerisinde I. grupta % 1.5 sevofluran, II. grupta % 3 desfluran, III.grupta ise %1 izofluran ile sağlandı. Hastaların hemodinamik verileri indüksiyon öncesi, endotrakeal entübasyonu takiben 1, 5,10, 15, 20, 25 ve 30. dk.’larda kaydedildi. Anestezi indüksiyonu- bebek çıkım zamanı, uyanma zamanı, oryantasyon zamanı kaydedildi. Kan kaybı ve uterin tonus değerlendirildi. Yenidoğanın çıkımından hemen sonra umblikal kan gazı için örnek alındı. Tam kan sayımı için maternal venöz kan örnekleri anestezi indüksiyonu öncesi ve ekstübasyondan 30 dk sonra alındı. Neonatal etkiler; uygulanan anestezi yönteminden habersiz ayrı gözlemci tarafından 1 ve 5. dk’da APGAR skoru , 2 ve 24. saat’de nöroadaptif kapasite skoru (NAKS) ile değerlendirildi. Bulgular: Maternal demografik veriler açısından gruplar arasında fark bulunmadı. Anestezi ve cerrahi süresi, anestezi indüksiyonu- bebek çıkım zamanı, anesteziden uyanma ve oryantasyon zamanları gruplar arasında benzerdi. Hemodinamik parametrelerde Grup S’de 1. dakikada başlangıç değerine, Grup D’de ise hem başlangıç değerine, hem de Grup S ve Grup I’ya göre yükselme tesbit edildi. Hesaplanan kan kayıpları üç grupta da benzerdi. APGAR skorları açısından gruplar arasında fark bulunmazken, NAC skorları açısından 2. saatdeki ölçümlerde ısofluran uygulanan Grup I’da daha düşük değerler elde edildi. Sonuç: Genel anestezi altında elektif sezaryen girişimlerinde izoflurana göre, neonatal etkilerinin daha olumlu olması nedeniyle, desfluran ve sevofluran kullanımı tercih edilebilir. Desfluranın da maternal kan basıncında yükselmeye neden olduğu gözönüne alındığı takdirde sevofluran, öncelikle tercih edilebilecek inhalasyon anesteziği olarak değerlendirilebilir.

Keywords

• genel anestezi
• sezaryen
• inhalasyon anestezikleri

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