Sezaryen hastalarında spinal anestezi sonrasıfetüs ağırlığı, plesenta ağırlığı, amniyonsıvı miktarı ve hipotansiyon gelişimi arasında korelasyon

Year 2019, Volume: 11 Issue: 3, 309 - 314, 01.09.2019

Hakan Tapar , İlhan Bahri Delibaş Serkan Doğru , Tuğba Karaman Serkan Karaman Hatice Yılmaz Doğru , Olcayto Uysal Mustafa Süren Gülşen Genç Tapar

https://doi.org/10.21601/ortadogutipdergisi.478069

Abstract

Amaç: Spinal anestezi sonrası gebenin kilosu veya karın çevresine göre hipotansiyon, efedrin ihtiyacı ve duysal blok seviyesini araştıran çalışmalar vardır. Gebenin kilosu veya karın çevresi uterus içeriğinin (fetüs ağırlığı, plesenta ağırlığı ve amniyon sıvı miktarı) kaba bir tasviridir. Bu çalışma ile amacımız fetüs ağırlığı, plesanta ağırlığı ve amnion sıvı miktarı ile spinal anestezi sonrası hipotansiyon ve efedrin ihtiyacı arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem: Elektif şartlarda spinal anestezi ile sezaryen planlanan 51 gebe çalışmaya alındı. Gebelere standart dozda L3-4 intervertebral aralıktan 12,5 mg hiperbarik bupivakain uygulandı. Spinal anestezi sonrası hipotansiyon sistolik kan basıncı <100 mmHg veya bazal değere göre %30 azalma olarak tanımlandı. Hipotansiyon olduğunda efedrin (5 mg) yapıldı. Bradikardi kalp tepe atımı <60 atım/dakika olarak tanımlandı. Bradikardi olduğunda atropin (0,5 mg) yapıldı. Spinal anestezi öncesi ve spinal anestezi sonrası 2, 5, 10, 20 ve 30’uncu dakika kan basıncı değerleri kaydedildi. Çalışma sonunda fetüs ağırlığı, plesenta ağırlığı ve amniyon sıvı miktarına göre kan basıncı değişikliği, efedrin ve atropin ihtiyacı değerlendirildi.
Bulgular: Fetüs ağırlığı, plesenta ağırlığı ve amnion sıvı indeksi ile efedrin ihtiyacı arasında önemli bir korelasyon bulunmadı (sırasıyla r =0,063, p =0,660; r =0,093, p =0,518; r =0,162, p =0,257).
Sonuç: Gebelerde spinal anestezi sonrası hemodinamik değişiklikler, kullanılan efedrin ve atropin miktarı ile fetüs ağırlığı, plesenta ağırlığı ve amnion sıvı miktarı arasında bir ilişki yoktur.

Keywords

sezaryen, spinal anestezi, efedrin, fetüs, plesenta, amniyon sıvı

Correlation between the fetal weight, placenta weight, amniotic fluid amount and the development of hypotension afterspinal anesthesia for cesarean section patients

Abstract

Aim: After spinal anesthesia, there are studies investigating the hypotension, ephedrine need and sensory block level according to the weight or abdominal circumference of the pregnant woman. Pregnant’s weight or abdominal circumference is a rough description of the uterine content (the weight of the fetus, the weight of the placenta and amount of the amniotic fluid). The aim of this study was to investigate the relationship between weight of the fetus, weight of the placenta and amount of the amniotic fluid and the ephedrine need after spinal anesthesia.
Material and Method: Fifty-one parturients who underwent cesarean section with spinal anesthesia were included in the study. 12.5 mg hyperbaric bupivacaine was injected into the subarachnoid space at the L3-4 intervertebral level. After spinal anesthesia, hypotension was defined as systolic blood pressure <100 mmHg or 30% decrease compared to baseline. Ephedrine (5 mg) was administered when hypotension was present. Bradycardia was defined as heart beat <60 beats / min. Atropine (0.5 mg) was made when bradycardia was present. Before spinal anesthesia and after spinal anesthesia, blood pressure values at 2, 5, 10, 20 and 30th minutes were recorded. At the end of the study, blood pressure variation, ephedrine and atropine requirement were evaluated according to fetus weight, placenta weight and amnion fluid amount.
Result: No significant correlation was found between fetal weight, placenta weight, amniotic fluid index and ephedrine requirement (r = 0.063, p = 0.660; r = 0.093, p = 0.518; r = 0.162, p = 0.257, respectively).
Conclusion: After spinal anesthesia, there are no relation between amount of the ephedrine used and fetal weight, placenta weight, amniotic fluid amount in pregnant women.

Keywords

cesarean section, spinal anesthesia, ephedrine, fetus, placenta, amniotic fluid

References

• Tsen LC. Anesthesia for cesarean delivery. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee W, Beilin Y, Mhyre J, editors. Chestnut’s Obstetric Anesthesia Principles and Practice. 5th edition. Phidelphia: Elseiver Saunders; 2014:545–603.
• Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development. Can J Anesth 2012;59:604–19.
• Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology 2008;109:856–63.
• Bieniarz J, Crottogini JJ, Curuchet E, ve ark. Aortocaval compression by the uterus in late human pregnancy: an arteriographic study. Am J Obstet Gynecol 1968;100:203–7.
• Kerr MG, Scott DB, Samuel E. Studies of the inferior vena cava in late pregnancy. BMJ 1964;1:532.
• Cavaliere F, Cina A, Biasucci D, ve ark. Sonographic assessment of abdominal vein dimensional and hemodynamic changes induced in human volunteers by a model of abdominal hypertension. Crit Care Med 2011;39:344–8.
• Nani FS, Torres ML. Correlation between the body mass index (BMI) of pregnant women and the development of hypotension after spinal anesthesia for cesarean section. Rev Bras Anestesiol 2011;61:21– 30.
• Kuok CH, Huang CH, Tsai PS, ve ark. Preoperative measurement of maternal abdominal circumference relates the initial sensory block level of spinal anesthesia for cesarean section: An observational study. Taiwanese Journal of Obstetrics & Gynecology 2016;55:810–4.
• Jawan B, Lee JH, Chong ZK, Chang CS. Spread of spinal anaesthesia for caesarean section in singleton and twin pregnancies. Br J Anaesth 1993;70:639–41.
• Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology, 1992;76:906–16.
• Butterworth JF, Walker FO, Lysak SZ. Pregnancy increases median nerve susceptibility to lidocaine. Anesthesiology 1990;72:962–5.
• Oyama T, Akitoma M, Takeo T, Ling N, Guillemin R. p-endorphin in obstretic analgesic. Am J Obstet Gynecol 1980;137:613–6.
• Mercier FJ, Auge M, Hoffmann C, Fischer C, Le Gouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol 2013;79:62–73.
• Onuki E, Higuchi H, Takagi S, Nishijima K, Fujita N, Matsuura T, ve ark. Gestation-related reduction in lumbar cerebrospinal fluid volume and dural sac surface area. Anesth Analg 2010;110:148–53.
• Al-Khan A, Shah M, Altabban M, Kaul S, Dyer KY, Alvarez M, Saber S. Measurement of intraabdominal pressure in pregnant women at term. J Reprod Med. 2011;56:53–7.
• Saravanakumar K, Hendrie M, Smith F, Danielian P. Influence of reverse Trendelenburg position on aortocaval compression in obese pregnantwomen. Int J Obstet Anesth 2016;26:15–8.
• Lee AJ, Landau R, Mattingly JL, Meenan MM, Corradini B, Wang S. Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status: A Randomized Controlled Trial. Anesthesiology 2017;127:241–9.
• Brull RB, Macfarlane AJ, Chan VW. Spinal, epidural and caudal anesthesia. In: Miller RD, editor. Miller. 8th ed. Philadelphia: Elsevier/ Churchill Livingstone; 2015. p. 1689‑720.
• Higuchi H, Takagi S, Zhang K, Furui I, Ozaki M. Effect of lateral tilt angle on the volume of the abdominal aorta and inferior vena cava in pregnant and nonpregnant women determined by magnetic resonance imaging. Anesthesiology 2015;122:286–93.
• Kerr MG, Scott DB, Samuel E. Studies of the inferior vena cava in latepregnancy. Br Med J 1964;1:532–3.
• Lotgering FK, Wallenburg HCS. Hemodynamic effect of caval and uterine venous occlusion in pregnant sheep. American Journal of Obstetrics and Gynecology 1986; 155:1164–70.
• Henriksen O, Amtrop O, Faris I, Agerskov K. Evidence for a local sympathetic veno arteriolar reflex in the dog hindleg. Circulation Research 1983;52:534.
• Kinsella SM, Lohmann G. Supine hypotensive syndrome. Obstet Gynecol 1994; 83:774–88