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Spinal Anestezi ile Sezaryen Uygulanan Hastalarda Üç Farklı Doz Norepinefrinin Değerlendirilmesi

Year 2023, Volume: 13 Issue: 1, 9 - 18, 16.03.2023
https://doi.org/10.31832/smj.1117648

Abstract

Amaç: Sezaryen doğum sırasında uygulanan spinal anestezi , maternal hipotansiyona neden olabilmekte ve tedavi amaçlı ilk olarak vazopresörler tercih edilmektedir. Norepinefrin, güçlü α-adrenerjik ve zayıf β-adrenerjik etkisiyle kalp hızı ve kalp debisi üzerinde daha az olumsuz etki ile kan basıncını korumada diğer vazopressörlerden üstün olduğu düşünülmektedir. Bu çalışmada sezaryan doğum sırasında post-spinal hipotansiyon yönetiminde üç farklı bolus doz norepinefrinin etkinlik ve güvenliğini karşılaştırılması amaçlandı.
Metot: Çalışmaya elektif şartlarda sezaryen uygulanacak 37-42 haftalık, 18-40 yaşlarında, ASA I-II fiziksel statüsüne sahip 100 hasta dahil edildi. Hastalar 4 gruba ayrılarak spinal anestezi yapıldıktan sonra Grup I’e % 0.9 NaCl (Salin), Grup II’ye 0.05 µg.kg-1, Grup III’e 0.075 µg.kg-1 ve Grup IV’e ise 0.1 µg.kg-1 tek doz norepinefrin toplam 2 ml olacak şekilde bolus uygulandı. Sistolik kan basıncı değeri <100 mmHg veya bazal sistolik kan basıncı değerinde % 20’den daha fazla bir düşme durumunda 5 mg efedrin iv bolus olarak uygulandı. Kalp atım hızının 60’ın altına düştüğünde 0.5 mg iv atropin ile tedavi edildi. Maternal sistolik kan basınçları, kalp atım hızları, efedrin ve atropin tüketimleri, umblikal arter kan gazı değerleri, Apgar skorları ve bulantı/kusma sıklığı karşılaştırıldı.
Bulgular: Demografik veriler tüm gruplarda benzerdi. Cerrahi operasyon süresince uygulanan toplam efedrin ve atropin dozları grup I ve grup II’de grup III ve IV’e göre anlamlı bir şekilde daha yüksek bulunmuştur ((p=0.032) (p=0.014), sırasıyla). Apgar skorları yönünden gruplar arasında bir fark tespit edilmezken umblikal arter kan gazında PO2 değerinin I. grupta, II, III ve IV. gruba göre anlamlı bir şekilde daha düşük, PCO2 değerinin ise anlamlı derecede daha yüksek olduğu bulunmuştur (p < 0,05). Bulantı ve kusma sayılarında gruplar arasında istatistiksel bir fark bulunmamıştır (p=0.096).
Sonuç: Elektif sezaryen doğumlarda spinal anesteziye bağlı hipotansiyonu önlemek için profilaktik tek doz bolus norepinefrin uygulamalarında 0.075 ve 0.1 µg.kg-1 dozları etkili olduğu, efedrin ve atropin ihtiyacını önemli derecede azalttığı kanısına varıldı.

References

  • KAYNAKLAR 1. Fitzgerald JP, Fedoruk KA, Jadin SM, Carvalho B, Halpern SH. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia. 2020; 75(1): 109-21.
  • 2. Karacaer F, Biricik E, Unal I, Buyukkurt S, Unlugenc H. Does prophylactic ondansetron reduce norepinephrine consumption in patients undergoing cesarean section with spinal anesthesia? J Anesth. 2018; 32(1): 90-7.
  • 3. Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: Acta Anaesthesiol Scand 2010; 54: 909-21.
  • 4. Lee AJ, Smiley RM. Phenylephrine infusions during cesarean section under spinal anesthesia. Int Anesthesiol Clin. 2014; 52: 29–47
  • 5. Sklebar I, Bujas T, Habek D. Spinal Anaesthesia-Induced Hypotension in Obstetrics: Prevention and Therapy. Acta Clin Croat. 2019; 58: 90-5.
  • 6. Ngan Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomized doubleblinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015; 122: 736–45.
  • 7. Singh PM, Singh NP, Reschke M, Ngan Kee WD, Palanisamy A, Monks DT. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes. Br J Anaesth. 2020; 124: 95-107.
  • 8. Mercier FJ, Soued M, Morau E, Ngan Kee WD. Noradrenaline for haemodynamic control in obstetric anaesthesia: Is it now a suitable alternative to phenylephrine? Anaesth Crit Care Pain Med. 2019; 38(6): 591-3.
  • 9. Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018; 73: 71–92.
  • 10. Hasanin A, Mokhtar AM, Badawy AA, Fouad R. Post-spinal anesthesia hypotension during cesarean delivery, a review article. Egypt J Anaesth. 2017; 33: 189–93.
  • 11. Heesen M, Kölhr S, Rossaint R, Straube S. Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis. Anaesthesia. 2014; 69: 143–65.
  • 12. Ngan Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomized doubleblinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015; 122: 736–45.
  • 13. Onwochei DN, Kee WDN, Fung L, Downey K, Xiang YY, Carvalho JC. Norepinephrine intermittent intravenous boluses to prevent hypotension during spinal anesthesia for cesarean delivery: a sequential allocation dose-finding study. Anesthesia & Analgesia. 2017; 125: 212-8.
  • 14. Ngan Kee WD. A Random-allocation Graded Dose-Response Study of Norepinephrine and Phenylephrine for Treating Hypotension during Spinal Anesthesia for Cesarean Delivery. Anesthesiology. 2017; 127: 934-41.
  • 15. Wang T, He Q, Zhang W, Zhu J, Ni H, Yang R, et al. Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Exp Ther Med. 2020; 19: 1763-70.
  • 16. Hasanin AM, Amin SM, Agiza NA, et al. Norepinephrine infusion for preventing postspinal anesthesia hypotension during cesarean delivery: a randomized dose-finding trial. Anesthesiology 2019; 130: 55-62
  • 17. Sharkey AM, Siddiqui N, Downey K, Ye XY, Guevara J, Carvalho JCA. Comparison of intermittent intravenous boluses of phenylephrine and norepinephrine to prevent and treat spinale-induced hypotension in cesarean deliveries: randomized controlled trial. Anesth Analg 2019; 129: 1312-8
  • 18. Yasmin S. Hassabelnaby1, Ahmed M. Hasanin1, Nada Adly1 , et al. Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial. BMC Anesthesiol. 2020: 17; 20- 84.
  • 19. Minzter BH, Johnson RF, Paschall RL, et al. The diverse effects of vasopressors on the fetoplacental circulation of the dual perfused human placenta. Anesth Analg. 2010; 110(3): 857–62.
  • 20. Warwick D Ngan Kee , Anna Lee, Kim S Khaw et al. A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: the effects on fetal acid-base status and hemodynamic control. Anesth Analg. 2008 ;107(4): 1295-302.
  • 21. David W Cooper , Mark Carpenter et al. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2002; 97: 1582-90.
Year 2023, Volume: 13 Issue: 1, 9 - 18, 16.03.2023
https://doi.org/10.31832/smj.1117648

Abstract

References

  • KAYNAKLAR 1. Fitzgerald JP, Fedoruk KA, Jadin SM, Carvalho B, Halpern SH. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia. 2020; 75(1): 109-21.
  • 2. Karacaer F, Biricik E, Unal I, Buyukkurt S, Unlugenc H. Does prophylactic ondansetron reduce norepinephrine consumption in patients undergoing cesarean section with spinal anesthesia? J Anesth. 2018; 32(1): 90-7.
  • 3. Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: Acta Anaesthesiol Scand 2010; 54: 909-21.
  • 4. Lee AJ, Smiley RM. Phenylephrine infusions during cesarean section under spinal anesthesia. Int Anesthesiol Clin. 2014; 52: 29–47
  • 5. Sklebar I, Bujas T, Habek D. Spinal Anaesthesia-Induced Hypotension in Obstetrics: Prevention and Therapy. Acta Clin Croat. 2019; 58: 90-5.
  • 6. Ngan Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomized doubleblinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015; 122: 736–45.
  • 7. Singh PM, Singh NP, Reschke M, Ngan Kee WD, Palanisamy A, Monks DT. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes. Br J Anaesth. 2020; 124: 95-107.
  • 8. Mercier FJ, Soued M, Morau E, Ngan Kee WD. Noradrenaline for haemodynamic control in obstetric anaesthesia: Is it now a suitable alternative to phenylephrine? Anaesth Crit Care Pain Med. 2019; 38(6): 591-3.
  • 9. Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018; 73: 71–92.
  • 10. Hasanin A, Mokhtar AM, Badawy AA, Fouad R. Post-spinal anesthesia hypotension during cesarean delivery, a review article. Egypt J Anaesth. 2017; 33: 189–93.
  • 11. Heesen M, Kölhr S, Rossaint R, Straube S. Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis. Anaesthesia. 2014; 69: 143–65.
  • 12. Ngan Kee WD, Lee SWY, Ng FF, Tan PE, Khaw KS. Randomized doubleblinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015; 122: 736–45.
  • 13. Onwochei DN, Kee WDN, Fung L, Downey K, Xiang YY, Carvalho JC. Norepinephrine intermittent intravenous boluses to prevent hypotension during spinal anesthesia for cesarean delivery: a sequential allocation dose-finding study. Anesthesia & Analgesia. 2017; 125: 212-8.
  • 14. Ngan Kee WD. A Random-allocation Graded Dose-Response Study of Norepinephrine and Phenylephrine for Treating Hypotension during Spinal Anesthesia for Cesarean Delivery. Anesthesiology. 2017; 127: 934-41.
  • 15. Wang T, He Q, Zhang W, Zhu J, Ni H, Yang R, et al. Determination of the ED50 and ED95 of intravenous bolus of norepinephrine for the treatment of hypotension during spinal anesthesia for cesarean delivery. Exp Ther Med. 2020; 19: 1763-70.
  • 16. Hasanin AM, Amin SM, Agiza NA, et al. Norepinephrine infusion for preventing postspinal anesthesia hypotension during cesarean delivery: a randomized dose-finding trial. Anesthesiology 2019; 130: 55-62
  • 17. Sharkey AM, Siddiqui N, Downey K, Ye XY, Guevara J, Carvalho JCA. Comparison of intermittent intravenous boluses of phenylephrine and norepinephrine to prevent and treat spinale-induced hypotension in cesarean deliveries: randomized controlled trial. Anesth Analg 2019; 129: 1312-8
  • 18. Yasmin S. Hassabelnaby1, Ahmed M. Hasanin1, Nada Adly1 , et al. Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial. BMC Anesthesiol. 2020: 17; 20- 84.
  • 19. Minzter BH, Johnson RF, Paschall RL, et al. The diverse effects of vasopressors on the fetoplacental circulation of the dual perfused human placenta. Anesth Analg. 2010; 110(3): 857–62.
  • 20. Warwick D Ngan Kee , Anna Lee, Kim S Khaw et al. A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: the effects on fetal acid-base status and hemodynamic control. Anesth Analg. 2008 ;107(4): 1295-302.
  • 21. David W Cooper , Mark Carpenter et al. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2002; 97: 1582-90.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Yusuf Emeli 0000-0002-2984-2688

H Murat Gündüz 0000-0002-0373-892X

Ergun Mendes 0000-0003-4350-6055

Publication Date March 16, 2023
Submission Date May 17, 2022
Published in Issue Year 2023 Volume: 13 Issue: 1

Cite

AMA Emeli Y, Gündüz HM, Mendes E. Spinal Anestezi ile Sezaryen Uygulanan Hastalarda Üç Farklı Doz Norepinefrinin Değerlendirilmesi. Sakarya Tıp Dergisi. March 2023;13(1):9-18. doi:10.31832/smj.1117648

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