TY  - JOUR
T1  - The Relatıonshıp Between Abdominal Cırcumference And Columna Vertebralıs Length Wıth Intraoperatıve Hypotensıon In Cesarean Cases Wıth Spınal Anesthesıa
TT  - SPİNAL ANESTEZİ YAPILAN SEZARYEN VAKALARINDA GÖBEK ÇEVRESİ VE COLUMNA VERTEBRALİS UZUNLUĞUNUN İNTRAOPERATİF HİPOTANSİYON İLE İLİŞKİSİ
AU  - Uslu Bayhan, Bahar
AU  - Yürekli, Ali İhsan
PY  - 2025
DA  - March
Y2  - 2025
DO  - 10.46871/eams.1590301
JF  - Experimental and Applied Medical Science
JO  - Exp Appl Med Sci
PB  - Gaziantep İslam Bilim ve Teknoloji Üniversitesi
WT  - DergiPark
SN  - 2757-847X
SP  - 83
EP  - 98
VL  - 6
IS  - 1
LA  - en
AB  - AbstractIntroduction: Most pregnant women develop varying degrees of abdominal hypertension dueto the enlarged uterus . Increased abdominal circumference and shorter columna vertebralislength have been found to be associated with increased with increased abdominal pressure andan enlarged uterus. We hypothesized that this was associated with the incidence of hypotensionafter spinal anesthesia. We conducted this study to investigate the relationship betweenabdominal circumference and columna vertebralis length and intraoperative hypotension incesarean section operations under spinal anesthesia.Materials And Methods: This study was conducted in Gazi Yaşargil Training and ResearchHospital, Obstetrics and Gynecology annex building as a prospective observational study afterethics committee approval. Patients who were 18 years of age or older, had elective cesareansection under spinal anesthesia, had ASA (American Society of Anesthesiologists) I-II, wereover 150 cm tall, and had a term (37-42 weeks) singleton pregnancy were included in the study.High-risk pregnancies (placenta previa, abruptio placenta, eclampsia, preeclampsia), multiplepregnancies, patients with additional disease related to other systemic diseases includingcardiovascular disease, patients with spinal anesthesia contraindications, and a total of 102patients were included in the study. Abdominal circumference, columna vertebralis lengths, andsymphysis-fundus distance were measured after the patients' name-surname, protocol number,age, height, weight, body mass index, gestational week, and parity values were recorded. Thepatients were seated and the standard 11 mg Heavy Marcaine injection rate was 1 mL/sec toeach patient with a 26 G – 27 G Quincke spinal needle through the L3-L4 interspinous space.After the procedure, the patients were placed on the operating table in the supine position andthe operating table was deviated 10 degrees to the left. Heart rate, mean arterial pressure andsaturation were recorded as 1 minute values. Afterwards, the 3rd minute, 5th minute, 10thminute, 15th minute and 30th minute values were recorded. Sensory block examination wasevaluated with pinprick test and motor block levels were evaluated with modified Bromagescoring and recorded. A decrease of 30% from the systolic blood pressure value measuredbefore spinal anesthesia or a decrease in the systolic blood pressure value below 90 mmHg wasconsidered as hypotension and 10 mg of ephedrine was administered simultaneously to allpatients with hypotension. After surgery, newborn APGAR score, newborn weight, time to zeroBromage score, time until sensory blockage regressed to T10, and presence of nausea andvomiting were recorded.Results: A significant correlation was found between the length of the vertebral column andthe level of sensory block in patients after spinal anesthesia. There is a significant relationshipbetween the length of the columna vertebralis and the time elapsed until the sensory block levelregresses to T10. There was no correlation between abdominal circumference and andsymphysis fundus distance and hypotension. However, a significant relationship was foundbetween abdominal circumference and nausea.Conclusıon: There are multiple mechanisms associated with intraoperative hypotension afterspinal anesthesia. Abdominal circumference and columna vertebralis length are importantparameters for measuring and providing prediction.
KW  - Abdominal circumference
KW  - columna vertebralis
KW  - cesarean section
KW  - hypotension
KW  - spinal anesthesia
N2  - AMAÇ: Spinal anestezi uygulanan sezaryen operasyonlarında abdominal çevre ve columna vertebralis uzunluğunun intraoperatif hipotansiyon ile ilişkisini araştırmak amacı ile bu çalışmayı yaptık.GEREÇ VE YÖNTEM: Bu çalışma, etik kurul onayı alındıktan sonra, prospektif gözlemsel bir çalışma olarak Gazi Yaşargil Eğitim ve Araştırma Hastanesi Kadın Doğum ek binasında yapıldı. 18 yaş ve üzeri spinal anestezi ile elektif sezaryen olan, ASA (Amerikan Anestezistler Derneği) I-II, boyu 150 cm üzerinde olan, term (37-42 hafta) tekil gebeliği olan hastalar çalışmaya dahil edildi. Yüksek riskli gebelikler (plasenta previa, abruptio plasenta, eklampsi, preeklampsi ), çoğul gebelik , kardiyovasküler hastalık dahil diğer sistemik hastalıklar ile ilgili ek hastalığı olan hastalar, spinal anestezi kontredikasyonu olan hastalar, çalışma dışı bırakılarak toplam 102 hasta çalışmaya dahil edildi. Hastalara ait isim-soy isim, protokol no, yaş, boy, kilo, body mass indeks (BMI), gebelik haftası, parite değerleri kaydedildikten sonra abdominal çevre, columna vertebralis uzunlukları ve symphsiofundal mesafe ölçüldü. Hastalar oturtularak L3-L4 interspinöz aralıktan 26 G – 27 G Quincke spinal iğne ile her hastaya standart 11 mgr Heavy Marcaine enjeksiyon hızı 1 mL/sn olacak şekilde yapıldı. İşlem sonrasında hastalar ameliyat masasına supin pozisyonda yatırdı ve ameliyat masası 10 derece sola deviye edildi. Kalp hızı, ortalama arteryel basınç ve saturasyon 1.dakika değerleri olarak kayıt edildi. Sonrasında 3. dakika , 5. dakika , 10. dakika, 15.dakika ve 30. dakika değerleri kaydedildi. Hastalarda duyusal blok muayenesi pinprick testi ile ve motor blok seviyeleri ise modifiye Bromage skorlaması ile değerlendirildi ve kaydedildi. Spinal anestezi öncesi ölçülen sistolik kan basıncı değerinden %30 düşme veya sistolik tansiyon değeri 90 mmHg altına düşmesi hipotansiyon olarak kabul edildi ve hipotansiyonu olan tüm hastalara eş zamanlı 10 mgr efedrin yapıldı. Cerrahi sonrasında yenidoğan APGAR skoru, yenidoğan kilosu, Bromage Skoru sıfır olana kadar geçen süre, duyu bloğu T10 a gerileyene kadar geçen süre, bulantı kusma varlığı kayıt edildi.BULGULAR: Spinal anestezi sonrasında hastalarda columna vertebralis uzunluğu ile duyu blok seviyesi arasında anlamlı bir ilişki bulunmuştur. Columna vertebralis uzunluğu ile duyu blok seviyesinin T10’a gerileyene kadar geçen süre arasında anlamlı bir ilişki mevcuttur. Abdominal çevre ve symphsiofundal mesafe ile hipotansiyon arasında korelasyon olmadığı görülmüştür. Ancak abdominal çevre ile bulantı arasında anlamlı bir ilişki bulunmuştur.SONUÇ: Spinal anestezi sonrası intraoperatif hipotansiyon ile alakalı birden çok mekanizma mevcuttur. Abdominal çevre ve columna vertebralis uzunluğu ölçülebilmesi ve öngörü sağlaması açısından önemli parametrelerdir.
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UR  - https://doi.org/10.46871/eams.1590301
L1  - https://dergipark.org.tr/tr/download/article-file/4389182
ER  -