Sezaryen Operasyonlarında Genel ve Rejyonal Anestezi Uygulamalarımızın Maternal ve Neonatal Etkilerinin Değerlendirilmesi

Öz

ÖZ Amaç: Çalışmamızda sezaryen operasyonlarındaki anestezi uygulamalarımızın anne ve yenidoğan üzerindeki sonuçlarının ve etkileyen faktörlerin belirlenmesi ve uygulamalarımızın bilimsel verilerle karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Haziran 2019-2021 tarihlerinde Üniversite Hastanesi’nde acil/elektif sezaryen ile doğum gerçekleştirilen 483 gebe çalışmaya dahil edildi. Gebelerin demografik verileri, sistemik hastalıkları, uygulanan anestezi teknikleri ve gelişen komplikasyonlar kaydedildi. Olguların sezaryen endikasyonu ve aciliyet kategorisi kaydedildi. Cilt insizyonu ve uterin insizyon ile bebek çıkımı arasındaki süre, intraoperatif komplikasyonlar, umblikal kord kan gazları, 1. ve 5. dk APGAR skorları kaydedildi. Yenidoğan ve annenin yoğun bakım gereksinimi ve mortalitesi kaydedildi. Bulgular: Demografik verileri arasında anlamlı fark saptanmadı (p>0,05). Rejyonal anestezi oranı (%62,7) genel anesteziye göre (%37,3) daha yüksekti ve gebelerin %57,5’ine ise spinal anestezi uygulandı. Sezaryenlerin %37,1’i acil, %62,9’u elektif idi. Term gebelerde preterm gebelere göre rejyonal anestezi oranı daha yüksek iken, plasenta anomalileri gibi komplike olgularda genel anestezi oranı daha yüksekti. Rejyonal anestezi grubunda ortalama arter basıncı değerlerinde tüm ölçümlerinde bazal değerlere göre anlamlı düşüşler bulundu (p<0,05). Yenidoğan 1. ve 5. dk APGAR skorları ve umblikal kord pH değeri rejyonal anestezi grubunda anlamlı olarak daha yüksekti (p=0,017). Genel anestezide umblikal kord pO2 değeri, anlamlı olarak daha yüksekti (p<0,001). Sonuç: Sezaryende maternal ve neonatal morbidite ve mortaliteyi etkileyen multipl faktörler söz konusu olduğu için, anesteziyologlar tüm bu faktörler konusunda yüksek farkındalığa sahip olmalı, gerekli ön hazırlıklar ile olgu bazında hastayı değerlendirerek en güvenli şekilde anestezi gerçekleştirilmelidir. Anahtar Kelimeler: Sezaryen, Rejyonal anestezi, Maternal etkiler, Fetal etkiler

Anahtar Kelimeler

• Sezaryen
• rejyonal anestezi
• maternal etkiler
• fetal etkiler

Evaluation of Maternal and Neonatal Effects of General and Regional Anesthesia in Caesarean Section Operations

Abstract

ABSTRACT Objective: In our study, we aimed to evaluate our anesthesia practices in caesarean sections and to compare our practices with scientific data. Materials and Methods: Between June 2019 and 2021, 483 pregnant women who delivered by emergency or elective caesarean section at the University Hospital were included in the study. Demographic data, applied anesthesia techniques and complications of all pregnant women were recorded. The indication and urgency category of the caesarean section were noted. The time between uterine incision and delivery, umbilical cord blood gases, 1st and 5th minute APGAR scores were recorded. The need for neonatal and maternal intensive care and mortality were also documented. Results: There was no significant difference between general and regional anesthesia groups in terms of demographic data (p>0,05). The rate of regional anesthesia (62,7%) was higher than the general anesthesia (37,3%), and spinal anesthesia was applied to 57,5% of the cases. The rate of regional anesthesia was higher in term pregnancies, the rate of general anesthesia was higher in complicated pregnancies such as placental anomalies. In the regional anesthesia group, the decrease in basal mean arterial pressure values in all measurements were significant (p<0,05). Newborn 1st and 5th minute APGAR scores and umbilical cord pH values were found significantly higher in the regional anesthesia group (p=0,017). The umbilical cord pO2 value of the general anesthesia group was significantly higher (p<0,001). Conclusion: Since there are multiple factors affecting maternal and neonatal morbidity in caesarean sections, anesthetists should have a high awareness of all these factors and evaluate the patient on a case-by-case basis to perform anesthesia in the safest way. Key Words: Caesarean section, Regional anesthesia, Maternal effects, Fetal effects

Keywords

• Caesarean section
• regional anesthesia
• maternal effects
• neonatal effects.

Kaynakça

1. 1. Rosen MA, Hughes SC. Obstetrik. In: Stoelting RK, Miller RD, editors. Temel Anestezi. 5th ed. Churchill Livingstone Elsevier 2010; 475–503.
2. 2. Chapman AB, Abraham WT, Zamudio S, Coffin C, Merouani A, Young D. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int 1998; 54(6):2056–63.
3. 3. Aksoy Sari M, Kucukguclu S, Ozbilgin S, Gunenc FS, Mercan S, Esen A, Yetim B. Retrospective Evaluation of Anaesthetic Techniques for Caesarean. Turk J Anaesthesiol Reanim 2019; 12;43(6):373–80.
4. 4. Palanisamy A, Mitani AA, Tsen LC. General anesthesia for cesarean delivery at a tertiary care hospital from 2000 to 2005: a retrospective analysis and 10-year update. Int J Obstet Anesth 2011; 20(1):10–6.
5. 5. Kan RK, Lew E, Yeo SW, Thomas E. General anesthesia for cesarean section in a Singapore maternity hospital: a retrospective survey. Int J Obstet Anesth 2004; 13(4):221–6.
6. 6. Laı HY, Tsaı PS, Fan YC, Huang CJ. Anesthetic practice for Caesarean section and factors influencing anesthesiologists’ choice of anesthesia: a population-based study. Acta Anaesthesiol Scand 2014; 58(7):843–50.
7. 7. Juang J, Gabriel RA, Dutton RP, Palanisamy A, Urman RD. Choice of Anesthesia for Cesarean Delivery. Anesth Analg 2017; 124(6):1914–7.
8. 8. Bidon C, Desgranges FP, Riegel AC, Allaouchiche B, Chassard D, Bouvet L. Retrospective cohort study of decision-to-delivery interval and neonatal outcomes according to the type of anaesthesia for code-red emergency caesarean sections in a tertiary care obstetric unit in France. Anaesth Crit Care Pain Med 2019; 38(6):623–30.

9. 9. Knigin D, Avidan A, Weiniger CF. The effect of spinal hypotension and anesthesia-to-delivery time interval on neonatal outcomes in planned cesarean delivery. Am J Obstet Gynecol 2020; 223(5):747.e1-747.e13.
10. 10. Koković JTK, Radunovic N, Filimonović DF, Nejković LN, Arsenijević LA, Mirković LJM,. Maternal hemodynamic influence on uteroplacental oxygen distribution during cesarean section. Clin Exp Obstet Gynecol 2015; 10;42(5):610–3.
11. 11. Tonni G, Ferrari B, De Felice C, Ventura A. Fetal acid-base and neonatal status after general and neuraxial anesthesia for elective cesarean section. International Journal of Gynecology & Obstetrics 2007; 97(2):143–6.
12. 12. Can G. Yenidoğanın Değerlendirilmesi. In: Neyzi O, Ertuğrul T, editors. Pediatri. 2nd ed. İstanbul: Tayt Ofset; 1993; 186–201.
13. 13. Şenses DA. Yenidoğan Bebeğin Değerlendirilmesi. In: Kinişçi H, Göksin E, editors. Temel Kadın Hastalıkları ve Doğum Bilgisi. Ankara: Melisa Matbaacılık; 1996; 214–9.
14. 14. Bowring J, Fraser N, Vause S, Heazell AEP. Is regional anaesthesia better than general anaesthesia for caesarean section? J Obstet Gynaecol (Lahore) 2006; 26(5):433–4.
15. 15. Mancuso A, De Vivo A, Giacobbe A, Priola V, Savasta LM, Guzzo M, DeVivo D,Mancuso A. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. The Journal of Maternal-Fetal & Neonatal Medicine 2010; 23(10):1114–8.
16. 16. Hashemi S, Jabalameli M, Mokhtary F. Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section. Adv Biomed Res 2015; 4(1):249.
17. 17. Kearns RJ, Shaw M, Gromski PS, Iliodromiti S, Pell JP, Lawlor DA, Nelson SM. Neonatal and Early Childhood Outcomes Following Maternal Anesthesia for Cesarean Section: A Population-based Cohort Study. Obstetric Anesthesia Digest 2022; 42(1):11–11.
18. 18 . Sung TY, Jee YS, You HJ, Cho CK. Comparison of the effect of general and spinal anesthesia for elective cesarean section on maternal and fetal outcomes: a retrospective cohort study. Anesth Pain Med (Seoul) 2021; 16(1):49–55.
19. 19. Metogo JAM, Nana TN, Ngongheh BA, Nyuydzefon EB, Adjahoung CA, Tochie JN, Minkande JZ. General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study. BMC Anesthesiol 2021; 21(1):68.
20. 20 Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G. Spinal and epidural versus general anesthesia for elective Cesarean section at term: effect on the acid–base status of the mother and newborn. The Journal of Maternal-Fetal & Neonatal Medicine 2003; 13(4):260–6.
21. 21. Krishnan L, Gunasekaran N, Bhaskaranand N. Neonatal effects of anesthesia for caesarean section. The Indian Journal of Pediatrics 1995; 62(1):109–13.
22. 22. Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. Sao Paulo Medical Journal 2015; 133(3):227–34.
23. 23. Abir G, Mhyre J. Maternal mortality and the role of the obstetric anesthesiologist. Best Pract Res Clin Anaesthesiol 2017; 31(1):91–105.
24. 24. Hofmeyr GJ, Qureshi Z. Preventing deaths due to haemorrhage. Best Pract Res Clin Obstet Gynaecol 2016; 36:68–82.
25. 25. Shalaby MA, Maged AM, Al-Asmar A, El Mahy M, Al-Mohamady M, Rund NMA. Safety and efficacy of preoperative tranexamic acid in reducing intraoperative and postoperative blood loss in high-risk women undergoing cesarean delivery: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22(1):201.
26. 26. Yu SP, Cohen JG, Parker WH. Management of Hemorrhage During Gynecologic Surgery. Clin Obstet Gynecol 2015; 58(4):718–31.
27. 27. De la Cruz CZ, Thompson EL, O’Rourke K, Nembhard WN. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review. Arch Gynecol Obstet 2015; 292(6):1201–15.