Does Prehydration in Spinal Anaesthesia Affect Oxygenation?

Yıl 2019, Cilt: 21 Sayı: 2, 130 - 138, 31.08.2019

Gülçin Aydın , Oktay Aydın , İşın Gençay , Faruk Pehlivanlı , Selim Çolak , Ünase Büyükkoçak

https://doi.org/10.24938/kutfd.499434

Öz

Objective: The aim
of this study is to investigate the effect of routine administration of
intravenous cristalloid and colloid fluids on subarachnoid block induced
hypotension and cerebral oxygenization.

Material
and Methods: Seventyfive, 18-50 years old, ASA
I patients that were scheduled for operation under spinal anesthesia were
enrolled into the study. Patients were divided into 3 groups after standard
monitoring. G1; intravenous prehydration with 4%Gelatine Polysuccinate before
spinal anesthesia, G2; intravenous prehydration with Ringers Lactate s before
spinal anesthesia, G3; no prehydration group.

After
spinal anesthesia, fluid maintenance was provided with intravenous Ringer
Lactate at a dose of 5 ml/kg/h in all patients. Systolic blood pressure levels
under 90 mmHg or 20%decrease from the baseline was accepted as hypotension.
Complications such as changes in haemodynamic parameters, nausea, vomiting and
shivering were recorded with an interval of 5 minutes during the operation. Bilateral
Near Infrared Spectroscopy monitoring was performed for cerebral oxygenation.

Results: It was
observed that intravenous prehydration significantly decreased the nausea and
vomiting before spinal anesthesia (p<0.05), whereas in G1 shivering was significantly
less (p<0.05). While ephedrine was used in 15 patients (60%) in G3, it was
observed that intravenous prehydration decreased ephedrine need significantly
(p<0.05). As the operation time increased, cerebral oxygenation was
significantly decreased in all three groups and there was no difference between
groups in terms of right and left lobe brain oxygenation. There was a
significant decrease in SAP, DAP and MAP values in all three groups as the
operation time increased, but there was no significant difference between the
groups.          

Conclusion: Although there is no difference between the
use of colloid or crystalloid solutions in terms of persistence of cerebral
oxygenation under spinal anesthesia, the use of ephedrine in the non-hydrated
group provides similar hemodynamic stability and the brain oxygenation is
maintained.

Anahtar Kelimeler

Cerebral oxygenation, spinal anesthesia, prehydration

SPİNAL ANESTEZİDE PREHİDRASYON SEREBRAL OKSİJENASYONU ETKİLER Mİ?

Öz

Amaç: Bu çalışmanın amacı spinal anestezi öncesi intravenöz
yoldan uygulanan kristaloid ve kolloid sıvıların serebral oksijenasyona
etkisini araştırmaktır.

Gereç ve Yöntemler: Çalışmaya 18-50 yaş arası, spinal anestezi altında
opere olacak, Amerikan Anestezistler Derneği I risk grubunda, 75 hasta dahil
edildi. Standart monitörizasyon sonrası hastalar 3 gruba ayrıldı. G1; spinal
anestezi öncesinde%4 Gelatine Polysuccinate solüsyonu ile iv prehidrasyon, G2;
spinal anestezi öncesinde Ringer Laktat solüsyonu ile iv prehidrasyon, G3;
prehidrasyon uygulanmayan grup idi.

Spinal anesteziden sonra bütün hastalara operasyon
boyunca sıvı idamesi 5 ml/kg/saat dozunda iv Ringer Laktat ile sağlandı.
Sistolik kan basıncının ≤90 mmHg olması ya da başlangıca göre%20 ‘lik düşme
hipotansiyon olarak kabul edildi. Operasyon süresince 5 dakika ara ile
hemodinamik parametrelerdeki değişiklikler, bulantı-kusma, titreme
komplikasyonları kaydedildi. Serebral oksijenizasyon için bilateral Near
Infrared Spectroscopy monitörizasyonu yapıldı.

Bulgular: Spinal anestezi öncesi intravenous prehidrasyonun
bulantı ve kusma yan etkisini anlamlı olarak azalttığı görülürken (p<0.05),
G1’de titreme bulguları anlamlı olarak az idi (p<0,05). G 3’te 15 hastada (%60)
efedrin kullanılırken, intravenous prehidrasyonun efedrin ihtiyacını anlamlı
olarak azalttığı görüldü (p<0.05). Operasyon süresi uzadıkça her üç grupta
da serebral oksijenizasyonda anlamlı düzeyde azalma görülürken sağ ve sol lob
beyin oksijenlenmesi açısından gruplar arası fark görülmedi. Operasyon süresi
uzadıkça her üç grupta da SAB, DAB, OAB değerlerinde anlamlı düzeyde azalma
olduğu görülürken, gruplar arası karşılaştırmada anlamlı fark yoktu.

Sonuç: Spinal anestezide, serebral oksijenizasyonun
devamı için kolloid ya da kristaloid kullanımı arasında fark olmamakla beraber
hidrasyon yapılmayan grupta efedrin kullanımı artırılarak benzer hemodinamik
stabilite sağlanmakta ve beyin oksijenlenmesi korunmaktadır.

Anahtar Kelimeler

Serebral oksijenasyon, spinal anestezi, prehidrasyon

Kaynakça

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