Sezaryen cerrahisinde anestezi deneyimlerimiz: Retrospektif çalışma

Öz

Amaç: Bu çalışmanın amacı, Zonguldak Bülent Ecevit Üniversitesi Hastanesi’nde gerçekleştirilen sezaryen ameliyatlarında tercih edilen anestezi yöntemlerini ve bu yöntemlere bağlı perioperatif bulguları değerlendirmektir. Gereç ve Yöntemler: Ocak 2018–Eylül 2019 tarihleri arasında Zonguldak Bülent Ecevit Üniversitesi Hastanesi'nde sezaryen operasyonu geçiren 1229 hastanın dosyaları retrospektif olarak incelendi. Demografik özellikler, anestezi tipi, yenidoğanın 1. ve 5. dakika APGAR skorları ile intraoperatif ve postoperatif komplikasyonlar kaydedildi. Bulgular: Olguların %58,4’üne spinal, %41,3’üne genel anestezi uygulandı. Spinal anestezi grubunda 1. ve 5. dakika APGAR (aktivite, nabız, refleks yanıtı, görünüm ve solunum) skorları anlamlı olarak daha yüksek bulundu (p<0.001). Spinal anestezide ephedrin gereksinimi (%36.9) genel anesteziye (%3.7) kıyasla belirgin derecede fazlaydı. Anestezi süresi spinal grupta daha kısa (p<0.001), ancak hastanede kalış süresi açısından fark yoktu (p=0.086). Sonuç: Sezaryen ameliyatlarında spinal anestezi, maternal ve neonatal sonuçlar açısından güvenli ve etkili bir yöntemdir. Ancak hipotansiyon ve ephedrin gereksinimi daha sık görüldüğünden hemodinamik stabilitenin yakından izlenmesi gereklidir.

Anahtar Kelimeler

• Sezaryen
• spinal anestezi
• genel anestezi
• APGAR skoru
• hipotansiyon

Anesthetic experiences in cesarean surgery: A retrospective study

Öz

Aim: To evaluate the anesthetic techniques used for cesarean deliveries and their perioperative outcomes at Zonguldak Bülent Ecevit University Hospital. Material and Methods: This retrospective study included 1,229 women who underwent cesarean delivery between January 2018 and September 2019 at Zonguldak Bülent Ecevit University Hospital. Demographic characteristics, anesthesia type, 1- and 5-minute APGAR (activity, pulse, grimace, appearance, respiration) scores, and perioperative complications were assessed. Results: Spinal anesthesia was performed in 58.4% of the cases, while general anesthesia was used in 41.3%. The APGAR scores at 1 and 5 minutes were significantly higher in the spinal group (p < 0.001). The requirement for ephedrine was significantly higher in the spinal anesthesia group (36.9%) compared to the general anesthesia group (3.7%). The duration of anesthesia was shorter in the spinal group (p < 0.001), whereas the length of hospital stay did not differ significantly between the groups (p = 0.086). Conclusion: Spinal anesthesia represents a safe and effective technique for cesarean delivery, demonstrating improved neonatal outcomes. Nevertheless, the increased incidence of hypotension and the need for vasopressor support necessitate vigilant hemodynamic monitoring.

Anahtar Kelimeler

• Cesarean section
• spinal anesthesia
• general anesthesia
• APGAR score
• hypotension

Kaynakça

1. Camann W, Ostheimer GW. Obstetric anesthesia: the patients and the practice. Anesthesiol Clin North Am. 2003;21(1):1-15.
2. Reynolds F, Seed PT. Anaesthesia for caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005;60(7):636-653. https://doi.org/10.1111/j.1365-2044.2005.04223.x
3. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012;(10):CD004350. https://doi.org/10.1002/14651858.CD004350.pub3
4. Küçükosman G, Say B. Our Experience of Epidural Anesthesia for Cesarean Section in Pregnant Woman with Corrected Tetralogy of Fallot: A Case Report. Med J West Black Sea. 2021;5(2):298-300. https://doi.org/10.29058/mjwbs.850305
5. Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979-2002. Obstet Gynecol. 2011;117(1):69-74. https://doi.org/10.1097/AOG.0b013e31820093a9
6. Apfelbaum JL, Hawkins JL, Agarkar M, Connis RT, Gambling DR, Nickinovich DG, et al. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force. Anesthesiology. 2020;132(2):251-274.
7. Sarı MA, Küçükgüçlü S, Özbilgin Ş, Günenç FS, Mercan S, Esen A, et al. Retrospective evaluation of anaesthetic techniques for caesarean. Turk J Anaesthesiol Reanim. 2015;43(6), 373. https://doi.org/10.5152/TJAR.2015.91069
8. Iddrisu M, Khan ZH. Anesthesia for cesarean delivery: general or regional anesthesia - a systematic review. Ain-Sams J Anesthesiol. 2021;13:1. https://doi.org/10.1186/s42077-020-00121-7

9. Khan ZH, Eftekhar N, Barrak R. General versus spinal anesthesia during caesarean section: a narrative review. Arch Anesth Crit Care. 2018;5(1):18-21.
10. Watson SE, Richardson AL, Lucas DN. Neuraxial and general anaesthesia for caesarean section. Best Pract Res Clin Anaesthesiol. 2022;36(1):53-68. https://doi.org/10.1016/j.bpa.2022.04.007
11. Mhyre JM, Sultan P. General anesthesia for cesarean delivery: occasionally essential but best avoided. Anesthesiology. 2019;130(6):864-866. https://doi.org/10.1097/ALN.0000000000002708
12. Guglielminotti J, Landau R, Li G. Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries. Anesthesiology. 2019;130(6):912-922. https://doi.org/10.1097/ALN.0000000000002629
13. Shi X, Xu C, Wen Y, Jiang M, Yu H, Wang X, Yuan H, Feng S. Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis. BMC Anesthesiol. 2024;24(1):33. https://doi.org/10.1186/s12871-024-02412-0
14. Karaca Ü, Özgunay ŞE, Ata F, Kılıçarslan N, Yılmaz C, Karasu D. Acil sezaryenlarda anestezi deneyimlerimiz. JARSS 2020;28(4):275-80.
15. Skoog CM, Katzer JF, Wendt LH, Ituk U. The association of anesthesia type and neonatal outcomes following category-1 cesarean delivery: a retrospective cohort study. Cureus. 2023;15(3):e35910. https://doi.org/10.7759/cureus.35910
16. 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(1):71-92. https://doi.org/10.1111/anae.14080
17. Ismail S, Huda A. An observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth. 2009;18(4):352-355. https://doi.org/10.1016/j.ijoa.2009.02.013
18. McCahon RA, Catling S. Time required for surgical readiness in emergency caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth. 2003;12(3):178-182. https://doi.org/10.1016/S0959-289X(02)00196-6
19. Nateghi MR, Saremi A, Abbasi B, Karimi E. Balancing Blood Pressure: Understanding Hemodynamic Fluctuations in Spinal Anesthesia. SJMR 2023, 8(1): 37-42. https://doi.org/10.61186/sjrm.8.1.37
20. Nugroho AM, Sugiarto A, Chandra S, Lembahmanah L, Septica RI, Yuneva A. A Comparative Study of Fractionated Versus Single Dose Injection for Spinal Anesthesia During Cesarean Section in Patients with Pregnancy-Induced Hypertension. Anesth Pain Med. 2019; 6;9(1):e85115. https://doi.org/10.5812/aapm-85115
21. Girard T, Savoldelli GL. Failed spinal anesthesia for cesarean delivery: prevention, identification and management. Curr Opin Anaesthesiol. 2024; 1;37(3):207-212. https://doi.org/10.1097/ACO.0000000000001362
22. Havas F, Orhan Sungur M, Yenigün Y, Karadeniz M, Kılıç M, Özkan Seyhan T. Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia. Agri. 2013; 1;25(2):55-63. https://doi.org/10.5505/agri.2013.42204
23. Madkour NM, Ibrahim SA, Ezz GF. General versus spinal anesthesia during elective cesarean section in term low-risk pregnancy as regards maternal and neonatal outcomes: a prospective, controlled clinical trial. Res. opin. anaesth. intensive care. 2019; 1;6(1):119-24. https://doi.org/10.4103/roaic.roaic_104_17