Which Should Be Performed; General Or Spinal Anesthesia İn Elective Cesarean Section?

Abstract

Objective: We aimed to determine the advantages and disadvantages of both techniques by comparing maternal and fetal outcomes in patients who underwent elective cesarean section with general anesthesia or spinal anesthesia.

Methods: 100 pregnant women who underwent elective cesarean operation due to recurrence history of cesarean section count between 1 and 3 were included. Cases with pregestational or gestational morbidity were excluded. The pregnancies were randomly divided into two equal groups. General anesthesia was performed in cases group I and spinal  anesthesia was performed  in cases group II. Demographic datas of pregnants, fetal delivery time, duration of operation, preoperative (preop) and postoperative (postop) hemoglobin (hb) and hematocrit (htc) levels, operative blood loss, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) score and umblical artery pH test, which are used in the evaluation of asphyxia and  fetal well-being were compared in two groups.

Results: The age, gravida, parity, birth week and the birth weight of newborns were similar in general anesthesia and spinal anesthesia cases (p> 0.05). There was no statistically significant difference between preop and postop  hb and htc in groupI and grupII.  When the groups were compared in terms of operative blood  loss (Preoperative hb- Postoperative hb, Preoperative htc- Postoperative htc), the difference was not significant while the general anesthesia group had more blood loss (p = 013, p = 0.10 respectively). In both groups, the 1st and 5th minute apgar scores and umbilical artery pH values ​​were similar (p=0.88, p=0.43, p=0.11 respectively). However, when 1st and 5th minute apgar scores were evaluated in both groups 5th minute apgar scores were significantly higher than 1st  minute apgar (P <0.001, P <0.001).

Conclusion: It is found that maternal and fetal outcomes of both anesthesia techniques are similar in elective cesarean section cases. When choosing anesthesia technique in elective cesarean section operation, comorbidity of the pregnancy, urgency of operation, experience of anesthetist, expectancy and  preference of mother should be taken  into consideration.

Keywords

• Elective cesarean,general anesthesia

Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?

Öz

Özet:

Amaç: Çalışmamızda genel anestezi veya spinal anestezi ile elektif sezaryena alınan olgularda maternal ve fetal sonuçları karşılaştırarak her iki tekniğin avantajlarını ve dezavantajlarını belirlemeyi hedefledik.

Materyal metod: Çalışmamıza 1 ile 3 arası sayıda tekrarlayan sezaryen öyküsü olan ve bu nedenle elektif sezaryen operasyonu yapılan 100 gebe dahil edildi. Tekrarlayan sezaryen öyküsü dışında pregestasyonel veya gestasyonel morbiditesi olan vakalar çalışma dışı bırakıldı. Gebeler randomize olarak iki eşit gruba ayrıldı. Grup I gebelere genel anestezi,  grup II gebelere ise spinal anestezi uygulandı. Her iki anestezi tekniği uygulanan gebelerin demografik verileri, fetüs çıkış süresi, operasyon süresi,  preoperatif (preop) ve postoperatif (postop) hemoglobin (hb) ve hematokrit (htc) düzeyleri,  operatif kan kaybı  ve yenidoğanın  fetal iyilik hali ve asfiksiyi değerlendirmede kullanılan APGAR (Activity, Pulse, Grimace, Appearance, Respiration) skoru ve umblikal arter pH testi  karşılaştırıldı.

Bulgular: Genel anestezi ve spinal anestezi uygulanan olguların yaş, gravide, parite, doğum haftası ve yenidoğanların doğum  tartısı benzerdi (p>0.05). GrupI ve grupII de preop ve postop hb ve htc arasında istatistiksel anlamlı bir fark bulunamadı. Operative kan  kaybı (Preoperative hb- Postoperative hb, Preoperative htc- Postoperative htc)  açısından gruplar karşılaştırıldığında genel anestezi alan grupta kan  kaybı daha fazla olsada aradaki fark anlamlı bulunmadı (p=013,  p=0.10 sırasıyla). Her iki grup yenidoğanlarınn 1.dakika, 5.dakika apgar skorları  ve umblikal arter pH ları birbirine  benzer saptandı ( p=0.88,  p=0.43,  p=0.11 sırasıyla). Ancak grup  içi 1.dakika ve 5.dakika apgar skorları değerlendirildiğinde iki grupta da 5.dakika APGAR skorları 1.dakika APGAR skorlarına göre anlamlı yüksek bulundu (p<0.001, p<0.001).

Sonuç: Elektif sezaryen olgularında her iki anestezi tekniğin maternal ve fetal sonuçlarının benzer olduğu saptandı. Elektif sezaryen yapılacak hastalarda anestezi tekniği seçimi yapılırken gebenin komorbitesi, operasyonun aciliyet durumu, anestezistin  tecrübesi, annenin beklentisi ve tercihi dikkate alınmalıdır.

Anahtar Kelimeler

• Elektif sezaryen,genel anestezi

Kaynakça

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