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

Yıl 2018, Cilt: 49 Sayı: 1, 44 - 48, 05.03.2018

Sibel Sak , Nurullah Peker , Hacer Uyanıkoğlu , Orhan Binici , Adnan İncebıyık Muhammet erdal Sak

https://doi.org/10.16948/zktipb.348924

Öz

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.

Anahtar Kelimeler

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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