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

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


Kaynakça

  • 1. Niino Y. The increasing cesarean rate globally and what we can do about it. Bioscience trends 2011;5(4):139-150.
  • 2. Liu S, Liston RM, Joseph K, Heaman M, Sauve R, Kramer MS et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Canadian medical association journal 2007;176(4):455-460.
  • 3. Erdem M, Özgen S, Coşkun F. Obstetrik anestezi ve analjezi. Temel Kadın Hastalıkları ve Doğum Bilgisi. Ankara: Melisa Matbaacılık 1996:173-186. 4. Lewis G, Drife JO. Why Mothers Die 2000-2002: Midwifery Summary and Key Findings: the Sixth Report of the Confidential Enquiries Into Maternal Deaths in the United Kingdom: RCOG; 2004.
  • 5. Hughes SC, Levinson G, Rosen MA, Shnider SM. Shnider and Levinson's anesthesia for obstetrics: Lippincott Williams & Wilkins; 2002.
  • 6. Reynolds F. General anesthesia is unacceptable for elective cesarean section. International journal of obstetric anesthesia 2010;19(2):212-217.
  • 7. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric Anesthesia Workforce SurveyTwenty-year Update. The Journal of the American Society of Anesthesiologists 2005;103(3):645-653.
  • 8. Kavak ZN, Başgül A, Ceyhan N. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section: A prospective randomized study. European Journal of Obstetrics & Gynecology and Reproductive Biology 2001;100(1):50-54.
  • 9. Laudenbach V, Mercier F, Rozé J-C, Larroque B, Ancel P-Y, Kaminski M et al. Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. International journal of obstetric anesthesia 2009;18(2):142-149.
  • 10. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. International journal of obstetric anesthesia 2008;17(4):329-335.
  • 11. Jenkins J, Khan M. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003;58(11):1114-1118.
  • 12. Gogarten W. Spinal anaesthesia for obstetrics. Best practice & research Clinical anaesthesiology 2003;17(3):377-392.
  • 13. Purtuloğlu T, Özkan S, Teksöz E, Dere K, Şen H, Yen T et al. Elektif sezaryen uygulanan olgularda genel ve spinal anestezinin maternal ve fetal etkilerinin karşılaştırılması. Comparison of maternal and fetal effects of general and spinal anesthesia in patients undergoing elective cesarean section. Gülhane Tıp Dergisi 2008;50:91-97.
  • 14. Marrin M, Paes B. Birth Asphyxia: Does the Apgar Score Have Diagnostic Value? Obstetric Anesthesia Digest 1989;9(1):12.
  • 15. Dennis J, Johnson A, Mutch L, Yudkin P, Johnson P. Acid-base status at birth and neurodevelopmental outcome at four and one-half years. American journal of obstetrics and gynecology 1989;161(1):213-220.
  • 16. Corke B, Datta S, Ostheimer G, Weiss J, Alper M. Spinal Anaesthesia for Caesarean Section. The Influence of Hypotension on Neonatal Outcome. Survey of Anesthesiology 1983;27(3):166.
  • 17. Moslemi F. Apgar scores and cord blood gas values on neonates from cesarean with general anesthesia and spinal anesthesia. Journal of Analytical Research in Clinical Medicine 2014;2(1):11-16.
  • 18. Juhani TP, Hannele H. Complications during spinal anesthesia for cesarean delivery: a clinical report of one year's experience. Regional anesthesia 1992;18(2):128-131.
  • 19. Krishnan L, Gunasekaran N, Bhaskaranand N. Neonatal effects of anesthesia for caesarean section. The Indian Journal of Pediatrics 1995;62(1):109-113.
  • 20. Datta S, Ostheimer GW, Weiss JB, BROWN Jr WU, Alper MH. Neonatal effect of prolonged anesthetic induction for cesarean section. Obstetrics & Gynecology 1981;58(3):331-335.
  • 21. Hodgson C, Wauchob T. A comparison of spinal and general anaesthesia for elective caesarean section: effect on neonatal condition at birth. International journal of obstetric anesthesia 1994;3(1):25-30.
  • 22. Mancuso A, De Vivo A, Giacobbe A, Priola V, Savasta LM, Guzzo M et al. 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):1114-1118.
  • 23. Abdallah MW, Elzayyat NS, Abdelhaq MM, Gado AAM. A comparative study of general anesthesia versus combined spinal–epidural anesthesia on the fetus in Cesarean section. Egyptian Journal of Anaesthesia 2014;30(2):155-160.
  • 24. Mueller MD, Brühwiler H, Schüpfer GK, Lüscher KP. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery. Obstetrics & Gynecology 1997;90(1):131-134.
  • 25. Ratcliffe F, Evans J. Neonatal wellbeing after elective caesarean delivery with general, spinal, and epidural anaesthesia. European journal of anaesthesiology 1993;10(3):175-181.
  • 26. Marx G, Luykx W, Cohen S. Fetal-neonatal status following caesarean section for fetal distress. BJA: British Journal of Anaesthesia 1984;56(9):1009-1013.
  • 27. Lertakyamanee J, Chinachoti T, Tritrakarn T, Muangkasem J, Somboonnanonda A, Kolatat T. Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet 1999;82(7):672-680.
  • 28. Martin T, Bell P, Ogunbiyi O. Comparison of general anaesthesia and spinal anaesthesia for Caesarean section in Antigua and Barbuda. West Indian Medical Journal 2007;56(4):330-333.
  • 29. Greene MF, Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore T. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice E-Book: Elsevier Health Sciences; 2008.
  • 30. Heesen M, Hofmann T, Klöhr S, Rossaint R, VELDE M, Deprest J et al. Is general anaesthesia for caesarean section associated with postpartum haemorrhage? Systematic review and meta‐analysis. Acta Anaesthesiologica Scandinavica 2013;57(9):1092-1102.
  • 31. Yalınkaya A, Güzel A, Kangal K, Uysal E, Erdem S. Spinal ve genel anestezi uygulanan sezaryen doğumlarında kan değerlerinin karşılaştırılması. Perinatoloji Dergisi 2009;17(2):70-73.

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

Yıl 2018, Cilt: 49 Sayı: 1, 44 - 48, 05.03.2018
https://doi.org/10.16948/zktipb.348924

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.


Kaynakça

  • 1. Niino Y. The increasing cesarean rate globally and what we can do about it. Bioscience trends 2011;5(4):139-150.
  • 2. Liu S, Liston RM, Joseph K, Heaman M, Sauve R, Kramer MS et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Canadian medical association journal 2007;176(4):455-460.
  • 3. Erdem M, Özgen S, Coşkun F. Obstetrik anestezi ve analjezi. Temel Kadın Hastalıkları ve Doğum Bilgisi. Ankara: Melisa Matbaacılık 1996:173-186. 4. Lewis G, Drife JO. Why Mothers Die 2000-2002: Midwifery Summary and Key Findings: the Sixth Report of the Confidential Enquiries Into Maternal Deaths in the United Kingdom: RCOG; 2004.
  • 5. Hughes SC, Levinson G, Rosen MA, Shnider SM. Shnider and Levinson's anesthesia for obstetrics: Lippincott Williams & Wilkins; 2002.
  • 6. Reynolds F. General anesthesia is unacceptable for elective cesarean section. International journal of obstetric anesthesia 2010;19(2):212-217.
  • 7. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric Anesthesia Workforce SurveyTwenty-year Update. The Journal of the American Society of Anesthesiologists 2005;103(3):645-653.
  • 8. Kavak ZN, Başgül A, Ceyhan N. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section: A prospective randomized study. European Journal of Obstetrics & Gynecology and Reproductive Biology 2001;100(1):50-54.
  • 9. Laudenbach V, Mercier F, Rozé J-C, Larroque B, Ancel P-Y, Kaminski M et al. Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. International journal of obstetric anesthesia 2009;18(2):142-149.
  • 10. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. International journal of obstetric anesthesia 2008;17(4):329-335.
  • 11. Jenkins J, Khan M. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003;58(11):1114-1118.
  • 12. Gogarten W. Spinal anaesthesia for obstetrics. Best practice & research Clinical anaesthesiology 2003;17(3):377-392.
  • 13. Purtuloğlu T, Özkan S, Teksöz E, Dere K, Şen H, Yen T et al. Elektif sezaryen uygulanan olgularda genel ve spinal anestezinin maternal ve fetal etkilerinin karşılaştırılması. Comparison of maternal and fetal effects of general and spinal anesthesia in patients undergoing elective cesarean section. Gülhane Tıp Dergisi 2008;50:91-97.
  • 14. Marrin M, Paes B. Birth Asphyxia: Does the Apgar Score Have Diagnostic Value? Obstetric Anesthesia Digest 1989;9(1):12.
  • 15. Dennis J, Johnson A, Mutch L, Yudkin P, Johnson P. Acid-base status at birth and neurodevelopmental outcome at four and one-half years. American journal of obstetrics and gynecology 1989;161(1):213-220.
  • 16. Corke B, Datta S, Ostheimer G, Weiss J, Alper M. Spinal Anaesthesia for Caesarean Section. The Influence of Hypotension on Neonatal Outcome. Survey of Anesthesiology 1983;27(3):166.
  • 17. Moslemi F. Apgar scores and cord blood gas values on neonates from cesarean with general anesthesia and spinal anesthesia. Journal of Analytical Research in Clinical Medicine 2014;2(1):11-16.
  • 18. Juhani TP, Hannele H. Complications during spinal anesthesia for cesarean delivery: a clinical report of one year's experience. Regional anesthesia 1992;18(2):128-131.
  • 19. Krishnan L, Gunasekaran N, Bhaskaranand N. Neonatal effects of anesthesia for caesarean section. The Indian Journal of Pediatrics 1995;62(1):109-113.
  • 20. Datta S, Ostheimer GW, Weiss JB, BROWN Jr WU, Alper MH. Neonatal effect of prolonged anesthetic induction for cesarean section. Obstetrics & Gynecology 1981;58(3):331-335.
  • 21. Hodgson C, Wauchob T. A comparison of spinal and general anaesthesia for elective caesarean section: effect on neonatal condition at birth. International journal of obstetric anesthesia 1994;3(1):25-30.
  • 22. Mancuso A, De Vivo A, Giacobbe A, Priola V, Savasta LM, Guzzo M et al. 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):1114-1118.
  • 23. Abdallah MW, Elzayyat NS, Abdelhaq MM, Gado AAM. A comparative study of general anesthesia versus combined spinal–epidural anesthesia on the fetus in Cesarean section. Egyptian Journal of Anaesthesia 2014;30(2):155-160.
  • 24. Mueller MD, Brühwiler H, Schüpfer GK, Lüscher KP. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery. Obstetrics & Gynecology 1997;90(1):131-134.
  • 25. Ratcliffe F, Evans J. Neonatal wellbeing after elective caesarean delivery with general, spinal, and epidural anaesthesia. European journal of anaesthesiology 1993;10(3):175-181.
  • 26. Marx G, Luykx W, Cohen S. Fetal-neonatal status following caesarean section for fetal distress. BJA: British Journal of Anaesthesia 1984;56(9):1009-1013.
  • 27. Lertakyamanee J, Chinachoti T, Tritrakarn T, Muangkasem J, Somboonnanonda A, Kolatat T. Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet 1999;82(7):672-680.
  • 28. Martin T, Bell P, Ogunbiyi O. Comparison of general anaesthesia and spinal anaesthesia for Caesarean section in Antigua and Barbuda. West Indian Medical Journal 2007;56(4):330-333.
  • 29. Greene MF, Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore T. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice E-Book: Elsevier Health Sciences; 2008.
  • 30. Heesen M, Hofmann T, Klöhr S, Rossaint R, VELDE M, Deprest J et al. Is general anaesthesia for caesarean section associated with postpartum haemorrhage? Systematic review and meta‐analysis. Acta Anaesthesiologica Scandinavica 2013;57(9):1092-1102.
  • 31. Yalınkaya A, Güzel A, Kangal K, Uysal E, Erdem S. Spinal ve genel anestezi uygulanan sezaryen doğumlarında kan değerlerinin karşılaştırılması. Perinatoloji Dergisi 2009;17(2):70-73.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Sibel Sak

Nurullah Peker

Hacer Uyanıkoğlu

Orhan Binici

Adnan İncebıyık Bu kişi benim

Muhammet erdal Sak

Yayımlanma Tarihi 5 Mart 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 49 Sayı: 1

Kaynak Göster

APA Sak, S., Peker, N., Uyanıkoğlu, H., Binici, O., vd. (2018). Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?. Zeynep Kamil Tıp Bülteni, 49(1), 44-48. https://doi.org/10.16948/zktipb.348924
AMA Sak S, Peker N, Uyanıkoğlu H, Binici O, İncebıyık A, Sak Me. Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?. Zeynep Kamil Tıp Bülteni. Mart 2018;49(1):44-48. doi:10.16948/zktipb.348924
Chicago Sak, Sibel, Nurullah Peker, Hacer Uyanıkoğlu, Orhan Binici, Adnan İncebıyık, ve Muhammet erdal Sak. “Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?”. Zeynep Kamil Tıp Bülteni 49, sy. 1 (Mart 2018): 44-48. https://doi.org/10.16948/zktipb.348924.
EndNote Sak S, Peker N, Uyanıkoğlu H, Binici O, İncebıyık A, Sak Me (01 Mart 2018) Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?. Zeynep Kamil Tıp Bülteni 49 1 44–48.
IEEE S. Sak, N. Peker, H. Uyanıkoğlu, O. Binici, A. İncebıyık, ve M. e. Sak, “Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?”, Zeynep Kamil Tıp Bülteni, c. 49, sy. 1, ss. 44–48, 2018, doi: 10.16948/zktipb.348924.
ISNAD Sak, Sibel vd. “Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?”. Zeynep Kamil Tıp Bülteni 49/1 (Mart 2018), 44-48. https://doi.org/10.16948/zktipb.348924.
JAMA Sak S, Peker N, Uyanıkoğlu H, Binici O, İncebıyık A, Sak Me. Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?. Zeynep Kamil Tıp Bülteni. 2018;49:44–48.
MLA Sak, Sibel vd. “Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?”. Zeynep Kamil Tıp Bülteni, c. 49, sy. 1, 2018, ss. 44-48, doi:10.16948/zktipb.348924.
Vancouver Sak S, Peker N, Uyanıkoğlu H, Binici O, İncebıyık A, Sak Me. Elektif Sezaryende Genel Anestezi’mi, Spinal Anestezi’mi Uygulanmalı?. Zeynep Kamil Tıp Bülteni. 2018;49(1):44-8.