Hakan TAPAR, İlhan Bahri DELİBAŞ, Serkan DOĞRU, Tuğba Karaman, Serkan KARAMAN, Hatice YILMAZ DOĞRU, Olcayto UYSAL, Mustafa SÜREN, Gülşen GENÇ TAPAR

Sezaryen hastalarında spinal anestezi sonrası fetüs ağırlığı, plesenta ağırlığı, amniyon sıvı miktarı ve hipotansiyon gelişimi arasında korelasyon

Amaç: Spinal anestezi sonrası gebenin kilosu veya karın çevresine göre hipotansiyon, efedrin ihtiyacı ve duysal blok seviyesini araştıran çalışmalar vardır. Gebenin kilosu veya karın çevresi uterus içeriğinin (fetüs ağırlığı, plesenta ağırlığı ve amniyon sıvı miktarı) kaba bir tasviridir. Bu çalışma ile amacımız fetüs ağırlığı, plesanta ağırlığı ve amnion sıvı miktarı ile spinal anestezi sonrası hipotansiyon ve efedrin ihtiyacı arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Elektif şartlarda spinal anestezi ile sezaryen planlanan 51 gebe çalışmaya alındı. Gebelere standart dozda L3-4 intervertebral aralıktan 12,5 mg hiperbarik bupivakain uygulandı. Spinal anestezi sonrası hipotansiyon sistolik kan basıncı <100 mmHg veya bazal değere göre %30 azalma olarak tanımlandı. Hipotansiyon olduğunda efedrin (5 mg) yapıldı. Bradikardi kalp tepe atımı <60 atım/dakika olarak tanımlandı. Bradikardi olduğunda atropin (0,5 mg) yapıldı. Spinal anestezi öncesi ve spinal anestezi sonrası 2, 5, 10, 20 ve 30’uncu dakika kan basıncı değerleri kaydedildi. Çalışma sonunda fetüs ağırlığı, plesenta ağırlığı ve amniyon sıvı miktarına göre kan basıncı değişikliği, efedrin ve atropin ihtiyacı değerlendirildi.Bulgular: Fetüs ağırlığı, plesenta ağırlığı ve amnion sıvı indeksi ile efedrin ihtiyacı arasında önemli bir korelasyon bulunmadı (sırasıyla r =0,063, p =0,660; r =0,093, p =0,518; r =0,162, p =0,257).Sonuç: Gebelerde spinal anestezi sonrası hemodinamik değişiklikler, kullanılan efedrin ve atropin miktarı ile fetüs ağırlığı, plesenta ağırlığı ve amnion sıvı miktarı arasında bir ilişki yoktur.

Anahtar Kelimeler:

sezaryen, spinal anestezi, efedrin, fetüs, plesenta, amniyon sıvı

Correlation between the fetal weight, placenta weight, amniotic fluid amount and the development of hypotension after spinal anesthesia for cesarean section patients

Aim: After spinal anesthesia, there are studies investigating the hypotension, ephedrine need and sensory block level according to the weight or abdominal circumference of the pregnant woman. Pregnant’s weight or abdominal circumference is a rough description of the uterine content (the weight of the fetus, the weight of the placenta and amount of the amniotic fluid). The aim of this study was to investigate the relationship between weight of the fetus, weight of the placenta and amount of the amniotic fluid and the ephedrine need after spinal anesthesia.Material and Method: Fifty-one parturients who underwent cesarean section with spinal anesthesia were included in the study. 12.5 mg hyperbaric bupivacaine was injected into the subarachnoid space at the L3-4 intervertebral level. After spinal anesthesia, hypotension was defined as systolic blood pressure <100 mmHg or 30% decrease compared to baseline. Ephedrine (5 mg) was administered when hypotension was present. Bradycardia was defined as heart beat <60 beats / min. Atropine (0.5 mg) was made when bradycardia was present. Before spinal anesthesia and after spinal anesthesia, blood pressure values at 2, 5, 10, 20 and 30th minutes were recorded. At the end of the study, blood pressure variation, ephedrine and atropine requirement were evaluated according to fetus weight, placenta weight and amnion fluid amount.Result: No significant correlation was found between fetal weight, placenta weight, amniotic fluid index and ephedrine requirement (r = 0.063, p = 0.660; r = 0.093, p = 0.518; r = 0.162, p = 0.257, respectively).Conclusion: After spinal anesthesia, there are no relation between amount of the ephedrine used and fetal weight, placenta weight, amniotic fluid amount in pregnant women.

Keywords:

cesarean section, spinal anesthesia, ephedrine, fetus, placenta, amniotic fluid,

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