Elektif Sezeryan Operasyonlarında Spinal Anestezi Uygulama Sırasında Propofol Sedasyonunun Anne ve Yenidoğan Üzerindeki Etkilerinin Karşılaştırılması
Regional anestezi, bilinç açıklığı sağlaması, spontan solunumun devamı, havayolu reflekslerinin korunması, aspirasyon riskinin olmaması, yeni doğanda solunum depresyonu olmaması, uterusta atoni olmaması nedeniyle sezaryen operasyonlar ında tercih edilir. 30 hastaya herhangi bir sedasyon olmadan (Grup K), 30 hastalık başka bir gruba da (Grup P) 0.5 mg/kg propofol spinal anestezi başlangıcında bolus tarzında verildi. Oksijen satürasyonu, Ramsey Sedasyon Skalası ve yüze yansıyan ağrı skalası 0, 1, 5, 7, 10, 15, 20nci dakikalarda ve operasyon sona erene kadar beşer dakika arayla ölçüldü ve kaydedildi. Sonuç olarak; propofol her ne kadar sezaryen operasyonlarında güvenilir ve geçerli bir anestezik ajan olarak kabul edilse de propofolün yeni doğan üzerindeki nörolojik, davranışsal ve ağrı etkisini değerlendirmek için gelecekte daha kapsamlı çalışmalara ihtiyaç vardır.
Comparison of The Effects of Propofol Sedation on Mother and Newborn During Spinal Anesthesia for Elective Cesarean Section
Regional anesthesia is preferred in cesarean sections, since it provides consciousness, continuation of spontaneous respiration, protection of airway reflexes, and causes no risk of aspiration, no respiratory depression in the newborn, and no uterine atony. Spinal anesthesia was administered to 30 patients without the application of any sedation (Group K) and in the other 30 cases, a single dose of 0.5 mg/kg propofol (Group P) was administered as an i.v. bolus at the beginning of the anesthesia. SaO2, Ramsey Sedation Scale and facial expression pain scale were measured and recorded at 0, 1, 5, 7, 10, 15, and 20 minutes and at five-minute intervals until the end of the operation following propofol administration.In conclusion although propofol is considered as a safe and reliable anesthetic agent in cesarian sections we sug gest that more comprehensive studies to determine the neurologic, behavioral and pain effects of propofol on newborns are needed in the future.
___
- 1. Erdine S: Neural Blockage. Istanbul: Emre Press, 1993:
9-24.
- 2. Yegul I: Regional Analgesia and Anesthesia in Obstetrics.
VI. National Congress, 5-8 December 1996, Bursa:
SummaryBook1996: 80-85.
- 3. Ready LB. Acute Perioperative Pain in Miller RD. Anesthesia,
Churchill Livingstone, Inc Fifth Edition, 2000;
2323-50
- 4. Can G:Accessment of Newborn. Neyzi O, Ertuğrul T
(Eds.)Pediatrics. Second edition. Vol1, 1993: 186-201. 33
5. Senses DA: Assesment of Newborn. Kinisci H, Göksin E
(Eds.) Essentials of Gynecological Diseases and Obstetrics.
Ankara: Melisa Press, 1996: 214-219
- 6. Lawrence J Alcock D et al. The development of a tool
to assess neonatal pain. Neonatal Network. 1993; 12 :
59-66.
- 7. Kocamanoğlu İS, Sarıhasan B, Şener B, Tür A, Şahinoğlu
H, Sunter S.Methods and complications of anesthesia
in cesarian/section operations: Retrospective evaluationos
3552 cases. J. Med Sci. 2005; 25: 810-16
- 8. G. Edward Morgan JR, Maged S. Mikhail. Clinical Anaesthesiology
2 nd Ed. Apleton&Lange 696–697, 1996.
- 9. Carvalho B, Collins J, Drover DR, AtkinsonRalls L, Riley
ET. ED(50) And ED(95) Of İntrathecal Bupivacaine İn
Morbidly Obese Patients Undergoing Cesarean Delivery.
Anesthesiology. 2011 Mar;114 :529-35.
- 10. Michie AR, Freeman, Dutton DA, Howie HB. Subarachnoid
anaesthesia for elective Caserean section, Anaesthesia
1988, 43: 96–99.
- 11. Albani A, Renghi A, Ciarlo M et al. Peridural anesthesia
versus subarachnoid anesthesia in cesarean section.
Prospective clinical study. Minerva Anestesiol
1998;64:387-391
- 12. Turkoz A, Togal T, Gokdeniz R et al. Effectiveness of
intravenous ephedrine infusion during spinal anaesthesia
for caesarean section based on maternal hypotension,
neonatal acid-base status and lactate levels.
Anaesth Intensive Care 2002;30 :316- 320
- 13. Dahlgren G, Granath FK, Pregner PG, Rosblad H. Irestedt
and Wessel L. Colloid vs. crystalloid preloading toprevent
maternal hypotension during spinal anesthesia
for elective cesarean section, Acta Anaesthesiol Scand
2005, 49: 1200– 12065
- 14. Sahar M. Siddik, Marie T. Aouad, Ghada E. Kai, Maria
M. Sfeirand Anis S. Baraka. Hydroxyethyls tarch 10 % is
superior to Ringer’s solution for preloading before spinal
anesthesia for Cesarean section, Canadian Journal
of Anesthesia 2000, 47: 616–621.
- 15. Glosten B. Epidural and Spinal Analgesia, Anesthesia,
Obstetric Anesthesia, 2 th Ed 1999, 360–386.
16. Corke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH.
Spinal anaesthesia for Caesarean section. The influence
of hypotension on neonatal outcome. Anaesthesia
1982; 37:658-662.
17. Morgan P. Spinal anaesthesia in obstetrics. Can J Anaesth
1995; 45:1145-1163
- 18. Kasaba T, Yamaga M, Iwasaki T, Yoshimura Y, Takasaki
M: Ephedrine, dopamine, or do butamine to treat hypotension
with propofol during epidural anesthesia. Can J
Anaesth ; 2000;47:237-41
- 19. Roud, CC. Rocke, DA. Levin, J., Gouws, E., Reedy, D., A revolution
of the role of crystalloid preload in the prevention
of hypotansion associated with spinal anesthesia for elective
caesarean section, Anesthesiology 1993;79: 262–9
- 20. Tarkkila PJ, Kaukinen S: Complications during spinal
anesthesia a prospective study. Reg Anesth 1991; 16:
100-106.
- 21. Carpenter RL, Caolan RA, Brown DL, Stephenson C, Wu
R: Incidence and risk factors for side effects of spinal
anesthesia. Anesthesiology 1992; 76: 906-916.
- 22. Hollmen AL, Jouppila R, Albright GA, Jouppila P, Vierola
H, Kolvula A. İntervillous blood flow during caesarea
section with prophylactic ephedrine and epidural anesthesia.
Acta Anaesth Scand 1984, 28: 396–400
- 23. Roberts SW, Levena KJ, Sidaw JE, et al. Fetal acidemia
associated with regional anesthesia for elective cesarean
delivery. ObstetGynecol, 1995; 85: 79-83
- 24. Mueller MD, Brühwiler H, Schüpfer GK, Lüscher KP.
Higher rate of fetal acidemia after regional anesthesia
for elective cesarean delivery. Obstet Gynecol
1997;90:131-134
- 25. Datta S, Ostheimer GW, Weiss JB, Brown JR. WU, Alper
MH. Neonatal effect of prolonged anesthetic inductionfor
cesarean section, Obstetrics and Gynecology
1981,58: 331– 335
- 26. Mackenzie N. Sedation during regional anesthesia: indications,
advantages and methods. Eur J Anaesthesiol
1996;13:2-7.
- 27. Jungheinrich C, Scharpf R, Wargenau M, Dilger C, Bepperling
F. Pharmacokinetics of the generic formulati on
propofol 1% fresenius in comparison with the original
formulation (Disoprivan 1%) Clin Drug Investig 2002;
22: 417–27.
- 28. Smith I, Monk TG, VVhite PF, Ding Y Propofolin fusion
during regional anaesthesia: sedative, amnesticandanxiolyticproperties.
Anesth Analg 1994; 79:313-9.
- 29. Sebel PS, Lowdon JD. Propofol: a newintravenousanesthetic.
Anesthesiology 1989;71:260–77.
- 30. Iyilikçi L, Cakmak S, Ogdul E, Canduz B, Boyacı F, Ozdemir
F ve ark. Remote Location Anesthesia: Experience
of Our Team. Turk J. Anesth Reanim 2006;10:169-76
- 31. Anderson EL, Reti IM. ECT in pregnancy: a review of
the literature from 1941to 2007. Psychosom Med 2009;
71: 235-42.
- 32. Alon E, Ball RH, Gillie MH, Parer JT, Rosen MA, Shnider
SM. Effects of propofol and thiopental on maternalandfetal
cardiovascular and acid-base variables in the
pregnantewe. Anesthesiology 1993;78:562–76.
- 33. Mongardon N, Servin F, Perin M, Bedairia E, Retout S,
Yazbeck C. Predicted propofol effect-site concentration
for induction and emergence of anesthesia during early
pregnancy. AnesthAnalg 2009;109:90–5
- 34. Cheng YJ, Wang YP, Fan SZ, Liu CC. Intravenous infusion
of low dose propofol for conscious sedation in
cesarean section before spinal anesthesia. Acta Anaesthesiol
Sin 1997; 35:79–84.
- 35. White PF, Negus JB: Sedative infusions during local and
regional anaesthesia. Clin Anesth 1991; 3:32-9.
- 36. Tulunay M, Tulunay FC (2000) Ağrı Değerlendirilmesi
ve Ağrı Ölçümleri, S Erdine (Ed), Agrı, Istanbul, Pres
Alemdar, s.91-107.
- 37. Celleno D, Capogna G, Tomassetti M, Costantino P, DiFeo
G, Nisini R. Neuro behavioural effects of propofol on
the neonate following elective caesarean section. Br J
Anaesth. 1989;62:649-54.
- 38. Gregory M A, Gin T, You G et al. Propofol infusion anaesthesia
for Caesarean section. Canadian Journal of
Anaesthesia 1990; 37:514-520