Bumin Gözde AYDIN, Fehmi COŞKUN, Altan ŞAHİN, Ülkü AYPAR

Elektif sezaryen ameliyatlarında sevofluran ve desfluran anestezisinin yenidoğanda nörolojik ve adaptasyon kapasite skoruna etkisi

Değişik genel anestetiklerin yenidoğana depresyon etkisi daha önce yapılan çalışmalarda gösterilmiştir. Fakat son zamanlarda kullanıma giren desfluran ve sevofluran anestezisinin yenidoğana olan etkileri henüz araştırılmamıştır. Bu çalışmanın amacı efektif sezaryen ameliyatlarında desfluran ve sevofluran inhalasyon anestezisinin annenin vital bulguları, umblikal arter kan gazı değerleri, yenidoğanın Apgar skoru, Nörolojik ve Adaptasyon Kapasite Skorlarına (NACS) etkilerinin karşılaştınlmasıdır. Çalışmaya elektif sezaryen ameliyatı olacak ASA l grubunda 20-35 yaşlarında 102 miadında (37-42 hafta) gebe dahil edildi. Hastalar randomize edilerek iki gruba ayrıldı. 4 mg $kg^-1$ tiyopental ile indüksiyon ve 1.5 mg $kg^-1$ süksinil kolin ile kas gevşekliği sağlanarak bir gruba %50 azot protoksit-oksijen karışımı içinde 0.4 MAC desfluran, ikinci gruba 0.75 MAC sevofluran anestezisi uygulandı. Her iki gruba da narkotik analjezik verilmedi. Preoperatif ve intraoperatif 3 dakikada bir ortalama arteriyel basınçları izlendi. Kanama miktarları, umblikal arter kan gazı değerleri, Apgar ve NACS skorları değerlendirildi. Desfluran grubunda NACS skorları 15. dakika ve 2. saatte belirgin olarak iyi bulundu. Apgar skorlarında, umblikal arteriyel kan gazı değerlerinde anlamlı fark bulunmadı. Elektif sezaryen ameliyatlarında erken dönemde subanestezik desfluran alan annelerin bebeklerinin subanestezik sevofluran alan annelerin bebeklerine göre nörolojik açıdan daha aktif oldukları gösterildi.

Anahtar Kelimeler:

Sezaryen, Anestezikler, inhalasyon, Süt çocuğu, yenidoğan

The influence of sevoflurane and desflurane on neurological and adaptive capacity scores of newborn in elective cesarean operations

Depressive effects of general anesthetics on the newborn have been documented in several previous studies. However, studies comparing the effects ofdesflurane and sevoflurane on newborn is still lacking. The aim of this study is to compare the effects of these inhalational agents on the vital signs of the mother umbilical arterial blood gases, Apgar scores and Neurologic and Adaptive Capacity Scores (NACS) of the neonate. One hundred two ASA I patients, between 20-35 years having 37-42 weeks of gestation were randomly allocated into two groups. Thiopental 4 mg $kg^-1$ and succinylcholine 1.5 mg $kg^-1$ were administered for induction. First group received 0.4 MAC desflurane and second group received 0.75 MAC sevoflurane in 50 % N2O, without opioid and analgesic addition. Mean arte-riyel pressures were evaluated preoperatively and intraoperativefy every 3 minutes. Amount of blood loss, umbilical arterial gases, Apgar scores and NACS were evaluated. In desflurane group, NACS scores were significantly better on 15th minute and 2nd hour evaluation. There were no statistically significant differences between Apgar scores, and umbilical arterial blood gases between the two groups. In conclusion, subanesthetic desflurane offers more favorable neurological outcome at earlier times compared to subanesthetic sevoflurane, in newborn delivered by elective cesarean section.

Keywords:

Cesarean Section, Anesthetics, Inhalation, Infant, Newborn,

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