TÜLAY ÖZKAN SEYHAN, Mukadder ORHAN SUNGUR, Fatma DEMİRCAN, İbrahim KALELİOĞLU, Ahmet Cem İYİBOZKURT, Mert ŞENTÜRK

Plesenta akreta vakalarında perioperatif anestezi yaklaşımı (Retrospektif analiz)

Amaç: Hastanemizde sezaryen ameliyatı olmuş ve plasenta akreta tanısı almış vakaların majör obstetrik kanama açısından araştırılması ve anestezi yönetimi, transfüzyon gereksinimi ve karşılaşılan problemlerin incelenmesi amaçlanmıştır. Yöntem: 2007-2011 yılları arasında sezaryen olgularında plasenta akreta/perkreta tanısı alan hasta kayıtlarından ön tanı varlığı, operasyonun zamanlaması (gündüz/nöbet), anestezi tipi (genel/rejyonal), operasyon süresi, sezaryen dışında yapılan cerrahi girişim, peroperatif hemodinamik veriler, ketamin, vazopressör, oksitosin, kristalloid, kolloid tüketimi, santral ven kanülasyonu gereksinimi araştırılarak kaydedildi. Yine perioperatif eritrosit süspansiyonu, taze donmuş plazma, trombosit süspansiyonu tüketimi, hastaneye girişte alınmış kontrol hemoglobin, trombosit, protrombin zamanı, aktive parsiyel tromboplastin zamanı ve peroperatif ölçülen en düşük hemoglobin değerleri kaydedildi. Hastaların ekstübasyon yeri, varsa yoğun bakımdaki kalış ve mekanik ventilasyon süreleri, hastanede kalış süreleri, mortalite oranları ve yenidoğan verileri değerlendirilerek kaydedildi. Çalışma için hedef parametre olarak majör obstetrik kanama varlığı seçilerek, hastalar beş ünite altında veya beş ünite ve üzerinde eritrosit süspansiyonu (ES) verilmesine göre iki gruba (ES< 5Ü grubu ve ES≥ 5Ü grubu) ayrılarak kıyaslandı. Bulgular: Plasenta perkreta sayısı 13 olmak üzere toplam 74 olgu saptanmıştır. ES< 5Ü grubunda 2 (0-4), ES≥ 5Ü grubunda 7,5 (5-21) Ü eritrosit süspansiyonu kullanılmıştır. ES≥ 5Ü grubunda operasyon süresi daha uzun, mesane onarımı, peroperatif hipotansiyon, ketamin ile vazopressör gereksinimi daha sık bulunmuştur. Benzer şekilde bu grupta kan ürünü ve sıvı gereksinimi daha fazla bulunmuştur. Sonuç: Plasenta invazyon anomalisi vakalarda operasyonunun rutin sezaryenden daha karmaşık olacağı hatırlanmalı ve anesteziyologlar dinamik anestezi yönetimi ve transfüzyon gereksinimine hazırlıklı olmalıdırlar.

Perioperative anaesthetic approach for placenta accreta cases (A retrospective analysis)

Objective: We aimed to investigate anaesthetic approach, transfusion requirements and perioperative problems in terms of major obstetric hemorrhage presence in cesarean section patients operated and diagnosed with placenta accreta at our hospital. Methods: Antenatal diagnosis, operation timing (day/night), anaesthesia type (general/regional), operation duration, surgical operations other than hysterectomy, peroperative hemodynamics, ketamine, vasopressor, oxytocine, crystalloid, colloid and central venous cannulation requirements were noted in parturients diagnosed with placenta accreta/percreta between 2007-2011. Perioperative red blood cell (RBC), fresh frozen plasma, platelet transfusion, lowest peroperative hemoglobin level, as well as hemoglobin concentration, platelet count, activated partial thromboplastin time, prothrombin time at hospital entry were recorded. Extubation location, intensive care stay and duration of mechanical ventilation, length of hospital stay, in-hospital mortality and newborn data were evaluated. The presence of major obstetric hemorrhage was determined as primary outcome and patients were compared in two groups: patients transfused less than five units of RBC (ES<5U Group) and patients transfused equal or more than five units of RBC (ES≥ 5U Group). Results: Placenta percreta was documented in thirteen out of 74 cases. RBC transfusion was 2 (0-4) in ES< 5U and 7.5 (5-21) in ES≥ 5U groups. Operation time was longer, bladder repair, peroperative hypotension, ketamine and vasopressor requirements were more frequent in ES≥ 5U group. Similarly blood products and fluid consumed were higher in ES≥ 5U. Conclusion: Cases with placental invasion abnormalities must be considered more complicated than routine cesarean section and anaesthesiologists must be prepared for dynamic anaesthesia care and transfusion requirements.

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