ELİF DOĞAN BAKI, Demet EROL DOğAN, Reha DEMİREL, Yücel ERDOĞAN

Sezaryen operasyonlarında intratekal levobupivakain ve bupivakainin maternal ve fetal etkilerinin karşılaştırılması

Amaç:Sezaryen operasyonlarında uygulanan genel anestezide maternal ve fetal mortalite ve morbidite yüksek olduğu için rejyonal anestezi tercih edilen bir tekniktir. Rejyonal anesteziye bağlı komplikasyonlar nadir olarak aşırı yüksek sempatik blo kveya lokal anestezik toksisitesi iledir. Gebelik sırasında hızlı hipoksi gelişimi ve kardiyojenik resüsitasyon uygulamasındaki zorluklar nedeniyle kardiyotoksisitenin önemi büyüktür. Son yıllarda kullanıma sunulan bupivakainin enantiomeri olan ve bu nedenle kardiyotoksisitesi düşük olan levobupivakainin sezaryen olgularında intratekal uygulamasının maternal ve fetal etkileri ni bupivakain ile karşılaştırmayı amaçladık. Metod:Çalışmaya etik kurul onayı ile sezaryen operasyonuna alınacak, 20-45 yaş arası, ASAI-II risk grubunda, 36-41 gesta- syonel haftalardaki 40 gönüllü gebe onayları alınarak dahil edilmiştir. Plasenta akımı bozuk olan veya bozulma olasılığı bulunan hipertansiyon, preeklampsi, diabetes mellitus, morbid obez olanlar, nöropatileri olanlar, enjeksiyon yerinde infeksiyonu olanlar, spinal anestezi için kontrendikasyonu olanlar, çalışma ilaçlarına alerjisi olanlar çalışmaya alınmamıştır. Tüm olgulara standart monitörizasyon uygulanarak sistolik, diastolik ve ortalama arter basınçları, nabız, periferik O 2satürasyonu 180.dkya kadar belli aralıklarla kaydedilmiştir. Spinal anestezi öncesi hipotansiyon profilaksisi için tüm olgulara 10 ml kg-1 Ringer Laktat infüze edil- miş ve hipotansiyon gelişiminde efedrin uygulanmıştır. Randomize, sol lateral dekübit pozisyonunda 22-26 gauge spinal iğne ile %0.5 Levobupivakain 10 mg veya %0.5 Bupivakain 10 mg uygulanmıştır. Blok seviyeleri; motor blok Bromaj skalasına göre, duyusal blok pin-prik testi ile, sempatik blok alkollü pamukla test edilip spinal başlangıcından 180.dkya kadar belli aralıklarla kaydedilmiştir. Ayrıca oluşabilecek yan etkiler (hipotansiyon, bradikardi, bulantı-kusma, idrar retansiyonu, post spinal başağrısı), bebeğin 1. ve 5.dk.lardaki Apgar değerleri ve umblikal kan gazı değerleri kaydedilmiştir. Bulgular: Çalışma sonunda bupivakain grubunda kalp hızı, hipotansiyon ve periferik O2 satürasyonunda düşme; blok etkilerinde levobupivakainin bupivakaine göre daha az motor blok etki, daha yavaş sempatik blok ve daha uzun süreli duyusal blok oluşturduğu saptanmıştır. Sonuç:Sonuç olarak sezaryen operasyonlarında spinal anestezi için intratekal levobupivakainin, bupivakaine göre daha az toksik etkiye sahip olduğu; daha potent anestezik olduğu ve yenidoğan için olumsuz etkisinin olmadığı kararına varılmıştır.

Maternal and fetal effects of intratecal bupivacaine and levobupivacaine during cesarean section

Objective: For cesarean section, regional anesthesia is preferred a technique to general anesthesia because of maternal and fetal high morbidity and mortality. Complications of regional anesthesia techniques are rarely high sensorial block or local anesthetic toxicity. We aimed to compare maternal and fetal effects of intratecal bupivacaine and levobupivacaine during cesarean section. Methods: Forty, ASA I or II parturients volunteers, between 20 and 45 years old and 36-41 gestational weeks undergoing elective cesarean delivery were enrolled in our study. Patients who were morbid obese, preeclamptic and having diabetes mellitus, enfection in enjection area, contrandications to spinal anesthesia and allergic to drugs that would be used were not enrolled in the study. Standart monitorization including sistolic, diastolic and mean arterial pressure; heart rate, peripheral oxygen saturation were recorded. 10ml kg-1 Ringer Lactate infusion was administered to prevent hypotension before spinal anesthesia to all patients and ephedrine was used in case of hypotension. 0.5% levobupivacaine 10 mg or 0.5% bupivacaine 10 mg was randomly injected through spinal needle in the lateral decubitus position. Block levels were recorded from the onset of the spinal until 180 minutes. Motor block was assessed using Bromage scale while sensory block was assessed by pinprick sensation and sympathetic blockage were assessed by cotton with alcohol. In addition, complications (hypotension, nausea-vomiting, bradycardia, convulsions, urine retention, post spinal headache) that could exist, and Apgar values of newborn at first and fifth minutes and umbilical cord blood gases were recorded. Results: At the end of the study in the bupivacaine group decrease of heart rate, hypotension and peripheral oxygen saturation were detected and longer duration of sensory block, slower sempathetic block and less motor blockage were noted in the levobupivacaine group. Conclusion: In conclusion we have shown that, levobupivacaine was less toxic than bupivacaine group and more potent anestesic and had no effects unwished for neonates during spinal anesthesia for cesarean delivery

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