Büyükkıdan Birgül YELKEN, Sacit GÜLEÇ, Ayşegül ÖZÖNER, Serdar EKEMEN, Yılmaz ŞENTÜRK

Sezaryen operasyonlarında S(+) ketamin ve ketaminin anne ve bebek üzerine etkileri

S(+) ketaminin klinik kullanımlarda rasemik karışıma göre daha potent, daha az psikomimetik etkili olduğu ve daha düşük dozlarda kullanılmasının yan etkileri azalttığı bilinmektedir (1-3). Sezaryen operasyonlarında S(+) ketaminin bebek Apgar Skoru üzerine etkisini, annede oluşabilecek hemodinamik değişiklikleri ve uyanma dönemindeki komplikasyonları araştırmak ve bu değişiklikleri rasemik ketamin ile karşılaştırmak üzere çalışma planlanmıştır. Elektif şartlarda operasyonu planlanan 30 olgu rastgele iki gruba ayrıldı ve anestezi indüksiyonu Grup I deki 16 olguya 0.5 mg kg-1 S(+) ketamin, Grup II'deki 14 olguya 1 mg kg-1 ketamin IV verilerek yapıldı. Tüm olgulara entübasyon öncesi 1.0 mg kg-1 süksinilkolin verildi ve bebek çıkımından sonra 0.03 $mu$g kg-1 fentanil, TOF yanıtına göre 0.03 mg kg-1 vekuronyum ve 0.04 mg kg-1 dehidrobenzperidol (DHB) IV yapıldı. Anestezi idamesi % 50 O2+% 50 N2O ile sağlandı. Tüm olgularda operasyon öncesinde, indüksiyon ve entübasyon sonrasında, bebek çıkımında ve operasyon süresince 15 dk aralıklarla kalp atım hızı (KAH), sistolik ve diyastolik kan basınçları (SKB, DKB), oksijen satürasyonu, 1. ve 5. dk Apgar Skoru ve umbilikal kan gazı değerleri kaydedildi. Uyanma döneminde olgular Postanestezi Derlenme Skorlama Sistemi ile değerlendirildi. Her iki grup arasında KAH değerleri farklılık göstermezken, SKB ve DKB değerleri Grup II'de ketamin verildikten sonra yükseldi ve operasyon boyunca yüksek seyretti (p

Anahtar Kelimeler:

Ketamin, Apgar skoru, Sezaryen, Anestezikler

A comparison of S(+) ketamine and ketamine in patients undergoing cesarean section

S(+) ketamine is known to be more potent and have less psychomimetic side effects than the racemic mixture. Our purpose for this study was to evaluate the haemodynamic side effects and complications of recovery stage and the effect on Apgar Score of S(+) ketamine and to compare with ketamine in cesarean section. Thirty healty patients undergoing elective cesarean section were enrolled in this study. Patients have no any premedication were randomly assigned to two groups and 0.5 mg kg-1 of S(+) ketamine (Group I ) and 1 mg kg-1 of ketamine (Group II) were given for induction of anesthesia and 1.0 mg kg-1 succinylcholine was administered IV for muscle relaxation. After delivery, all patients received 0.03 $mu$g/kg fentanyl, 0.03 mg kg-1 vecuronium and 0.04 mg kg-1 dehydrobenzperidol and anesthesia was maintained by N2O+O2 Maternal heart rate, blood pressure and oxygen saturation were recorded before the operation, after induction of anesthesia and intubation, at delivery and every 15 min thereafter. At delivery, umblical blood gas values were measured and Apgar Scores were recorded at 1. and 5. min. After surgery all patients assessed by postanesthetic recovery scoring system into recovery room. There were no significant differences in heart rate among groups but blood pressures were significantly increased in Group II after induction of anesthesia with ketamine and remained increased during surgery. No differences were noted with respect to Apgar Scores or neonatal umblical blood gas values. Postanesthetic recovery scoring was similiar for two groups. Vivid dreams were observed for two patients in Group I and four patients in Group II and hallucinations were observed for only one patient in Group II. We concluded that S(+) ketamine produced less haemodynamic changes and side effects than racemic ketamine and may be safe alternative anesthesia for mother and newborn in cesarean section.

Keywords:

Ketamine, Apgar Score, Cesarean Section, Anesthetics,

PDF

___

1. Glosten B:Anesthesia for obstetrics. In: Anesthesia, Miller RD(ed), Churchill Livingstone, New York 2000; p2024.
2. Adams HA: S(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation. Anaesthesist 1997; 46: 1081-7.
3. Engelhardt W: Recovery and psychomimetic reactions following S(+) ketamine. Anaesthesist 1997,46 (suppl 1): S38-42.
4. Graf BM, Vicenzi MN, Martin E, Bosnjak ZJ, Stowe DW: Ketamine has steriospresific effects in isolated perfused guinea pig heart. Anesthesiology 1995; 82: 1426-37.
5. Steward DJ: A simplified scoring system for the post-operative recovery room. Can Anaesth Soc. J:1975; 22: 111-3.
6. Ong BY, Cohen MM, Palahniuk RJ: Anesthesia forcesarean section effects on neonates. Anesth Analg 1989; 68,270-5.
7. Laurence SR, Dennis L: Anesthesia for cesarcan section. In Obstetric Anesthesia, Chestnut DH(ed), Mosby, Si Louis, 1999; 465-92.
8. McDonalds IS, Maleo CV, Reed EC:Modîfied nitrous oxide or ketamine hydrochloricie for cesarean section. Anesth Analg 1972; 51: 975-85.
9. Hempelmann G, Kuhn DF: The clinical significance of S(+) ketamine. Anaesthesist. 1997; 46 (suppl l}:S3-7.
10. Zielmann S, Kazmaicr S, Schnüller AW: Circulatory effects of S(+)-ketamine. Anaesthesist 1997; 46 (suppl 1): S 43-46.
11. Moore J, McNabb TG, Dundee JW: Preliminary report on ketamine in obstetrics. BrJAnacsth 1971; 43: 779-82.
12. Little B, Chang T, Chucol L, et al: Study of ketamine as an obstetric anesthetic agent. Am J Obstet Gynecol 1972; 113:247-60.
13. Dich-Nielsen J, Holasek J: Ketamine as induction agent for cesarean section. Acta Anesthesiol Scand 1982; 26: 139-42.
14. Akamatsu TJ.Bonica JJ, Rehmet R, Eng M, Ueland K: Experiences with the use of ketumine for parturition Anesth Analg 1974; 53: 284-7.
15. Janeczko GF, El-Etr AA, Younes S: Low-dose ketamine anesthesia for obstetrical delivery. Anesth Analg 1974;53:828-31.
16. KudoT, KudoM, Ishihara H, Kotanı N, MatsukiA: Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine-3. Masui 1991; 40: 179-83.
17. Ataallah MM, el-Mohayman HA, el-Metwally RE: Ketamine-midazolam total intravenous anaesthesia for prolonged abdominal surgery. Eur J Anaesthesiol 2001; 18:29-35.
18. Zickmann B, Kling D, Quis S: S(+) ketamine versus ketamîne racemic mixture: hemodynamic studies, Anaesthesiol Intensiv Med Notfallmed Schmerzther 2000; 35: 333-9.
19. Levinson G, Shnider SM, Gildea JE ,DeLorimier AA; Maternal and foetal cardiovascular and acid-base changes during ketamine anaesthesia in pregnant ewes. BrJ Anaesth 1973; 45:1111-5.
20. Maduska AL, Hajghassemali M: Arterial blood gases in mothers and infants during ketamine anesthesia for vaginal delivery. Anesth Analg 1978:57: 121-3.
21. Downing JW, Mahomedy MC, Jeal DE, Allen PJ: Anaesthesia for cesarean section with ketamine. Anaesthesia 1976; 31: 883-92.