DUDU BERRİN GÜNAYDIN, Nuray CAMGÖZ, Gülşah Alp POLAT

Sezaryen operasyonlarında spinal anestezi öncesi sabit volümde kristalloid veya koloid önyüklemesinin maternal ve neonatal etkilerinin karşılaştırılması

Amaç: Bu çalışmada elektif sezaryenlerde düşük doz ropivakain + opioidle yapılan spinal anesteziden önce iv infüzyonla uygulanan Ringer laktat (RL) veya kolloid (Voluven %6) solüsyonlarının spinal anestezinin yol açtığı hipotansiyon, efedrin miktarı, maternal ve neonatal parametreler üzerine etkilerinin karşılaştırılması amaçlandı. Yöntem: Elektif sezaryen planlanan ASA II 60 gebeye ropivakain + opioidle yapılan spinal anesteziden önce rastgele ya 1000 mL RL (n:30, Grup RL) ya da 500 mL kolloid (n:30, Grup V) uygulandı. ‹ki grubun; maternal hipotansiyon, bulantı ve kusma insidansları, kullanılan efedrin miktarı, duyusal ve motor blok özellikleri, ilk analjezik ihtiyacı ve mobilizasyon zamanları ile Apgar skorları karşılaştırıldı. Bulgular: Her iki grupta da spinal anesteziden sonra ortalama kan basıncında bazal değere göre anlamlı düşme saptandı. Hipotansiyon insidansları (Grup RL’ de % 83.3, Grup V’ de % 80) ve tedavide kullanılan efedrin miktarları benzerdi (Grup RL: 28.5 ± 3.5 mg, Grup V: 21.8 ± 3.4 mg). Grupların bulantı-kusma insidansları, duyusal ve motor blok özellikleri, ilk analjezik gereksinimi, mobilizasyon zamanları ve Apgar skorları arasında fark saptanmadı. Sonuç: Bu araştırmada elektif sezaryenlerde sabit volümde kolloid veya kristalloid önyüklemesinin düşük doz ropivakain + opioidle yapılan spinal anesteziye bağlı hipotansiyon insidansı, kullanılan efedrin miktarı ile diğer maternal ve neonatal parametreleri benzer şekilde etkilediği gösterilmiştir.

Comparison of maternal and neonatal effects of fixed volume of crystalloid or colloid preloading for elective cesarean sections before spinal anesthesia

Objective: The aim of this study is to compare the effects of iv infusion of fixed volume Lactated Ringer’s solution (LR) or colloid (Voluven 6%) before spinal anesthesia with low dose ropivacaine p + opioid on the incidence of hypotension due to spinal anesthesia, amount of ephedrine used, maternal and neonatal parameters for elective cesarean deliveries. Methods: Sixty ASA II parturients scheduled to undergo elective cesarean section were randomly allocated to administer 1000 mL LR (n:30, group RL) or 500 mL colloid (Voluven 6%) (n:30, group V) before spinal anesthesia with ropivacaine+opioid. Both groups were compared in terms of the incidence of maternal hypotension, nausea and vomiting, amount of ephedrine used, sensory and motor block characteristics, first analgesic requirement, mobilization time and neonatal Apgar scores. Results: There were significant decreases in the mean blood pressure compared to control value after spinal anesthesia within each group. The incidence of hypotension (Group RL: 83.3 %, Group V: 80 %) and the amount of ephedrine used (Group RL: 28.5 ± 3.5 mg, Group V: 21.8 ± 3.4 mg) were similar. The incidence of nausea and vomiting, sensory and motor block characteristics, first analgesic requirement and Apgar scores were comparable. Conclusion: It has been demonstrated that fixed volume of either crsytalloid or colloid preloading similarly affected the incidence of hypotension due to spinal anesthesia with low dose ropivacaine + opioid, amount of ephedrine used, and other maternal and neonatal parameters during elective cesarean sections in the present study.

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