Hacer SERDAROĞLU, Saban YALÇIN, Hüsamettin ERDAMAR, Zekeriyya ALANOĞLU, Ali Abbas YILMAZ, Menekşe HASDOĞAN, Şirali OBA, Asuman UYSALEL

Sezaryende anne ve fetusta tiyopental ve propofolün oksidatif stres parametreleri üzerine etkileri

Amaç: Bu çalışmada, elektif sezaryen yapılan hastalarda propofol ve tiyopentalin genel anestezi indüksiyonu için kullanımının oksidatif stres üzerine etkilerinin karşılaştırılması planlandı. Yöntem: Çalışmaya propofol grubunda 19, tiyopental grubunda 21 olmak üzere toplam 40 genel anestezi ile sezaryenle doğum yapacak gebe dahil edildi. Her iki grupta anestezi idamesi sevofluran ile sağlandı. Grupların intraoperatif hemodinamik verileri, periferik oksijen satürasyonları, anestezi, bebek çıkımı ve cerrahi süreler kaydedildi. Anneden bazal ve bebek çıkımında, bebekten kord kanı örnekleri alınarak serumlarında oksidatif stresin göstergesi olan MDA, MPO, Nox, nitrit ve antioksidan kapasitenin göstergesi olan SOD düzeyleri çalışıldı. Bebek çıkımında anneden arteriyel kan gazı ve kord kanından venöz kan gazı örnekleri alındı. Bulgular: Gruplar arası demografik, hemodinamik verileri, periferik oksijen satürasyonları, anestezi, cerrahi ve bebek çıkım süreleri, Apgar 1. ve 5. dakika skorları açısından istatistiksel olarak bir fark bulunmadı. Gruplar kendi içlerinde bazal değere göre karşılaştırıldığında tiyopental grubunda MPO’da indüksiyon sonrasında azalma görüldü. Gruplar arası karşılaştırmada bazal değerler arasında istatistiksel olarak fark bulunmazken, indüksiyon sonrası değerlerde tiyopental grubunda SOD düzeyinde artma bulundu. Umbilikal kord kanları karşılaştırıldığında propofol grubunda NOx ve nitrit düzeylerinde azalma bulundu. Bebek çıkımında anne arter kan gazında baz açığı propofol grubunda Grup tiyopentalden daha düşük bulundu. Bebek kord kanından alınan venöz kanda ise oksijen satürasyonu propofol grubunda tiyopental grubundan daha düşük bulundu. Sonuç: Sezaryende, propofol ve tiyopental, benzer hemodinamik ve klinik etkilere sahip, oksidatif stres ve antioksidan mekanizmaları olumlu etkileyebilen iki ilaçtır. Sezaryende, oksidatif stres ve antioksidan savunma mekanizmaları açısından genel anestezi indüksiyonunda her iki ilaçta güvenle kullanılabilir.

The effect of propofol and thiopental on maternal and fetal oxidative stress parameters in cesarean section

Aim: In this study, we aimed to compare the effects of propofol and thiopental as induction agents, on oxidative stress in elective cesarean section (C/S) under general anesthesia. Method: Fourty patients scheduled to undergo C/S under general anesthesia were enrolled in this study. There were 19 patients in propofol group and 21 patients in thiopental group. General anesthesia was maintained with sevoflurane in both groups. Intra- operative hemodynamic data, peripheral oxygen saturations, anesthesia and surgery duration and delivery times were recorded. Blood samples were collected at the baseline and delivery and also umbilical cord blood samples were collected. MDA, MPO, Nox, nitrite as oxidative stress markers and SOD as a marker of antioxidant capacity were studied. At the time of delivery fetal venous blood gas sample from umbilical cord and arterial blood gas sample from mother was collected. Results: There were no statistically significant differences between groups in demographic and, hemodynamic data, peripheral oxygen saturations, and, anesthesia and surgery duration and delivery times and 1. and 5. minute Apgar scores. In thiopental group MPO levels decreased after induction compared to baseline levels. There were no statistically significant differences in baseline values between groups but after the induction SOD values increased in thiopenthal group. In umbilical cord blood samples, NOx and nitrite levels were significantly lower in propofol group. Base excess was significantly lower in propofol group in ABG. Oxygen saturation is statistically significant lower in propofol group in cord blood gas evaluation there were no statistically significant differences in other parameters. Conclusion: Propofol and thiopental are two agents which both have similar hemodynamic effects and positive consequences on oxidative stress and antioxidant mechanisms in newborns and pregnant woman whom have restricted antioxidant capacity. Both drugs might be confidently used in general anesthesia induction in cesarean section considering oxidative stress and antioxidant mechanisms.

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