Spinal anestezi uygulanan sezaryen operasyonlarında kristaloid ve kolloid solüsyonları ile volüm önyüklemesinin etkinliklerinin karşılaştırılması

Amaç: Çalışmamızda; sezaryen operasyonlarında spinal anestezi öncesi kristaloid ve kolloid ile volüm önyüklemesinin maternal ve yenidoğandaki etkilerinin karşılaştırılması amaçlandı. Yöntem: Hastanemiz Etik Kurul onayıyla elektif sezaryen operasyonu planlanan, ASA I-II grubundan 80 olgu çalışmaya dahil edildi. Olgularda Grup Ide %5 dektroz/ringer laktat, Grup IIde %6 HES 10 mL kg-1 olarak uygulandıktan sonra, spinal anestezi lateral pozisyonda, L3-4 veya L2-3 seviyesinden 1.8 mL %0.5 hiperbarik bupivakain ve 20 μg fentanil kombinasyonu ile gerçekleştirildi. Hemodinamik parametreler spinal blok öncesinde ve blok uygulandıktan sonraki ilk 15 dk. da 1er dk. lık, 15-30 dk arasında 2şer dk. lık ve devamında operasyon bitimine kadar 5er dk. lık aralıklarla kaydedildi. Hipotansiyon oluşması durumunda efedrin bolus dozlarıyla tedavi edilmesi planlandı. Hipotansiyon oluşumu, kullanılan efedrin miktarı, annede oluşan semptomlar, umblikal kord kan gazı değerleri ve APGAR skorları kaydedildi. Bulgular: Gruplar arası karşılaştırmada; kan basıncı değerleri benzer, kalp atım hızı değerleri spinal anestezi sonrası 1. ve 2. dk. larda Grup Ide Grup IIye göre istatistiksel olarak anlamlı seviyede düşüktü. Hipotansiyon insidansı, efedrin kullanımı, bulantı-kusma insidansı, umblikal arter kan gazı değerleri ile APGAR skorları gruplar arasında benzerdi. Sonuç: Çalışmamızda; sezaryen operasyonlarında spinal anesteziye bağlı hipotansiyonu önlemede volüm önyüklemesinde kullanılan kristaloid ve kolloid solüsyonların etkinlik ve yenidoğanda oluşturdukları etkileri bakımından benzer olduklarını sonucuna vardık.

Comparison of the effectiveness of volum preloading with crystalloid and colloid solutions in caesarean section operations under spinal anaesthesia

Introduction: In our study we aimed to compare the effects of preloading with either crystalloid and colloid solutions on parturient and newborn in caesarean section operations under spinal anaesthesia. Method: After the approval from Ethics Committee of our hospital 80 parturients in ASA I-II group undergoing elective caesarean section were enrolled the study. Spinal anaesthesia was induced with 1.8 mL 0.5% hyperbaric bupivacaine and 20 μg fentanyl combination from L3-4 or L2-3 intervertebral space in lateral position, after the patients received 10 mL kg-1 either 5% dextrose/ ringer lactate solution in Group I or 6% HES solution in Group II before the procedure. Haemodynamic parameters were recorded before the spinal block and with 1 min intervals for the first 15 min, with 2 min intervals in 15-30 min and 5 min intervals until the end of the operation. Hypotension was planned to treat with 5 mg of bolus dose of ephedrine. Incidence of hypotension, ephedrine consumption, maternal symptoms, umblical cord blood gase analyses and APGAR values were recorded. Results: Blood pressure values were similar between the groups and HR values were statistically lower in Group I compared to Group II after spinal anaesthesia and at 1. and 2. min. Incidence of hypotension, ephedrine consumption, incidence of nausea and vomiting, umblical arterial blood gas analyses, APGAR scores at 1. and 5. min were similar between the groups. Conclusion: We conclude that; the efficiency in prevention of spinal induced hypotension and the effects on newborn of volume preloading with either crystalloid or colloid solutions were similar in caesarean section.

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