Çiğdem YILDIRIM GÜÇLÜ, Başak Ceyda MEÇO, Süheyla KARADAĞ ERKOÇ, Volkan BAYTAŞ, Ali Abbas YILMAZ, Hanife Asuman UYSALEL

Lokal Anestezik Dozun Azaltılması, Tek Doz Spinal Anestezi ile C/S Uygulamasında Obez Gebelerde Maternal Hipotansiyonu Önlerken Cerrahi Anestezi Sağlar Mı?

Amaç: Gebe hastalarda anestezi, iki sağlıklı insanı (anne ve bebek) etkilediği için dikkat gerektirmektedir. Genellikle rejyonel anestezi tercih edilse de, genel ve rejyonel anestezi birer seçenekdir. Maternal hipotansiyonu önlemek anestezi sırasında önemlidir ve bu komplikasyonu önlemede lokal anestezik dozunu azaltmak bir yöntemdir. Bu çalışma, obez gebelerde düşük doz rejimin, maternal hipotansiyonu önlerken cerrahi anestezi sağlayıp sağlamadığını değerlendirmek için planlanmıştır. Gereç ve Yöntem: Bilgilendirilmiş onam alınan 130 hasta, vücut kitle indekslerine göre dört gruba randomize edildi ve hastalara spinal anestezi için 10 mg hiperbarik bupivakain veya 7,5 mg hiperbarik bupivakain+25 mcg fentanil uygulandı. Spinal anesteziden sonra hipotansiyon, ek anestezik ihtiyacı, rejyonel anestezideki teknik zorluk, Bromage skala skoru, cerrahi süre ve postoperatif analjezik gereksinimler kaydedildi. Komplikasyonlar ve Apgar skorları da kaydedildi. Bulgular: Genel anestezi, başarısız spinal anestezi nedeniyle sadece grup II’deki iki hastaya uygulandı. Hemodinamik parametreler gruplar arasında farklılık göstermedi. Motor bloğun düzelmesinde gruplar arasında fark olmadığı (p=0,235), ancak postoperatif analjezi süresinde farklılık olduğu görüldü (p=0,00). Sonuç: Obez gebelerde lokal anestezik dozunu azaltmak, obez olmayan hastalarda spinal anestezi ile karşılaştırıldığında hipotansiyonda anlamlı farklılıklara yol açmaz. Bir opioid eklemek, ameliyat sonrası ağrı kontrolünü iyileştirebilir. Düşük dozda lokal anestezik ile birlikte opioid uygulaması obez gebelerde sezaryen için cerrahi anestezi de sağlayabilir.

Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?

Objectives: Anesthesia for pregnant patients requires attention because it affects two healthy people: the mother and the baby. Both general andregional anesthesia are options, although regional anesthesia is generally favored. Avoiding maternal hypotension is an important issue duringregional anesthesia, and lowering the dose of local anesthetic is one method for this complication. This study was designed to assessment whethera low-dose regimen provides surgical anesthesia in obese pregnant patients while avoiding maternal hypotension.Materials and Methods: After informed consent was received from 130 patients, they were randomized to four groups according to their bodymass index and received 10 mg hyperbaric bupivacaine or 7.5 mg hyperbaric bupivacaine+25 mcg fentanyl for spinal anesthesia. Hypotension afterspinal anesthesia, need for additional anesthetic, technical difficulty with regional anesthesia, Bromage scale score, surgery time, and postoperativeanalgesic requirements were recorded. Complications and Apgar scores were also recorded.Results: General anesthesia was administered only to two patients in group II because of ineffective spinal anesthesia. The hemodynamic parametersdid not differ among the groups. The analysis revealed no difference among groups in recovery from motor block (p=0.235), but the groups differedin the duration of postoperative analgesia (p=0.00).Conclusion: Reducing the local anesthetic dose for obese pregnant patients does not lead to significant differences in hypotension compared withspinal anesthesia in non-obese patients. Adding an opioid may also improve postoperative pain control. Even a low dose of local anesthetic withopioid can maintain surgical anesthesia for cesarean section in obese pregnant patients.

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