Spinal anesteziye bağlı hipotansiyonun önlenmesi: Anestezi öncesi kolloid ve kristaloid ön yüklemesinin prehidrasyon uygulanmayan grupla karşılaştırılması

Spinal anestezinin indüklediği hipotansiyondan korunmak için prehidrasyon pratikte rutin olarak uygulanmaktadır. Ancak son dönemde prehidrasyonun gerekli olup olmadığı veya hangi solüsyonların seçilmesi gerektiği konusunda çelişkili sonuçlar bildirilmiştir. Çalışmamızda elektif ortopedik cerrahi hasta grubunda spinal anestezi öncesi kolloid veya kristaloid prehidrasyonu ile prehidrasyon uygulanmayan grubun hipotansiyon sıklığını ve vazopressör desteğe olan ihtiyacını araştırmayı planladık.ASA 1, 2 grubu 60 hasta çalışmaya dahil oldu. Olgulara randomize olarak spinal anestezi öncesi 10 dakikada gidecek şekilde 500 mL %6 HES, 500 mL modifiye jelatin veya 1000 mL ringer laktat solüsyonu uygulandı. Kontrol grubuna da prehidrasyon uygulanmadı. Hipotansiyon bazal değerden %30 azalma veya sistolik arter basıncının

Anahtar Kelimeler:

Anestezi, spinal, Kolloidler, Rehidratasyon solüsyonları, Hipotansiyon

Prevention of hypotension during spinal anesthesia: Comparison between preanesthetic administration of colloids, crystalloids, and no prehydration

The practice of routinely prehydrating patients for prevention of spinal anesthesia-induced hypotension has been challenged recently. The type of the solution (colloid or crystalloid) for using routine prehydration is also controversial. We compared the incidence of hypotension and vasopressor therapy during spinal anesthesia without prehydration or prehydration with crystalloid and colloid solutions in elective orthopedic surgery. Sixty ASA grade I or II patients were enrolled in the study. They were randomized to receive 500 mL 6% HES, 500 mL modified gelatin, or 1000 mL lactated ringer’s solution over 10 min prior to spinal anesthesia. Control group did not have prehydration. Hypotension was defined as a 30 % decrease of systolic blood pressure from baseline or systolic pressure detected <90 mmHg and was treated with ephedrine 5 mg boluses. Hemodynamic measurements after spinal anesthesia remained stable in prehydration groups than control. The incidence of hypotension and total dose of ephedrine use were significantly lower in colloid groups than control. Our study show that, prehydration is valuable for prevention of spinal anesthesia induced hypotension. Moreover, colloid solutions are more effective than crystalloids for minimizing the hemodynamic responses to spinal anesthesia.

Keywords:

Anesthesia, Spinal, Colloids, Rehydration Solutions, Hypotension,

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