İlkben GÜNEŞEN, S. KARAMAN, F. AKERCAN, V. FIRAT

Elektif sezaryenlerde farklı anestezi yöntemlerinin yenidoğan üzerine etkileri: Retrospektif çalışma

Amaç: Sezaryende kullanılan anestezi yöntemlerinin yenidoğan üzerine olan etkileri ile ilgili yapılan bir çok çalışmaya rağmen araştırmalar halen devam etmektedir. Çalışmamızda, hastanemizde rutin sezaryen uygulamalarında kullanılan farklı anestezi tekniklerinin fetüs üzerine olan etkilerini retrospektif olarak inceledik. Yöntem ve Gereç: Ege Üniversitesi Tıp Fakültesi Hastanesi Kadın hastalıkları ve Doğum kliniğinde, 2007-2008 yılları arası 6 aylık dönemde primipar, ≥38 haftalık, tek gebeliği olan, elektif sezaryen uygulanan, ASA I sınıfına dahil 157 kadın retrospektif olarak incelendi. Demografik veriler, hemoglobin değerleri, cilt insizyonu-bebek çıkış zamanı, yenidoğanın Apgar skorları, umblikal kord arter-ven kan gazı değerleri, balon-valv-maske, entübasyon ve ilk 24 saat içindeki yoğun bakım gereksinimler kaydedildi. Bulgular: 157 olgunun %40.1'ne (n:63) spinal anestezi, %22.3'ne (n:35) genel anestezi ve %37.6'na (n:59) epidural anestezi uygulandığı görüldü. Demografik veriler, preoperatif hemoglobin değerleri ve gebelik haftaları açısından gruplar arasında fark saptanmazken, insizyon-bebek çıkış zamanı genel anestezi grubunda daha kısa bulundu. 5. dk Apgar skorları açısından gruplar benzer, 1. dk Apgar skoru ise genel anestezi grubunda anlamlı olarak düşüktü. Umblikal arter-ven kan gazı değerleri açısında gruplar arasında anlamlı bir farklılık yoktu. Doğum sonrası balon-valv-maske gereksinimi olan yenidoğan sayısı genel anestezi grubunda daha yüksek bulunurken, entübasyon ve yoğun bakım gereksinimleri açısından fark saptanmadı. Sonuç: Elektif sezaryenlerde üç anestezi yönteminin de geç dönemde birbirlerine üstünlükleri olmadığı, ancak fetal açıdan riskli gebelerde rejyonal yöntemlerin tercih edilmesinin daha uygun olacağı kanısına varıldı.

The effects of different anesthetic techniques on newborn in elective cesarean section: Retrospective study

Aim: Although there were several studies evaluating the effects of anesthetic techniques on fetuses during anesthesia for cesarean section, researches are still going on. In this study, we evaluated the effects of different anesthetic techniques on the fetuses in Ege University Hospital, retrospectivelly. Material and Methods: The study population consisted 157 women scheduled for elective cesarean section in our hospital at a period of six months between the years 2007-2008. Medical records of 157 women who were ASA 1 were evaluated. Medical records including demographic variables, hemoglobine concentrations, time interval between skin incision and delivery, Apgar scores, umbilical cord gas analyses, balloon- valve mask, entubation and needs for intensive care unit were recorded. Results: Spinal, epidural and general anesthesia were performed 63 (40.1%), 59 (37.6%) and, 35 women (22.3%), consequently. There were no differences between the groups according to the demographic datas, preoperative hemoglobin concentrations and gestational weeks. Time interval between skin incision and delivery was lower in general anesthesia group. While five minute Apgar scores were similar in both groups, 1 minute Apgar scores were significantly lower in general anesthesia group. There was no significant difference between the groups according to umbilical cord gas analyses, the number of newborns neccesiating entubation and neonatal intensive care unit. The number of newborns necessiating balloon- valve mask was higher in general anesthesia group. Conclusion: For elective cesarean section, although it was concluded that three anesthetic techniques had no advantages to each other in late period, for the pregnancies that fetuses were under risk, the choice of regional anesthesia was more convinience.

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1) McDonnell NJ, Paech MJ, Clavisi OM et al. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int J Obstet Anesth 2008;17:292-297
2) Kocamanoğlu IS, Sarıhasan B, Sener B et al. Methods and complications of Anesthesia in cesarean /section operations: Retrospective evaluations of 3552 cases. Turkiye Klinikleri J Med Sci 2005;25:810-816
3) Dahlgren G, Granath F, Pregner K et al. Colloid vs. crystalloid preloading to prevent maternal hypotension during spinal anesthesia for elective cesarean section. Acta Anaesthesiol Scand 2005;49:1200-1206
4) Gilstrap LC, Leveno KJ, Burris J et al. Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. Am J Obstet Gynecol 1989;161:825-830
5) Thorp JA, Sampson JE, Parisi VM, Creasy RK. Routine umblical cord blood gas determinations Am J Obstet Gynecol 1989;161:600-605
6) Desalu I, Kushimo OT. Is ephedrine infusion more effective at preventing hypotension than traditional prehydration during spinal anaesthesia for caesarean section in African parturients? Int J Obstet Anesth 2005;14:294-299
7) Blickstein I, Green T. Umblical cord blood gases. Clin Perinatol 2007;34:451-459
8) Suidan JS, Wasserman JF, Young BK. Placental contribution to lactate production by the human fetoplacental unit. Am J Perinatol 1984;1:306-309
9) Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput 2007;21:125-129
10) Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002;94:920-926
11) Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G. Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on the acid-base status of the mother and newborn. J Matern Fetal Neonatal Med 2003;13:260-266
12) Khoury AD, Moretti ML, Barton JR et al. Fetal blood sampling in patients undergoing elective cesarean section: a correlation with cord blood gas values obtained at delivery. Am J Obstet Gynecol 1991;165:1026-1029
13) Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anaesthesia for cesarean section. Anesthesiology 1982;56:68-70
14) Mueller MD, Brühwiler H, Schüpfer GK, Lüscher KP. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery. Obstet Gynecol 1997;90:131-134
15) Fong J, Gurewitsch ED, Press RA et al. Prevention of maternal hypotension by epidural administration of ephedrine sulfate during lumbar epidural anesthesia for cesarean section. Am J obstet Gynecol 1996;175:985-990
16) Albani A, Renghi A, Ciarlo M et al. Peridural anesthesia versus subarachnoid anesthesia in cesarean section. Prospective clinical study. Minerva Anestesiol 1998;64:387-391
17) Turkoz A, Togal T, Gokdeniz R et al. Effectiveness of intravenous ephedrine infusion during spinal anaesthesia for caesarean section based on maternal hypotension, neonatal acid-base status and lactate levels. Anaesth Intensive Care 2002;30 :316-320
18) Park GE, Hauch MA, Curlin Fet al. The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure. Anesth Analg 1996;83:299-303
19) Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput 2007;21:125-129
20) French GWG, White JB, Howell SJ, Popat M. Comparison of pentastarch and Hartmann's solution for volume preloading in spinal anaesthesia for elective caesarean section. Br J Anaesth 1999;83:475-477
21) Corke BC, Datta S, Ostheimer GW et al. Spinal anaesthesia for caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia 1982;37:658-662
22) Crawford JS, Burton M, Davies P. Anaesthesia for section: Further refinements of a technique. Br J Anaesth 1973:45;726-732
23) Datta S, Ostheimer GW, Weiss JB et al. Neonatal effects of prolonged anesthetic induction for cesarean section. Obstet Gynecol 1981;58:331-335
24) Li CH, Zhu CX, He J. Effects of general anesthesia for cesarean section on infants. Zhonghua Fu Chan Ke Za Zhi 2006;41:162-164
25) Dick W, Traub E, Kraus H et al. General anaesthesia versus epidural anaesthesia for primary caesarean section-a comparative study. Eur J Anaesthesiol 1992;9:15-21