A. SARGIN, S. KARAMAN, N. KILINÇ, İ. GÜNÜŞEN, A. AKDEMİR

Sezaryen uygulanan trombositopenik gebelerde anestezi yöntemlerinin retrospektif incelenmesi

Amaç: Rejyonal blok açısından gebelerde güvenli en düşük trombosit düzeyi konusunda araştırmalar sürmektedir. Amacımız, trombositopenik gebelerde sezaryende kullanılan anestezi yöntemlerini retrospektif olarak değerlen- dirmektir. Gereç ve Yöntem: 2006-2011 tarihleri arasında sezaryen uygulanan trombositopenik gebelerin kayıtları retrospektif olarak incelendi. Bu 51 hastanın gebelik yaşı, gebelik haftası, gebelik sayısı, paritesi, sezaryen tipi, obstetrik ek hastalıkları kaydedildi. Ayrıca preoperatif ve postoperatif dönemde hemoglobin, hematokrit, trombosit düzeyleri, koagülasyon parametreleri, steroid ve/veya intravenöz immunglobulin (IVIG) kullanımı, kan ve/veya trombosit replasman tedavisi, uygulanan anestezi yöntemi ve postoperatif dönemde görülen komplikasyonlarla ilgili bilgiler toplandı. Bulgular: Çalışmaya dahil edilen 51 trombositopenik gebe sezaryenle 51 sağlıklı bebek doğurdu. Yapılan sezaryen operasyonlarının %52,9u elektif, %47,1i acil olarak yapıldı. Trombositopeni başlama zamanı, hastaların 3ünde (%5,9) pregestasyonel dönemde, 4ünde (%7,8) 1. trimesterde, 1inde (%2) 2. trimesterde ve 43ünde (%84,3) 3.trimesterde tespit edildi. Sezaryen uygulanan 51 kadının %78,4üne genel anestezi %21,6sına spinal anestezi uygulanmıştı. Spinal uygulanan hastalarda preoperatif en düşük trombosit değeri 87,000 μL-1 iken genel anestezi uygulananlarda bu değer 24,000 μL-1/ idi. Sonuç: Ciddi trombositopenisi olan gebelerde yakın izlem ile rejyonal anestezinin güvenle uygulanabilecek bir yöntem olduğunu düşünmekteyiz. Ancak, doğuma hazırlık sürecinde en uygun anestezi yöntemi konusunda kararlar anestezist, obstetrisyen ve hematoloğun olduğu multidisipliner bir ekip tarafından alınmalıdır.

Retrospective analysis of anesthesia procedures of pregnant women with thrombocytopenia during cesarean section

Aim: Studies investigating a minimum safe platelet level for regional block are on going. Our aim is to evaluate methods of anesthesia and limits of regional anesthesia practice of pregnant patients with a history of thrombocytopenia under going cesarean section. Materials and Methods: The data of pregnant patients with thrombocytopenia under going cesarean section between 2006-2011, were analyzed retrospectively. The data of 51 patients, including maternal age at delivery, gestational age at delivery, gravidity, parity, nature of cesarean, and obstetric additional diseases were recorded. Also, information including hemoglobin, hematocrite, platelet levels, coagulation parameters, steroid or IVIG use, blood and/or thrombocyte placement treatment during preoperative and postoperative period, the method of anesthesia and postoperative complications were collected. Results: In the study, a total number of 51 pregnant women with thrombocytopenia gave birth to 51 healthy babies by cesarean delivery. Elective and emergency cesareans comprised 52.9% and of 47.1% all cesareans, respectively. The onset time of thrombocytopenia among the 51 cases, i.e, 3 cases (5.9%), 4 cases (7.8%), 1 case (2%), 43 cases (84.3%) of thrombocytopenia were detected in the pregestational time, first, second and third trimester, respectively. Of these 51 pregnant patients, 78.4% and 21.6% of received general anesthesia or spinal anesthesia, respectively. -1 -1The lowest platelet count for spinal anesthesia was 87,000μL comparing to the level of 24,000μL for general anaesthesia during the preoperative period. Conclusion: We suggest that regional anestesia may be a safe method with careful monitoring for pregnant patients with severe trombocytopenia. However, decisions on the safest method of anesthesia in preparation for delivery should be made with a multidisciplinary team involving the obstetrician, hematologist, and anesthesiologist.

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