Ahmet KAYA, Alev ESERCAN, Mehmet TERCAN, Mahmut Alp KARAHAN

Covid 19 Tanılı Gebe Hastalara Genel Yaklaşım: Sezaryende Anestezi Deneyimlerimiz

Ülkemizi ve tüm dünyayı etkisi altına alan Covid-19 pandemisi döneminde ötelenemeyen cerrahi prosedürler arasında yer alan sezaryen operasyonunda anestezik yaklaşım ve olası yoğun bakım süreci nitelikli bakım gerektirmektedir . Gebe kadınlar, modüle edilmiş bağışıklık ve kardiyopulmoner sistemleri nedeniyle solunum yolu patojenlerine ve şiddetli pnömoniye karşı özellikle savunmasız olabilirler. Viral pnömoni, küresel olarak gebelik ölümlerinin önde gelen nedenlerinden biridir. Hücre aracılı bağışıklıktaki değişiklikler, bu duyarlılıkta merkezi bir rol oynar, çünkü bu, hamile kadının allojenik fetüse karşı toleranslı kalmasını sağlar, ancak virüsler gibi hücre içi patojenlere karşı savunma yeteneğini azaltır. Ayrıca gebelik sırasında kardiyopulmoner sistemlerde meydana gelen oksijen tüketiminde artış, toplam akciğer hacimlerinde azalma, gebe uterusa bağlı diyafram yükselmesi, üst solunum yollarında mukozal ödem ve sekresyonlarda artışa yol açan vazodilatasyon gibi fizyolojik değişiklikler, hamile kadının hipoksiye karşı daha savunmasız olmasına neden olmaktadır. Tüm bu özellikler düşünüldüğünde Covid-19 pozitif tanılı gebe hastaların sezaryen anestezisinin tipi ve yönetiminin önemi ön plana çıkmaktadır. Çalışmamızda COVID-19 tanılı gebelerde sezaryen anestezisi deneyimlerimizi, uygulanan anestezi yöntemlerinin ve olası yoğun bakım süreçlerinin maternofetal sonuçlara etkilerini görmek istemekteyiz.

Anahtar Kelimeler:

Covid, anestezi, sezaryen

General Approach to Pregnant Patients Diagnosed with Covid 19: Our Experiences about Anesthesia in Cesarean Section

Background: Pregnancy increases susceptibility to respiratory complications of viral diseases. Managing obstetric emergencies in the Covid-19 pandemic poses a challenge as timely care and intervention are needed to save the life of mother and baby. This study aims to evaluate our anesthesia practices in pregnant women with Covid-19 undergoing cesarean section. Materials and Methods: A total of 69 patients who under went cesarean section and had positive Polymerase Chain Reaction (PCR) testing for Covid-19 with nasopharyngeal swabs were included in the study. Patient demog-raphics and information about anesthesia were analyzed retrospectively from the patient medical files. Results: A total of 69 parturients undergoing cesarean section that had positive SARS-CoV-2 PCR tests were assessed. General anesthesia was applied to only one patients ,while spinal anesthesia was administered to there maining 68 patients . While the rate of pneumonia in symptomatic patients was %31,88 (22/69) parturients. Twelve Covid-19 patients required intensive care in the perioperative period. The overall mortality rate was 8,69 % (6/69) among parturients with Covid-19 undergoing cesarean section. Conclusions: It was observed that Covid-19 is associated with mortality in pregnant women undergoing cesarean section. Spinal anesthesia was safely and effectively administered in Covid-19 parturients, especially in patients with pneumonia. Key Words: Anesthesia, Cesarean Section, Covid-19

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