Gülçin AYDIN, OKTAY AYDIN, Işın GENÇAY, Faruk PEHLİVANLI, Selim ÇOLAK, Ünase BÜYÜKKOÇAK

SPİNAL ANESTEZİDE PREHİDRASYON SEREBRAL OKSİJENASYONU ETKİLER Mİ?

Amaç: Bu çalışmanın amacı spinal anestezi öncesi intravenöz yoldan uygulanan kristaloid ve kolloid sıvıların serebral oksijenasyona etkisini araştırmaktır.Gereç ve Yöntemler: Çalışmaya 18-50 yaş arası, spinal anestezi altında opere olacak, Amerikan Anestezistler Derneği I risk grubunda, 75 hasta dahil edildi. Standart monitörizasyon sonrası hastalar 3 gruba ayrıldı. G1; spinal anestezi öncesinde%4 Gelatine Polysuccinate solüsyonu ile iv prehidrasyon, G2; spinal anestezi öncesinde Ringer Laktat solüsyonu ile iv prehidrasyon, G3; prehidrasyon uygulanmayan grup idi. Spinal anesteziden sonra bütün hastalara operasyon boyunca sıvı idamesi 5 ml/kg/saat dozunda iv Ringer Laktat ile sağlandı. Sistolik kan basıncının ≤90 mmHg olması ya da başlangıca göre%20 ‘lik düşme hipotansiyon olarak kabul edildi. Operasyon süresince 5 dakika ara ile hemodinamik parametrelerdeki değişiklikler, bulantı-kusma, titreme komplikasyonları kaydedildi. Serebral oksijenizasyon için bilateral Near Infrared Spectroscopy monitörizasyonu yapıldı. Bulgular: Spinal anestezi öncesi intravenous prehidrasyonun bulantı ve kusma yan etkisini anlamlı olarak azalttığı görülürken (p<0.05), G1’de titreme bulguları anlamlı olarak az idi (p<0,05). G 3’te 15 hastada (%60) efedrin kullanılırken, intravenous prehidrasyonun efedrin ihtiyacını anlamlı olarak azalttığı görüldü (p<0.05). Operasyon süresi uzadıkça her üç grupta da serebral oksijenizasyonda anlamlı düzeyde azalma görülürken sağ ve sol lob beyin oksijenlenmesi açısından gruplar arası fark görülmedi. Operasyon süresi uzadıkça her üç grupta da SAB, DAB, OAB değerlerinde anlamlı düzeyde azalma olduğu görülürken, gruplar arası karşılaştırmada anlamlı fark yoktu. Sonuç: Spinal anestezide, serebral oksijenizasyonun devamı için kolloid ya da kristaloid kullanımı arasında fark olmamakla beraber hidrasyon yapılmayan grupta efedrin kullanımı artırılarak benzer hemodinamik stabilite sağlanmakta ve beyin oksijenlenmesi korunmaktadır.

Anahtar Kelimeler:

Serebral oksijenasyon, spinal anestezi, prehidrasyon

Does Prehydration in Spinal Anaesthesia Affect Oxygenation?

Objective: The aim of this study is to investigate the effect of routine administration of intravenous cristalloid and colloid fluids on subarachnoid block induced hypotension and cerebral oxygenization.Material and Methods: Seventyfive, 18-50 years old, ASA I patients that were scheduled for operation under spinal anesthesia were enrolled into the study. Patients were divided into 3 groups after standard monitoring. G1; intravenous prehydration with 4%Gelatine Polysuccinate before spinal anesthesia, G2; intravenous prehydration with Ringers Lactate s before spinal anesthesia, G3; no prehydration group.After spinal anesthesia, fluid maintenance was provided with intravenous Ringer Lactate at a dose of 5 ml/kg/h in all patients. Systolic blood pressure levels under 90 mmHg or 20%decrease from the baseline was accepted as hypotension. Complications such as changes in haemodynamic parameters, nausea, vomiting and shivering were recorded with an interval of 5 minutes during the operation. Bilateral Near Infrared Spectroscopy monitoring was performed for cerebral oxygenation. Results: It was observed that intravenous prehydration significantly decreased the nausea and vomiting before spinal anesthesia (p<0.05), whereas in G1 shivering was significantly less (p<0.05). While ephedrine was used in 15 patients (60%) in G3, it was observed that intravenous prehydration decreased ephedrine need significantly (p<0.05). As the operation time increased, cerebral oxygenation was significantly decreased in all three groups and there was no difference between groups in terms of right and left lobe brain oxygenation. There was a significant decrease in SAP, DAP and MAP values in all three groups as the operation time increased, but there was no significant difference between the groups. Conclusion: Although there is no difference between the use of colloid or crystalloid solutions in terms of persistence of cerebral oxygenation under spinal anesthesia, the use of ephedrine in the non-hydrated group provides similar hemodynamic stability and the brain oxygenation is maintained.

Keywords:

Cerebral oxygenation, spinal anesthesia, prehydration,

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1. Andrews WW, Ramin SM, Maberry MC, Shearer V, Black S, Wallace DH. Effect of type of anesthesia on blood loss at elective repeat cesarean section. Am J Perinatol. 1992;9(3):197-200. Doi:10.1055/s-2007-999320.
2. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000;84(4):450-5.
3. Ceruti S, Anselmi L, Minotti B, Franceschini D, Aguirre J, Borgeat A et al. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth. 2018;120(1):101-8. Doi: 10.1016/j.bja.2017.08.001.
4. Cuvas O, Er AE, Ongen E, Basar H. Spinal anesthesia for transurethral resection operations. Bupivacaine versus levobupivacaine. MinervaAnestesiol. 2008;74(12):697-701.
5. Ni HF, Liu HY, Zhang J, Peng K, Ji FH. Crystalloid coload reduced the incidence of hypotension in spinal anesthesia forces are andelivery, when compared to crystalloid preload: A Meta-Analysis. Biomed Res Int. 2017;3462529. Doi:10.1155/2017/3462529 (Epub 2017 Dec 17).
6. Tawfik MM, Tarbay AI, Elaidy AM, Awad KA, Ezz HM, Tolba MA. Combined colloid preload and crystalloid coload versus crystalloid coload during spinal anesthesia forces are andelivery: a randomized controlled trial. Anesth Analg. 2019;128(2):304-312 Doi:10.1213/ANE.0000000000003306.
7. Practice guidelines for obstetric anesthesia: an updated report by the american society of anesthesiologists task force on obstetric anesthesia and the society for obstetric anesthesia and perinatology. Anesthesiology. 2016;124(2):270-300. Doi:10.1097/ALN.0000000000000935.
8. Hahn RG. Volume kinetics for infusion fluids. Anesthesiology. 2010;113(2):470-81. Doi:10.1097/ALN.0b013e3181dcd88f.
9. Westphal M, James MF, Kozek-Langenecker S, Stocker R, Guidet B, Van Aken H. Hydroxyethyl starches: different products–different effects. Anesthesiology. 2009;111(1):187-202. Doi:10.1097/ALN.0b013e3181a7ec82.
10. Saghafinia M, Jalali A, Eskandari M, Eskandari N, Lak M. TheEffects of hydroxyethylstarch 6% and crystalloid on volume preloading changes following spinal anesthesia. Adv Biomed Res. 2017;21;6:115. Doi:10.4103/abr.abr_151_16. eCollection 2017.
11. Bottiger BA, Bezinover DS, MetsB, Dalal PG, Prozesky J, Ural S et al. Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference? J Anaesthesiol Clin Pharmacol. 2016;32(3):319-24. Doi:10.4103/0970-9185.168159.
12. Sun S, Liu NH, Huang SQ. Role of cerebral oxygenation for prediction of hypotension after spinal anesthesia for caesarean section. J Clin Monit Comput. 2016;30(4):417-21. Doi:10.1007/s10877-015-9733-4 (Epub 2015 Jul 18).
13. Çelik EC, Çiftçi B. Serebral oksimetre ve anestezi altında uygulama alanları. İst Tıp Fak Derg. 2018;81(1):33-6.
14. Madsen PL, Secher NH. Near-infrared oximetry of the brain. Prog Neurobiol. 1999;58(6):541-60.
15. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007;11(4):274-81. Doi:10.1177/1089253207311685.
16. Akçay L, Soyalp C, Yüzkat N, Gülhaş N. A comparison of the effects of desflurane and sevoflurane on cerebral oxygen saturation in patients undergoing thyroidectomy: a randomized controlled clinical study. Turk J Anaesthesiol Reanim. 2019; Doi:10.5152/TJAR.2019.23911.