A.Kadir But, Erdoğan Öztürk, Nurçin Gülhaş, Mahmut Durmuş, Zafer Doğan, M.Özcan Ersoy

Elektif Sezaryenlerde İntratekal Bupivakaine İlave Edilen Fentanil ve Morfinin Efedrin Gereksinimi ve Fetusa Etkisi

Amaç: Bu çalışmada elektif sezaryenlerde intratekal bupivakaine ilave edilen fentanil ve morfinin, efedrin gereksinimine ve fetus üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Elektif sezaryen planlanan 54 olgu çalışmaya alındı ve tüm olgulara laktatlı ringer; anestezi öncesi 10-12 mL kg-1 ve operasyon süresince 8-10 mL kg sa-1 verildi. Grup I (n=18)'de 2 mL %0.5 bupivakain, Grup II (n=18)'de 1.5 mL %0.5 bupivakain + 0.5 mL'de 25 μg fentanil ve Grup III (n=18)'te 1.5 mL %0.5 bupivakain + 0.5 mL'de 0.1 mg morfin kullanılarak spinal anestezi uygulandı. Spinal anestezi sonrası 5 mg bolus efedrini takiben operasyon süresince kan basıncı, giriş sistolik arter basıncı değerinin %80-110'ları olacak şekilde efedrin infüzyonu uygulandı. Bulgular: Operasyon süresince grupların total efedrin ihtiyacı Grup I'de 58.4±25.4 mg, Grup II'de 46.3±22.3 mg ve Grup III'te 38.6±16.3 mg idi. Kullanılan total efedrin miktarı Grup III'te Grup I'e göre anlamlı olarak düşük bulundu (p<0.05). Fetal umblikal pH, Grup I'de Grup III'e göre daha düşük tespit edildi (p<0.05) Sonuç: Spinal anestezi uygulanmış elektif sezaryenlerde, bupivakain ile morfin kombinasyonunun, bupivakainin tek başına kullanımına göre daha az dozda efedrin ile aynı hemodinamik koşulları sağladığı kanısına varıldı. Anahtar kelimeler: Sezaryen, Bupivakain, Fentanil, Morfin, Efedrin

Anahtar Kelimeler:

Sezaryen, Bupivakain, Fentanil, Morfin, Efedrin

The Effects of Intrathecal Bupivacaine-Fentanyl and Bupivacaine-Morphine on Ephedrine Requirements and Health Status of Fetus in Elective Cesarean Section.

Objectives: In this study, we aimed to compare the effects of intrathecal bupivacaine-fentanyl and bupivacainemorphine on ephedrine requirements and on health status of fetus. Methods: We enrolled 54 cases undergoing elective cesarean section in this study. Ringer's lactate was infused to all patients at a rate of 10-12 mL kg-1 preoperatively and 8-10 mL kg hr-1 during operation. Spinal anesthesia was achieved with 2 mL of bupivacaine %0.5 in Group I (n=18), with 1.5 mL of bupivacaine %0.5 + 0.5 mL fentanyl, 25 μg, in Group II (n=18) and with 1.5 mL of bupivacaine %0.5 + 0.5 mL morphine, 0.1 mg, in Group III (n=18). After spinal anesthesia, ephedrine infusion was given following a bolus dose of 5 mg ephedrine, to maintain arterial pressure during the operation at the level of 80-110% of the basal value. Results: We found that total ephedrine requirements during operation was 58.4±25.4 mg in Group I, 46.3±22.3 mg in Group II and 38.6±16.3 mg in Group III. The total amount of ephedrine administered in Group III was found to be significantly lower than that in Group I (p<0.05). Umblical blood pH in Group I was detected lower than that in Group III (p<0.05). Conclusion: We concluded that; combination of bupivacaine+morphine with lower doses of ephedrine achieved the same hemodynamic states than bupivacaine alone in elective cesarean sections. Key words: Cesarean section, Bupivacaine, Fentanyl, Morphine, Efedrine

Keywords:

Cesarean section, Bupivacaine, Fentanyl, Morphine, Efedrine,

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