Işıl TURAN ÖZKOÇAK, İnan İlker ARIKAN, Hilal AYOĞLU, Bülent Serhan YURTLU, Rahşan Dilek OKYAY, Gülay KAYHAN ERDOĞAN, Volkan HANCI, Sedat HAKİMOĞLU, Ülkü BAYAR, Selime Evrim BOSTANKOLU

Hipotansiyon insidansı üzerine etkiler: sezaryen için spinal anestezide hiperbarik, isobarik bupivakain ve kombinasyonları

Amaç: Sezaryen için spinal anestezide hipotansiyon yaygındır. Bu çalışma sezaryende hipotansiyon sıklığının hiperbarik,isobarik bupivakain veya bunların ardışık uygulanması ile değişip değişmediğini araştırmak üzere planlanmıştır.Yöntem ve gereç: Spinal anestezi ile sezaryen operasyonu geçirecek 144 hasta randomize olarak dört gruba ayrıldı.Spinal anestezi H10 grubunda 10 mg hiperbarik bupivakainle, Grup H5P5’de ardışık 5 mg hiperbarik ve isobarikbupivakain uygulanmasıyla, Grup P5H5’de ardışık 5 mg isobarik hiperbarik ve isobarik bupivakain uygulanmasıylave P10 grubunda 10 mg isobarik bupivakainle gerçekleştirildi. Hemodinamik parametreler, hipotansiyon, bradikardiinsidansı ve hipotansiyonu tedavi etmek için gereken efedrin miktarı kaydedildi. Fetal Apgar, umblikal kord kan pH’sıve yan etkiler de not edildi.Bulgular: ASA risk grubu, cerrahi süre ve demografi k veriler gruplar arasında benzerdi. Hipotansiyon insidansı H10,H5P5, P10 ve P5H5 gruplarında sırasıyla % 69,4, % 66,7, % 75,0 ve % 83,3 olarak bulundu. Hipotansiyon insidansıistatistiksel olarak farklı değildi. Gruplar arasındaki bradikardi insidansı, efedrin tüketimi, kord kan pH’sı ve yan etkilerde farklı değildi.Sonuç: Lokal anestezik dozu aynı olduğunda, sezaryen operasyonu için spinal anestezide, spinale bağlı hipotansiyoninsidansı bupivakainin hiperbarik, isobarik veya yarı dozda ardışık uygulanması ile düşürülemez.

Anahtar Kelimeler:

Barisite, bupivakain, spinal anestezi, sezeryan

Eff ects on hypotension incidence: hyperbaric, isobaric, and combinations of bupivacaine for spinal anesthesia in cesarean section

To determine if hypotension frequency changes when hyperbaric or isobaric formulations of bupivacaine, or their sequential administrations, are used for cesarean section. Hypotension after spinal anesthesia for cesarean section is common. Materials and methods: A total of 144 patients who were to undergo cesarean section with spinal anesthesia were allocated into 4 groups. Spinal anesthesia was achieved with 10 mg of hyperbaric bupivacaine in Group H10, sequential 5-mg administrations of hyperbaric and isobaric bupivacaine in Group H5P5, sequential 5-mg administrations of isobaric and hyperbaric bupivacaine in Group P5H5, and 10 mg of isobaric bupivacaine in Group P10. Hemodynamic parameters were determined and the incidence of hypotension, incidence of bradycardia, and amount of ephedrine required to treat hypotension were recorded. Fetal Apgar scores, the pH of the umbilical cord blood, and side effects were also noted. Results: American Society of Anesthesiologists risk group, surgical duration, and demographic values were similar among the groups. The incidence of hypotension was found to be 69.4%, 66.7%, 75.0%, and 83.3% in the H10, H5P5, P10, and P5H5 groups, respectively. The incidences of hypotension were not significantly different. Bradycardia incidence, ephedrine consumption, the pH of cord blood, and side effects were not different among the groups. Conclusion: When the dose of local anesthetic is the same, the incidence of spinal-induced hypotension cannot be lowered using hyperbaric, isobaric, or sequential injections of a half dose of bupivacaine for spinal anesthesia during cesarean section.

Keywords:

Key words: Baricity, bupivacaine, spinal anesthesia, cesarean section,

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