SPİNAL ANESTEZİ YAPILAN SEZARYEN VAKALARINDA GÖBEK ÇEVRESİ VE COLUMNA VERTEBRALİS UZUNLUĞUNUN İNTRAOPERATİF HİPOTANSİYON İLE İLİŞKİSİ
Abstract
AMAÇ: Spinal anestezi uygulanan sezaryen operasyonlarında abdominal çevre ve columna vertebralis uzunluğunun intraoperatif hipotansiyon ile ilişkisini araştırmak amacı ile bu çalışmayı yaptık.
GEREÇ VE YÖNTEM: Bu çalışma, etik kurul onayı alındıktan sonra, prospektif gözlemsel bir çalışma olarak Gazi Yaşargil Eğitim ve Araştırma Hastanesi Kadın Doğum ek binasında yapıldı. 18 yaş ve üzeri spinal anestezi ile elektif sezaryen olan, ASA (Amerikan Anestezistler Derneği) I-II, boyu 150 cm üzerinde olan, term (37-42 hafta) tekil gebeliği olan hastalar çalışmaya dahil edildi. Yüksek riskli gebelikler (plasenta previa, abruptio plasenta, eklampsi, preeklampsi ), çoğul gebelik , kardiyovasküler hastalık dahil diğer sistemik hastalıklar ile ilgili ek hastalığı olan hastalar, spinal anestezi kontredikasyonu olan hastalar, çalışma dışı bırakılarak toplam 102 hasta çalışmaya dahil edildi. Hastalara ait isim-soy isim, protokol no, yaş, boy, kilo, body mass indeks (BMI), gebelik haftası, parite değerleri kaydedildikten sonra abdominal çevre, columna vertebralis uzunlukları ve symphsiofundal mesafe ölçüldü. Hastalar oturtularak L3-L4 interspinöz aralıktan 26 G – 27 G Quincke spinal iğne ile her hastaya standart 11 mgr Heavy Marcaine enjeksiyon hızı 1 mL/sn olacak şekilde yapıldı. İşlem sonrasında hastalar ameliyat masasına supin pozisyonda yatırdı ve ameliyat masası 10 derece sola deviye edildi. Kalp hızı, ortalama arteryel basınç ve saturasyon 1.dakika değerleri olarak kayıt edildi. Sonrasında 3. dakika , 5. dakika , 10. dakika, 15.dakika ve 30. dakika değerleri kaydedildi. Hastalarda duyusal blok muayenesi pinprick testi ile ve motor blok seviyeleri ise modifiye Bromage skorlaması ile değerlendirildi ve kaydedildi. Spinal anestezi öncesi ölçülen sistolik kan basıncı değerinden %30 düşme veya sistolik tansiyon değeri 90 mmHg altına düşmesi hipotansiyon olarak kabul edildi ve hipotansiyonu olan tüm hastalara eş zamanlı 10 mgr efedrin yapıldı. Cerrahi sonrasında yenidoğan APGAR skoru, yenidoğan kilosu, Bromage Skoru sıfır olana kadar geçen süre, duyu bloğu T10 a gerileyene kadar geçen süre, bulantı kusma varlığı kayıt edildi.
BULGULAR: Spinal anestezi sonrasında hastalarda columna vertebralis uzunluğu ile duyu blok seviyesi arasında anlamlı bir ilişki bulunmuştur. Columna vertebralis uzunluğu ile duyu blok seviyesinin T10’a gerileyene kadar geçen süre arasında anlamlı bir ilişki mevcuttur. Abdominal çevre ve symphsiofundal mesafe ile hipotansiyon arasında korelasyon olmadığı görülmüştür. Ancak abdominal çevre ile bulantı arasında anlamlı bir ilişki bulunmuştur.
SONUÇ: Spinal anestezi sonrası intraoperatif hipotansiyon ile alakalı birden çok mekanizma mevcuttur. Abdominal çevre ve columna vertebralis uzunluğu ölçülebilmesi ve öngörü sağlaması açısından önemli parametrelerdir.
References
- 1. J. F. Butterworth, D. C. Mackey, And J. D. Wasnick, Morgan And Mikhail’s Clinical Anesthesiology, 5. Edition. McGraw-Hill Lange Book, 2015.
- 2. D. Nag, D. Samaddar, … A. C.-W. J. of, and U. 2015, “Vasopressors in obstetric anesthesia: A current perspective,” 2015, [Accessed: Nov. 26, 2021] (Online) Available: https:// www.ncbi.nlm.nih.gov/pmc/articles/pmc4295220/.
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- 19. Y. G. Kang, E. Abouleish, and S. Caritis, “Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section,” Anesth. Analg., 61, 10, 839–842, 1982.
The Relatıonshıp Between Abdominal Cırcumference And Columna Vertebralıs Length Wıth Intraoperatıve Hypotensıon In Cesarean Cases Wıth Spınal Anesthesıa
Abstract
Abstract
Introduction: Most pregnant women develop varying degrees of abdominal hypertension due
to the enlarged uterus . Increased abdominal circumference and shorter columna vertebralis
length have been found to be associated with increased with increased abdominal pressure and
an enlarged uterus. We hypothesized that this was associated with the incidence of hypotension
after spinal anesthesia. We conducted this study to investigate the relationship between
abdominal circumference and columna vertebralis length and intraoperative hypotension in
cesarean section operations under spinal anesthesia.
Materials And Methods: This study was conducted in Gazi Yaşargil Training and Research
Hospital, Obstetrics and Gynecology annex building as a prospective observational study after
ethics committee approval. Patients who were 18 years of age or older, had elective cesarean
section under spinal anesthesia, had ASA (American Society of Anesthesiologists) I-II, were
over 150 cm tall, and had a term (37-42 weeks) singleton pregnancy were included in the study.
High-risk pregnancies (placenta previa, abruptio placenta, eclampsia, preeclampsia), multiple
pregnancies, patients with additional disease related to other systemic diseases including
cardiovascular disease, patients with spinal anesthesia contraindications, and a total of 102
patients were included in the study. Abdominal circumference, columna vertebralis lengths, and
symphysis-fundus distance were measured after the patients' name-surname, protocol number,
age, height, weight, body mass index, gestational week, and parity values were recorded. The
patients were seated and the standard 11 mg Heavy Marcaine injection rate was 1 mL/sec to
each patient with a 26 G – 27 G Quincke spinal needle through the L3-L4 interspinous space.
After the procedure, the patients were placed on the operating table in the supine position and
the operating table was deviated 10 degrees to the left. Heart rate, mean arterial pressure and
saturation were recorded as 1 minute values. Afterwards, the 3rd minute, 5th minute, 10th
minute, 15th minute and 30th minute values were recorded. Sensory block examination was
evaluated with pinprick test and motor block levels were evaluated with modified Bromage
scoring and recorded. A decrease of 30% from the systolic blood pressure value measured
before spinal anesthesia or a decrease in the systolic blood pressure value below 90 mmHg was
considered as hypotension and 10 mg of ephedrine was administered simultaneously to all
patients with hypotension. After surgery, newborn APGAR score, newborn weight, time to zero
Bromage score, time until sensory blockage regressed to T10, and presence of nausea and
vomiting were recorded.
Results: A significant correlation was found between the length of the vertebral column and
the level of sensory block in patients after spinal anesthesia. There is a significant relationship
between the length of the columna vertebralis and the time elapsed until the sensory block level
regresses to T10. There was no correlation between abdominal circumference and and
symphysis fundus distance and hypotension. However, a significant relationship was found
between abdominal circumference and nausea.
Conclusıon: There are multiple mechanisms associated with intraoperative hypotension after
spinal anesthesia. Abdominal circumference and columna vertebralis length are important
parameters for measuring and providing prediction.
References
- 1. J. F. Butterworth, D. C. Mackey, And J. D. Wasnick, Morgan And Mikhail’s Clinical Anesthesiology, 5. Edition. McGraw-Hill Lange Book, 2015.
- 2. D. Nag, D. Samaddar, … A. C.-W. J. of, and U. 2015, “Vasopressors in obstetric anesthesia: A current perspective,” 2015, [Accessed: Nov. 26, 2021] (Online) Available: https:// www.ncbi.nlm.nih.gov/pmc/articles/pmc4295220/.
- 3. N. MC, “Doğum döneminde hasta değişkenleri ve hiperbarik bupivakainin subaraknoid yayılımı,” J. Am. Soc., 1990, [Accessed: Nov. 26, 2021]. (Online). Available: https:// pubs.asahq.org/ anesthesiology/articlepdf/72/3/478/319438/0000542-199003000-00015.pdf.
- 4. N. Zhang, L. He, J. N.- Medicine, and undefined 2017, “Level of sensory block after spinal anesthesia as a predictor of hypotension in parturient,” ncbi.nlm.nih.gov, [Accessed: Nov. 26, 2021]. (Online) Available: https://www.ncbi.nlm.nih.gov /pmc/articles/PMC5484208/.
- 5. G. Hocking, J. W.-B. journal of anaesthesia, and undefined 2004, “Intrathecal drug spread,” academic.oup.com, 93, 4, 568–78, 2004.
- 6. Y. Hirabayashi, R. Shimizu, H. Fukuda, K. Saitoh, and T. Igarashi, “Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging.,” academic.oup.com, vol. 78, pp. 317–319, 1997, [Accessed: Nov. 26, 2021]. (Online). Available: https://academic.oup.com /bja/articleabstract/78/3/317/366123.
- 7. F. Brenck et al., “Hypotension after spinal anesthesia for cesarean section: Identification of risk factors using an anesthesia information management system,” J. Clin. Monit. Comput., 23, 2, 85–92, 2009,
- 8. S. H. Chung, H. J. Yang, J. Y. Lee, K. H. Chung, D. H. Chun, and B. K. Kim, “The relationship between symphysis- fundal height and intravenous ephedrine dose in spinal anesthesia for elective cesarean section,” Korean J. Anesthesiol., 59, 3, 173–178, Sep. 2010.
- 9. Ronenson, S. S.-A. i reanimatologiia, and undefined 2014, “Effect of intra-abdominal pressure in pregnant women on level of spina block and frequency of hypotension during cesarean section,” europepmc.org, [Accessed: Nov. 26, 2021]. (Online). Available: https:// europepmc.org/ article/med/25549482.
- 10. T. O. Seyhan et al., “The effect of intra-abdominal pressure on sensory block level of single-shot spinal anesthesia for cesarean section: an observational study,” Int. J. Obstet. Anesth., vol. 24, pp. 35–40, 2015, doi: 10.1016/j.ijoa.2014.08.004.
- 11. Q. H. Zhou, W. P. Xiao, and Y. Y. Shen, “Abdominal girth, vertebral column length, and spread of spinal anesthesia in 30 minutes after plain bupivacaine 5 mg/ml,” Anesth. Analg., 119, 1, 203–206, 2014.
- 12. C. H. Kuok et al., “Preoperative measurement of maternal abdominal circumference relates the initial sensory block level of spinal anesthesia for cesarean section: An observational study,” Taiwan. J. Obstet. Gynecol., 55, 6, 810–814, Dec. 2016.
- 13. H. Sugerman, A. Windsor, M. Bessos, and L. Wolfe, “Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity,” J. Intern. Med., vol. 241, no. 1, pp. 71–79, 1997.
- 14. P. Thomard, S. Morakul, N. Wirachpisit, W. Ittichaikulthol, and C. Pisitsak, “Relationship between Abdominal Circumference and Incidence of Hypotension during Cesarean Section under Spinal Anesthesia,” Anesthesiol. Res. Pract., 2020.
- 15. Al-Khan et al., “Measurement of intraabdominal pressure in pregnant women at term,” J. Reprod. Med. Obstet. Gynecol., vol. 56, no. 1–2, pp. 53–57, 2011, [Accessed: Dec. 26, 2021]. (Online). Available: https://europepmc.org/article/med/21366128.
- 16. E. J. Kim, J. H. Lee, J. S. Ban, and B. W. Min, “Patient Variables Influencing the Sensory Blockade Level of Spinal Anesthesia Using Hyperbaric Bupivacaine in Term Parturients,” Korean J. Anesthesiol.,45, 5, 627, 2003,
- 17. Güvençer M, Karatosun V, and Korman E, Omurganın Anatomisi Kemik Yapı, vol. 12. 2001.
- 18. Hartwell BL, Aglio LS, Hauch MA, and Datta S, “Vertebral column length and spread of hyperbaric subarachnoid bupivacaine in the term parturient - PubMed,” Reg Anesth Pain Med, 1991. https://pubmed.ncbi.nlm.nih.gov/2007099/ [accessed Dec. 26, 2021].
- 19. Y. G. Kang, E. Abouleish, and S. Caritis, “Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section,” Anesth. Analg., 61, 10, 839–842, 1982.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | April 28, 2025 |
| Publication Date | March 30, 2025 |
| Submission Date | November 23, 2024 |
| Acceptance Date | February 10, 2025 |
| Published in Issue | Year 2025 Volume: 6 Issue: 1 |
