Yüksek Riskli Sezaryen Operasyonlarında Anestezi Tipinin Kanama ve Kan Transfüzyonu İhtiyacı Üzerine Etkisi
Öz
Yüksek riskli gebeliklerde gerçekleştirilen sezaryen operasyonlarında tercih edilen anestezi tipinin intraoperatif ve postoperatif kanama ile kan transfüzyonu ihtiyacı üzerindeki etkisini değerlendirmeyi amaçlamaktadır. Bu retrospektif kohort çalışma Konya Şehir Hastanesinde 08 Ağustos 2020-31 Aralık 2024 tarihleri arasında yüksek riskli gebelerde gerçekleşen sezaryen operasyonlarını değerlendirme altına almıştır. Çalışmaya dahil edilen hastalar, Genel Anestezi (GA) Grubu ve Nöroaksiyel Anestezi (NA) Grubu olarak ikiye ayrılmıştır. Preoperatif ve postoperatif hemoglobin (Hb) ile hematokrit (Hct) değerleri, Hb <8 g/dL durumunda uygulanan eritrosit süspansiyonu (kan transfüzyonu), hastanede kalış süresi ve yoğun bakım ünitesi (YBÜ) ihtiyacı değerlendirilmiştir. İstatistiksel analizde p<0.05 anlamlı kabul edilmiştir. 08 Ağustos 2020 - 31 Aralık 2024 tarihleri arasında yapılan 14.450 sezaryen operasyonundan, yüksek riskli gebelik tanısı konulan 125 vaka retrospektif olarak incelenmiştir. Hastalar GA (n=79) veya NA (n=46) altında ameliyat geçirmiştir. Preoperatif Hb ve Hct değerlerinde gruplar arasında fark bulunmazken, postoperatif dönemde GA grubunda Hb (7.75±0.9 g/dL) ve Hct (%24.65±2.58) değerlerinde anlamlı düşüş saptandı (p<0.001). GA grubunda kan replasmanı ihtiyacı %82.6 iken, NA grubunda %43 olarak belirlendi (p<0.001). Ayrıca, NA hastalarında hastanede kalış süresi 2 (2–3) gün, GA’da ise 3 (3–4) gün; YBÜ yatış oranları sırasıyla %5.1 ve %23.9 olarak tespit edildi (p=0.002). Yüksek riskli gebeliklerde yapılan sezaryen operasyonlarında, GA uygulanan hastalarda NA’ya göre artan kan kaybı, daha yüksek transfüzyon ihtiyacı ve uzamış hastanede kalış süresi gözlenmiştir. Bu sonuçlar, anestezi seçiminin perioperatif kan kaybı ve transfüzyon gereksinimi üzerinde belirleyici etkisi olduğunu ortaya koymaktadır.
Anahtar Kelimeler
Yüksek riskli gebelik sezaryen doğum spinal anestezi genel anestezi kan kaybı transfüzyon.
Kaynakça
- 1. Ramadani HJIJoG, Obstetrics. Cesarean section intraoperative blood loss and mode of placental separation. 2004;87(2):114-8.
- 2. Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hodnett E, et al. A guide to effective care in pregnancy and childbirth: Oxford university press; 2000.
- 3. Liu S, Liston RM, Joseph K, Heaman M, Sauve R, Kramer MSJC. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. 2007;176(4):455-60.
- 4. Burke C, Allen RJMTAJoMCN. Complications of cesarean birth: clinical recommendations for prevention and management. 2020;45(2):92-9.
- 5. Kang H, Kim W, Jin S, Kim Y, Min T, Lee Y, et al. Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009–2016). 2019;47(9):4365-73.
- 6. Britain G. Department of Health and Social Security. Report on Confidential Enquiries into Maternal Deaths in England and Wales 1973-1975. HMSO, London; 1979.
- 7. Haeri S, Dildy III GA, editors. Maternal mortality from hemorrhage. Seminars in perinatology; 2012: Elsevier. 8. Goffman D, Nathan L, Chazotte C, editors. Obstetric hemorrhage: A global review. Seminars in Perinatology; 2016: Elsevier. 9. Andrews WW, Ramin SM, Maberry MC, Shearer V, Black S, Wallace DHJAjop. Effect of type of anesthesia on blood loss at elective repeat cesarean section. 1992;9(03):197-200.
- 10. Lertakyamanee J, Chinachoti T, Tritrakarn T, Muangkasem J, Somboonnanonda A, Kolatat TJJotMAoTCT. Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial. 1999;82(7):672-80.
- 11. Hassan IT, Murshed RM, Saleh JI. The Role of Types of Anesthesia on Maternal Blood Parameters among Women Underwent Cesarean Section. 2016.
- 12. NAJAM SNS, Dar LRJB. The effect of anaesthesia modus on amount of blood loss in cesarean sections. 2012;28(2):153-5.
- 13. Rajeev Kumar D, Manu S. A Comparison Study of Spinal Anesthesia with General Anesthesia in Cesarean Section. Academia Anesthesiologica International. 2019;4(2).
- 14. Yalınkaya A, Güzel Aİ, Kangal K, Uysal E, Erdem SJPJ. Comparing the blood values of the patients operated by cesarean under spinal and general anesthesia. 2009;17(2):70-3--3.
- 15. Hong J, Jee Y, Yoon H, Kim SJIJoOA. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. 2003;12(1):12-6.
- 16. Havas F, Orhan Sungur M, Yenigün Y, Karadeniz M, Kılıç M, Özkan Seyhan TJA. Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia. 2013;25(2):55-63.
- 17. Oh TT, Martel CG, Clark AG, Russo MB, Nossaman BD. Impact of Anesthetic Predictors on Postpartum Hospital Length of Stay and Adverse Events Following Cesarean Delivery: A Retrospective Study in 840 Consecutive Parturients. 2015;15(3):228-36.
- 18. Fassoulaki A, Petropoulos G, Staikou C, Siafaka I, Sarantopoulos C. General versus neuraxial anaesthesia for caesarean section: Impact on the duration of hospital stay. Journal of Obstetrics and Gynaecology. 2009;29(1):25-30.
- 19. Wiskott K, Jebrin R, Ioscovich D, Grisaru-Granovsky S, Tevet A, Shatalin D, et al. General Versus Regional Anesthesia for Emergency Cesarean Delivery in a High-volume High-resource Referral Center: A Retrospective Cohort Study. 2020;27:6 - 10.
The Impact of Anesthesia Type on Bleeding and Blood Transfusion Requirements in High-Risk Cesarean Sections
Öz
To evaluate the impact of the chosen anesthesia type on intraoperative and postoperative blood loss and blood transfusion requirements in cesarean sections for high-risk pregnancies. This retrospective cohort study included cesarean sections performed in high-risk pregnancies at Konya City Hospital between August 8, 2020 and December 31, 2024. Patients were divided into two groups: General anesthesia (GA) and Neuraxial anesthesia (NA). Preoperative and postoperative hemoglobin (Hb) and hematocrit (Hct) values were assessed, along with the administration of erythrocyte suspension (transfusion) for Hb <8 g/dL, length of hospital stay, and intensive care unit (ICU) admission. Statistical significance was set at p<0.05. Out of 14.450 cesarean sections performed during the study period, 125 cases diagnosed with high-risk pregnancy were retrospectively analyzed. Of these, 79 patients underwent surgery under GA and 46 under NA. While no differences were observed in preoperative Hb and Hct values between the groups, the GA group exhibited a significant decline in postoperative Hb (7.75±0.9 g/dL) and Hct (24.65±2.58%) (p<0.001). Blood transfusion was required in 82.6% of the GA group compared to 43% in the NA group (p<0.001). Additionally, the median hospital stay was 2 (2–3) days in the NA group versus 3 (3–4) days in the GA group, and ICU admission rates were 5.1% and 23.9%, respectively (p=0.002). In cesarean sections for high-risk pregnancies, patients receiving GA exhibited increased blood loss, higher transfusion requirements, and prolonged hospital stays compared to those receiving NA. These findings suggest that the choice of anesthesia significantly influences perioperative blood loss and transfusion needs.
Anahtar Kelimeler
High-risk pregnancy cesarean section spinal anesthesia general anesthesia blood loss transfusion.
Kaynakça
- 1. Ramadani HJIJoG, Obstetrics. Cesarean section intraoperative blood loss and mode of placental separation. 2004;87(2):114-8.
- 2. Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hodnett E, et al. A guide to effective care in pregnancy and childbirth: Oxford university press; 2000.
- 3. Liu S, Liston RM, Joseph K, Heaman M, Sauve R, Kramer MSJC. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. 2007;176(4):455-60.
- 4. Burke C, Allen RJMTAJoMCN. Complications of cesarean birth: clinical recommendations for prevention and management. 2020;45(2):92-9.
- 5. Kang H, Kim W, Jin S, Kim Y, Min T, Lee Y, et al. Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009–2016). 2019;47(9):4365-73.
- 6. Britain G. Department of Health and Social Security. Report on Confidential Enquiries into Maternal Deaths in England and Wales 1973-1975. HMSO, London; 1979.
- 7. Haeri S, Dildy III GA, editors. Maternal mortality from hemorrhage. Seminars in perinatology; 2012: Elsevier. 8. Goffman D, Nathan L, Chazotte C, editors. Obstetric hemorrhage: A global review. Seminars in Perinatology; 2016: Elsevier. 9. Andrews WW, Ramin SM, Maberry MC, Shearer V, Black S, Wallace DHJAjop. Effect of type of anesthesia on blood loss at elective repeat cesarean section. 1992;9(03):197-200.
- 10. Lertakyamanee J, Chinachoti T, Tritrakarn T, Muangkasem J, Somboonnanonda A, Kolatat TJJotMAoTCT. Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial. 1999;82(7):672-80.
- 11. Hassan IT, Murshed RM, Saleh JI. The Role of Types of Anesthesia on Maternal Blood Parameters among Women Underwent Cesarean Section. 2016.
- 12. NAJAM SNS, Dar LRJB. The effect of anaesthesia modus on amount of blood loss in cesarean sections. 2012;28(2):153-5.
- 13. Rajeev Kumar D, Manu S. A Comparison Study of Spinal Anesthesia with General Anesthesia in Cesarean Section. Academia Anesthesiologica International. 2019;4(2).
- 14. Yalınkaya A, Güzel Aİ, Kangal K, Uysal E, Erdem SJPJ. Comparing the blood values of the patients operated by cesarean under spinal and general anesthesia. 2009;17(2):70-3--3.
- 15. Hong J, Jee Y, Yoon H, Kim SJIJoOA. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. 2003;12(1):12-6.
- 16. Havas F, Orhan Sungur M, Yenigün Y, Karadeniz M, Kılıç M, Özkan Seyhan TJA. Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia. 2013;25(2):55-63.
- 17. Oh TT, Martel CG, Clark AG, Russo MB, Nossaman BD. Impact of Anesthetic Predictors on Postpartum Hospital Length of Stay and Adverse Events Following Cesarean Delivery: A Retrospective Study in 840 Consecutive Parturients. 2015;15(3):228-36.
- 18. Fassoulaki A, Petropoulos G, Staikou C, Siafaka I, Sarantopoulos C. General versus neuraxial anaesthesia for caesarean section: Impact on the duration of hospital stay. Journal of Obstetrics and Gynaecology. 2009;29(1):25-30.
- 19. Wiskott K, Jebrin R, Ioscovich D, Grisaru-Granovsky S, Tevet A, Shatalin D, et al. General Versus Regional Anesthesia for Emergency Cesarean Delivery in a High-volume High-resource Referral Center: A Retrospective Cohort Study. 2020;27:6 - 10.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | ORİJİNAL MAKALELER / ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Mayıs 2025 |
| Gönderilme Tarihi | 20 Şubat 2025 |
| Kabul Tarihi | 11 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 47 Sayı: 3 |