Preeklampsili gebelerde sezeryan anestezisi için intratekal uygulanan Levobupivakain ve Bupivakain etkinliğinin karşılalaştırılması
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Preeklampsili gebelerde spinal anestezi de uygulanan levobupivakainin ve bupivakainin etkinliğini, hemodinamik değişiklikleri, hasta ve cerrah memnuniyetinin araştırılması amaçlandı. Çalışma DÜTF araştırma hastanesinde ASA I-II, 18–45 yaş arası sezeryan operasyonu uygulanacak 60 olgudan gerçekleştirildi. Girişim öncesi tüm hastalara her iki el sırtından 20 numara branül ile damar yolu açılıp, nabız ve kan basıncı ölçümleri yapıldıktan sonra, uygulamadan 30 dakika önce 500ml kolloid solusyonu, 10 ml/kg izotonik iv uygulandı. Cerrahi işlemin uygulandığı süre boyunca 5 ml/kg/saat iv izotonik verildi. Hastaların SAB, DAB, KAH kaydedildi. Spinal anestezi; aseptik şartlarda hastalar oturur pozisyonda 26 gauce spinal iğne ile L2-L3 veya L3-L4 lumbal aralıktan girilerek, birinci gruptaki hastalara 10 mg bupivakain, ikinci gruptaki hastalara 10 mg levobupivakain, toplam doz 2 cc olacak şekilde subaraknoid aralığa verildi. Spinal anestezi uygulandıktan sonra hastalar uzatılarak 3., 6., 9., 12. ve 15. dakikalarda, sonrasında da 5 dakikada bir SAB, DAB, KAH ölçülerek kaydedildi. T4 ulaşma süresine pin prick testi ile bakıldı. Duyusal blok T4 –T5 seviyesine ulaştığında cerrahi işlem başlatıldı. Cerrahi süre boyunca tüm hastalara oksijen maskesi ile 3 lt/dk oksijen verildi. Hasta ve cerrah memnuniyetlerine VAS ile değerlendirildi. Verilerin değerlendirilmesinde SPSS for Windows 17,0 istatistik paket programı kullanıldı. Karşılaştırmalarda Independent Samples Test, ANOVA Test ve Mann Whitney U Testleri kullanıldı. P<0.05 anlamlı kabul edildi. Demografik verilerin guruplara göre dağılımı; Grup 1 deki hastaların yaş ortalamaları 32,56 yıl, Grup 2 hastaların ise 31,83 yıl. Grup 1 deki kadınların boy ortalamaları 159,97 cm, Grup 2 kadınların 160,73 cm. Grup 1 deki kadınların ağırlıkları ortalama 81,6 kg, Grup 2 kadınların vücut ağırlıkları ise ortalama 89,70 kg bulundu. Gruplar arasında istatiksel olarak anlamlı fark gözlenmedi (p>0,05). Grup 1deki hastaların; hasta konforu (VAS) skalaları ortalama 4, 50 idi. Grup 2 deki hastaların; hasta konforu (VAS) skalaları ortalama 3,53 olarak bulundu. Her iki gurup arasında anlamlı fark gözlendi (p<0,05). Grup 1de, cerahi konfor (VAS) skalaları ortalama 3,83 idi. Grup 2 de; cerahi konfor (VAS) skalaları ortalama 3,40 olarak bulundu. Her iki gurup arasında anlamlı fark gözlenmedi (p>0,05). Grup 1’ deki hastaların 15’inde (%50), Grup 2 hastalarının 10’unda (%33,3)’ünde hipotansiyon gelişti ve istatistiksel olarak anlamlı kabul edildi (p<0.05). Hipotansiyon gelişen 25 (%41,6) hastaya efedrin uygulandı (p<0.05). Sonuç olarak preeklamsili gebelerde sezaryan ameliyatları; hasta ve cerrah uyumunun iyi olduğu, cerrahi işlemin kısa süreceği düşününlen sezaryan operasyonlarında; levobupivakain ve bupivakainle yeterli hasta ve cerrahi memnuniyet sağladığını gördük. Hastalarımızda levobupivakain kullandığımızda, bupivakaine göre daha az hipotansiyon görülmesine rağmen anlamlı derecede hipotansiyon ve efedrin ihtiyacı olduğunu gözlemledik. Bunun için daha geniş kapsamlı ve daha fazla hastanın çalışmalara dahil edildiği doz çalışmalarına ihtiyaç olduğunu düşünüyoruz.
Underwent spinal anesthesia in the preeclampsia and bupivacaine levobupivakainin efficacy, hemodynamic changes, patient and surgeon satisfaction were evaluated. The study is achieved with 60 individuals treated with cesarean operation between the ages of 18–45 in Universty of Dicle faculty of medicine ASA I-II. Before the procedure we obtained vascular access from both hand dorsums using branule no: 20 of each patient and evaluated both puls rate and blood pressure. Before 30 minutes of application, we deliwered 500 ml Hidroksi asetil and 10 ml/kg isotonic iv. 5 ml/kg/h isotonic solution was deliwered by the time the surgical operation is lasted. All the patients SAB, DAB, KAH were recorded. Spinal anesthesia was aschieved each patient in aseptic conditions, in sitting position, by 26 gauce spinal needle and entering from L2-L3 or L3-L4 separation. The first groups of patients in the bupivacaine 10 mg, 10 mg levobupivacaine in the second group of patients, total dose of 2 cc were injected to sunarachnoidal cavity. After the procedure of spinal anesthesia all patients were lied down and SAB, DAB, KAH were recorded at 3., 6., 9., 12., 15., minutes than recorded at 5 minutes interval. T4 accession time was evaluated by pin prick test. The surgical operation was initiated at the time the sensorial block got at T4 level. All patients were deliwered 3lt/min. oxygen by oxygen mask by the duration of surgical operation. Datas were evaluated by SPSS programme by windows 17.0 statistical packet. İn comparision, Independent Samples Test, ANOVA Test and Mann Whitney U Tests were used. p<0.05 was regarded as significant. The distributions of demographic datas for groups are with an average age of patients at 32.56 years in group 1 patients and 31.83 years in Group 2 patients. Group of women at a mean height are 159.97 cm in group 1 and 160.73 cm in Group 2. The average weight of 81.6 kg of women in group 1 and group 2, the average body weight of women was 89.70 kg. No statistically significant difference between groups was observed (p> 0.05). Patients in group 1, patient comfort (VAS) scales were the average of 4.50. Patients in group 2, patient comfort (VAS) scale was found to be 3.53 average. No significant difference was observed between the two groups (p <0.05). Group 1, Surgery comfort (VAS) scale was the average of 3.83. Group 2; Surgery comfort (VAS) scale was found to be 3.40 average. There was no significant difference between the two groups (p> 0.05). With 1 in 15 patients (50%), Group 2 of the 10 patients (33.3%) of them developed hypotension and was accepted as statistically significant (p<0.05). Hypotension in 25 (41.6%) patients were administered ephedrine (p <0.05). Caesarean section in preeclampsia as a result of surgery, the patient and the surgeon was a good fit, surgical procedures are likely to be short of cesarean operations, levobupivacaine and bupivacaine provide adequate patient satisfaction and surgical saw. We use in our patients levobupivacaine, bupivacaine, although significantly less hypotension in hypotension and ephedrine requirements were observed. For this, broader and more patients were included in the study dose studies are needed to think.
Underwent spinal anesthesia in the preeclampsia and bupivacaine levobupivakainin efficacy, hemodynamic changes, patient and surgeon satisfaction were evaluated. The study is achieved with 60 individuals treated with cesarean operation between the ages of 18–45 in Universty of Dicle faculty of medicine ASA I-II. Before the procedure we obtained vascular access from both hand dorsums using branule no: 20 of each patient and evaluated both puls rate and blood pressure. Before 30 minutes of application, we deliwered 500 ml Hidroksi asetil and 10 ml/kg isotonic iv. 5 ml/kg/h isotonic solution was deliwered by the time the surgical operation is lasted. All the patients SAB, DAB, KAH were recorded. Spinal anesthesia was aschieved each patient in aseptic conditions, in sitting position, by 26 gauce spinal needle and entering from L2-L3 or L3-L4 separation. The first groups of patients in the bupivacaine 10 mg, 10 mg levobupivacaine in the second group of patients, total dose of 2 cc were injected to sunarachnoidal cavity. After the procedure of spinal anesthesia all patients were lied down and SAB, DAB, KAH were recorded at 3., 6., 9., 12., 15., minutes than recorded at 5 minutes interval. T4 accession time was evaluated by pin prick test. The surgical operation was initiated at the time the sensorial block got at T4 level. All patients were deliwered 3lt/min. oxygen by oxygen mask by the duration of surgical operation. Datas were evaluated by SPSS programme by windows 17.0 statistical packet. İn comparision, Independent Samples Test, ANOVA Test and Mann Whitney U Tests were used. p<0.05 was regarded as significant. The distributions of demographic datas for groups are with an average age of patients at 32.56 years in group 1 patients and 31.83 years in Group 2 patients. Group of women at a mean height are 159.97 cm in group 1 and 160.73 cm in Group 2. The average weight of 81.6 kg of women in group 1 and group 2, the average body weight of women was 89.70 kg. No statistically significant difference between groups was observed (p> 0.05). Patients in group 1, patient comfort (VAS) scales were the average of 4.50. Patients in group 2, patient comfort (VAS) scale was found to be 3.53 average. No significant difference was observed between the two groups (p <0.05). Group 1, Surgery comfort (VAS) scale was the average of 3.83. Group 2; Surgery comfort (VAS) scale was found to be 3.40 average. There was no significant difference between the two groups (p> 0.05). With 1 in 15 patients (50%), Group 2 of the 10 patients (33.3%) of them developed hypotension and was accepted as statistically significant (p<0.05). Hypotension in 25 (41.6%) patients were administered ephedrine (p <0.05). Caesarean section in preeclampsia as a result of surgery, the patient and the surgeon was a good fit, surgical procedures are likely to be short of cesarean operations, levobupivacaine and bupivacaine provide adequate patient satisfaction and surgical saw. We use in our patients levobupivacaine, bupivacaine, although significantly less hypotension in hypotension and ephedrine requirements were observed. For this, broader and more patients were included in the study dose studies are needed to think.
Açıklama
Anahtar Kelimeler
Anestezi, Anesthesia, Bupivakain, Bupivacaine, Gebelik, Pregnancy, Levobupivakain, Levobupivacaine, Preeklampsi, Pre eclampsia, Sezaryen operasyonu, Cesarean section
