Turkiye Klinikleri Journal of Anesthesiology Reanimation

Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study
Preoperatif Anksiyetesi olup Acil Kategori-1 Sezaryen Cerrahisi Geçiren Gebelerde, Sedasyonun Spinal Anestezinin Sebep Olduğu Maternal Hipotansiyon Üzerine Etkileri: Tarihi Bir Kohort Çalışma
Cenk ŞAHANa, Emine Aysu ŞALVIZb, Gülçin Hilal ALAYa, Halide ERTEN ŞAHANc, Volkan ANAKLId, Kamil Mehmet TUĞRULb
Clinics of
aAnesthesiology and Reanimation,
cPsychiatry, Van Training and Research Hospital, Van
bDepartment of Anesthesiology, Istanbul University Faculty of Medicine,
dClinic of Anesthesiology, Istanbul Esenler Gynecology, Obstetrics and Pediatric Hospital, İstanbul
Turkiye Klinikleri J Anest Reanim. 2017;15(2):41-9
doi: 10.5336/anesthe.2016-53782
Article Language: EN
Full Text
Objective: This study was designed to investigate the effect of sedation on maternal hypotension in preoperatively anxious parturients underwent urgent category-1 Cesarean section (C/S) under spinal anesthesia (SA). Material and Methods: After ethics committee approval, data of 1824 parturients underwent C/S were reviewed from the surgical database and patient charts. Parturients with high preoperative anxiety scores (VAS-A)≥70) underwent C/S under SA with thiopental 2 mg/kg (if necessary additional 50 mg) sedation until reaching Ramsay sedation score≥3 (Group S, n=49), and without any other type of sedation (Group NS, n=53) were included in the study. All parturients received SA with hyperbaric bupivacaine 0.5% 2.5 mL. Hemodynamic parameters and maximum systolic arterial pressure (SAP) reductions (%) from the baseline were recorded. Maternal hypotension (SAP≥30% decrease or <100 mmHg) and bradycardia (heart rate <55 beats/min) incidences, required ephedrine (5mg IV bolus) and atropine (0.5 mg IV bolus) doses, and newborn Apgar scores were also analyzed. Results: Fifty-nine parturients' data (Group S: 29 and Group NS: 30) were analyzed. The maximum SAP reductions were 23±12.8% and 30.8±16.1% in Groups S and NS, respectively (p=0,044). Hypotension was observed in 5 (17,2%) parturients of Group S and 15 (50%) of Group NS (p=0.012, 95% CI 0,14-0,82; relative risk=0,344). Ephedrine requirement was 17±4,4 mg and 25±7,4 mg in Groups S and NS, respectively (p=0,04). Incidence of bradycardia, required atropine dose and newborn Apgar scores were similar in both groups (p>0,05). Conclusions: The maximum SAP reduction, hypotension incidence and required ephedrine doses were lower in thiopental sedation used preoperatively anxious parturients who underwent category-1 C/S under SA.

Keywords: Cesarean section; anxiety; anesthesia, spinal; conscious sedation; thiopental
Amaç: Bu çalışma, preoperatif dönemde anksiyöz olup spinal anestezi (SA) altında acil kategori-1 sezaryen (C/S) operasyonu geçiren gebelerde, sedasyonun hipotansiyona etkisini araştırmak için planlanmıştır. Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra, C/S operasyonu geçiren 1824 gebenin verileri cerrahi arşiv ve hasta dosyaları aracılığıyla incelendi. Preoperatif anksiyete skoru (VAS-A)≥70) yüksek olup SA altında C/S geçiren gebelerden Ramsay sedasyon skoru ≥3 olacak şekilde tiyopental 2 mg/kg (gereğinde 50 mg ek doz) uygulanan hastalar (Grup S, n=49) ve herhangi bir sedasyon uygulanmayan hastalar (Grup NS, n=53) çalışmaya dahil edildi. Tüm gebelere, 2,5mL %0,5'lik hiperbarik bupivakain ile SA uygulandı. Hemodinamik parametreler ve bazale göre sistolik arteryal basınçtaki (SAB) maksimum düşüşler (%) kaydedildi. Maternal hipotansiyon (SAB'ın ≥%30 düşmesi veya <100 mmHg olması) ve bradikardi (kalp hızı <55 atım/dk) insidansları, efedrin gereksinimi (5 mg IV bolus), atropin gereksinimi (0,5 mg IV bolus) ve yenidoğan Apgar skorları da analiz edildi. Bulgular: Elli dokuz hastanın (Grup S: 29 ve Grup NS: 30) verisi analiz edildi. SAB'taki maksimum düşüşler, Grup S ve NS'te sırasıyla %23±12 ve %30,8±16,1 idi (p=0,044). Hipotansiyon, Grup S'te 5 (%17,2) hastada ve Grup NS'te 15 (%50) hastada görüldü (p=0,012, 95% CI 0,14-0,82; rölatif risk=0,344). Efedrin gereksinimi Grup S ve NS'te sırasıyla 17±4,4 mg ve 25±7,4 mg idi (p=0,04). Bradikardi insidansı, atropin gereksinimi ve yenidoğan Apgar Skorları açısından iki grup birbirine benzerdi (p>0,05). Sonuç: Bazale göre SAB'taki maksimum düşüş, hipotansiyon insidansı ve ihtiyaç duyulan efedrin dozları, preoperatif dönemde anksiyöz olup tiyopental sedasyonu uygulanarak SA altında kategori-1 C/S geçiren gebelerde daha düşüktür.

Anahtar Kelimeler: Sezaryen; anksiyete; anestezi, spinal; bilinçli sedasyon; tiyopental



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