Öz
Amaç:
Cerrahi sonrası hızlandırılmış iyileşme protokolü sezaryen ameliyatlarında daha sık uygulanmaya başlanmış olup, postoperatif avantajlarından dolayı rejyonel anestezi ilk tercihtir. Spinal anestezinin yan etkileri arasında hipotansiyon ve bradikardi sık görülmektedir. 5-HT3 reseptörlerinin uyarılmasıyla meydana gelen Bezold Jarisch refleksinin etkili olduğu düşünülmektedir. Bu çalışma spinal anestezi altında sezaryen yapılan gebelerde 5-HT3 reseptör antagonisti olan ondansetron uygulamasının hemodinamiye etkisini araştırmak amacıyla planlanmıştır.
Yöntem:
Spinal anestezi ile elektif sezaryen planlanan 78 gebe çalışmaya dahil edildi. Hastalar rastgele iki gruba ayrılarak; spinal anesteziden önce grup 1 (n=38) 4 mg intravenöz ondansetron almış, grup 2 (n=40) ise ondansetron almamıştır. Her iki gruptaki hastaların kan basıncı, kalp tepe atımı ve vazopressör gereksinimleri değerlendirilmiştir.
Bulgular:
Ortalama arter basıncındaki düşüşler grup 2’de 2. ve 4. dakikalarda grup 1’e göre anlamlı olarak daha düşüktü (p<0,05). Grup 1’deki hastaların vazopressör ihtiyacı (p=0,001) ve bulantı- kusma insidansı anlamlı olarak daha düşüktü (p=0,01).
Sonuç:
Elektif sezaryen uygulanan gebelerde spinal anestezi öncesi ondansetron kullanıldığında hemodinami daha stabil olup, vazopressör kullanımı azalmış ve bulantı-kusmanın daha az olduğu görülmüştür.
Anahtar Kelimeler: ERAS, kan basıncı, kusma, ondansetron, spinal anestezi
Kaynakça
Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). Am J Obstet Gynecol 2018;219(6):533-544.
Wrench IJ, Allison A, Galimberti A, Radley S, Wilson MJ. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience. Int J Obstet Anesth 2015;24(2):124-130.
Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, et al. Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). Am J Obstet Gynecol 2018;219(6):523.e1-523.e15.
Corso E, Hind D, Beever D, Fuller G, Wilson MJ, Wrench IJ, et al. Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews. BMC Pregnancy Childbirth 2017;17(1):91.
Ali HM, Mohamed MY, Ahmed YM. Postdural puncture headache after spinal anesthesia in cesarean section: experience in six months in 2736 patients in Kasr El aini teaching hospital – cairo University. Egypt. J. Anaesth. Egyptian Journal of Anaesthesia 2014;30:383-386.
Asehnoune K, Larousse E, Tadié JM, Minville V, Droupy S, Benhamou D. Small-dose bupivacaine-sufentanil prevents cardiac output modifications after spinal anesthesia. Anesth Analg 2005;101(5):1512-1515.
Meyhoff CS, Hesselbjerg L, Koscielniak-Nielsen Z, Rasmussen LS. Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients. Eur J Anaesthesiol 2007;24(9):770-5.
Mercier FJ, Augè M, Hoffmann C, Fischer C, Le Gouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol 2013;79(1):62-73.
Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth 2001;86(6):859-868.
Yamano M, Kamato T, Nishida A, Ito H, Yuki H, Tsutsumi R, et al. Serotonin (5-HT)3-receptor antagonism of 4,5,6,7-tetrahydrobenzimidazole derivatives against 5-HT-induced bradycardia in anesthetized rats. Jpn J Pharmacol 1994;65(3):241-248.
Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of Spinal Anesthesia-Induced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Meta-regression. Anesth Analg 2016;123(4):977-988.
Ortiz-Gómez JR, Palacio-Abizanda FJ, Morillas-Ramirez F, Fornet-Ruiz I, Lorenzo-Jiménez A, Bermejo-Albares ML. The effect of intravenous ondansetron on maternal haemodynamics during elective caesarean delivery under spinal anaesthesia: a double-blind, randomised, placebo-controlled trial. Int J Obstet Anesth 2014;23(2):138-143.
Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszułowicz R, Dylczyk-Sommer A, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med 2008;33(4):332-339.
Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-induced hypotension with ondansetron in parturients undergoing caesarean section: a double-blind randomised, placebo-controlled study. Int J Obstet Anesth 2012;21(1):24-28.
Gao L, Zheng G, Han J, Wang Y, Zheng J. Effects of prophylactic ondansetron on spinal anesthesia-induced hypotension: a meta-analysis. Int J Obstet Anesth 2015;24(4):335-343.
Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2017;8(8):CD002251.
Terkawi AS, Mavridis D, Flood P, Wetterslev J, Terkawi RS, Bin Abdulhak AA, et al. Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia?: Meta-analysis, Meta-regression, and Trial Sequential Analysis. Anesthesiology 2016 Apr;124(4):846-869.
Koju RB, Gurung BS, Dongol Y. Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section. BMC Anesthesiol 2015;15:18.
Oofuvong M, Kunapaisal T, Karnjanawanichkul O, Dilokrattanaphijit N, Leeratiwong J. Minimal effective weight-based dosing of ondansetron to reduce hypotension in cesarean section under spinal anesthesia: a randomized controlled superiority trial. BMC Anesthesiol 2018;18(1):105.
Terkawi AS, Tiouririne M, Mehta SH, Hackworth JM, Tsang S, Durieux ME. Ondansetron Does Not Attenuate Hemodynamic Changes in Patients Undergoing Elective Cesarean Delivery Using Subarachnoid Anesthesia: A Double-Blind, Placebo-Controlled, Randomized Trial. Reg Anesth Pain Med 2015;40(4):344-348.
Šklebar I, Bujas T, Habek D. Spinal Anaesthesia-Induced Hypotension in Obstetrics: Prevention And Therapy. Acta Clin Croat 2019;58(Suppl 1):90-95.
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016;124(2):270-300.
Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology 2003;98(2):530-547.
Pinder AJ, Dresner M, Calow C, Shorten GD, O’Riordan J, Johnson R. Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia. Int J Obstet Anesth 2002;11(3):156-159.
Abdellah MS, Abbas AM, Ali MK, Mahmoud A, Abdullah SA. Uterine exteriorization versus intraperitoneal repair: effect on intraoperative nausea and vomiting during repeat cesarean delivery - A randomized clinical trial. Facts Views Vis Obgyn 2018;10(3):131-137.
Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006;(4):CD002251.
Ituk U, Habib AS. Enhanced recovery after cesarean delivery. F1000Res. 2018 Apr 27;7:F1000 Faculty Rev-513.
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 2000;84(1):6-10.
