Spinal anestezide oluşan hipotansiyonu önlemek için prehidrasyon uygulamasında kristalloid ve kolloid kullanımı
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Dosyalar
Tarih
2008
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda spinal anestezi uygulanan hastalarda, prehidrasyon amacıyla verilen kristalloid ve kolloid sıvıların perioperatif dönemde spinal anesteziyle ortaya çıkan hipotansiyonu önlemedeki etkilerini araştırmayı amaçladık. Elektif plastik cerrahi, üroloji ve ortopedi operasyonu için spinal anestezi uygulanan American Society of Anesthesiologists I-III grubu toplam 50 hasta rastgele olarak iki gruba ayrıldı. I. Gruba (n=25) 500 ml %0.9 izotonik, II. Gruba (n=25) 500 ml polijelin (17.5gr/500 ml) 18 gauge intraket ile açılan intravenöz damar yolundan 20 dakikada verildi. Premedikasyon uygulanmayan olgular operasyon odasına alınarak monitorize edildikten sonra L3-4 aralığından spinal anestezi gerçekleştirildi ve duyu kontrolü ?pin prick? testiyle yapıldı. Hemodinamik parametreler, operasyon başlangıcından, operasyon sonrası 15. dakikaya kadar kaydedildi. Operasyon sonrası sıvı yüklenme belirtileri de değerlendirildi. Sistolik kan basıncının bazal değerine göre %25 azalması hipotansiyon, kalp tepe atımının 50/dk'nın altında olması ise bradikardi olarak değerlendirildi. Gruplar arasında demografik veriler, operasyon süresi ile sensoriyal blok seviyeleri açısından fark saptanmadı. Peroperatif sistolik kan basıncı, diastolik kan basıncı, ortalama kan basıncı değerleri, Grup I'de Grup II'ye göre anlamlı olarak düşük bulundu. Hipotansiyon görülme sıklığı Grup II'de %4-12, Grup I'de ise %9.1-17.6 olarak olmasına karşın iki grup arasında istatistiksel olarak anlamlı fark yoktu. Bazal değerlere göre kalp tepe atımı değerleri, Grup I'de, Grup II'ye göre anlamlı olarak düşük bulundu. Bradikardi Grup I'de görülmesine rağmen, Grup II'de saptanmadı. Sonuç olarak, prehidrasyon amacıyla kullanılan kristalloid ve kolloidlerin spinal anestezi sonrası hipotansiyonun sıklığını azalttığı saptadık. Ancak kolloidler uzun süreli volüm genişlemesi sağlayarak spinal anesteziyle ortaya çıkan hemodinamik değişiklikleri daha erken düzeltmiş ve kristalloidlere göre daha etkin olmuştur.
Abstract
In this study, our aim was to investigate the effect of crystalloid and colloid solutions given for prehydratation to prevent spinal anaesthesia-induced hypotension during perioperative period in cases who were applied spinal anaesthesia. Fifty American Society of Anesthesiologists I-III patients undergoing elective plastic surgery, urology and orthopedic surgery by spinal anaesthesia divided into two groups randomly. Group I (n=25) received 500 ml %0.9 ısotonic solution and Group II (n=25) received 500 ml poligelin (17, 5 gr/500ml) intravenously by 18 gauge cannula in twenty minutes. The patients without any premedication were taken to the operation room and after monitorization spinal anesthesia was performed from L3-L4 level, sensory levels were controlled using pinprick test. Hemodynamic parameters were recorded from the beginning of operation to the fifteenth minute after operation. The volume excess symptoms were evaluated in postoperative period. Hypotension was defined as a 25% decrease from baseline systolic blood pressure values or ? 90 mmHg and bradycardia was defined as lower than 50/min heart rate. There was no significant difference in demographic data, operation time and the levels of blockage between all groups. The systolic, diastolic and mean blood pressure values were significantly lower in Group I than Group II. Although hypotension rate was 4-12% in Group I and 9.1-17.6% in Group II, there was no significant statistical difference between the groups. According to the baseline values, heart rates were lower in Group I than Group II. İnspite of bradycardia in Group I, there was no bradycardia reported in Group II. Consequently, we confirmed that, administration of crystalloid and colloid for preloading decreases the incidence of hypotension after spinal anesthesia. However the long lasting vasculer extension effect and earlier recovery of haemodynamic changes the colloids are more effective than crystalloids.
Abstract
In this study, our aim was to investigate the effect of crystalloid and colloid solutions given for prehydratation to prevent spinal anaesthesia-induced hypotension during perioperative period in cases who were applied spinal anaesthesia. Fifty American Society of Anesthesiologists I-III patients undergoing elective plastic surgery, urology and orthopedic surgery by spinal anaesthesia divided into two groups randomly. Group I (n=25) received 500 ml %0.9 ısotonic solution and Group II (n=25) received 500 ml poligelin (17, 5 gr/500ml) intravenously by 18 gauge cannula in twenty minutes. The patients without any premedication were taken to the operation room and after monitorization spinal anesthesia was performed from L3-L4 level, sensory levels were controlled using pinprick test. Hemodynamic parameters were recorded from the beginning of operation to the fifteenth minute after operation. The volume excess symptoms were evaluated in postoperative period. Hypotension was defined as a 25% decrease from baseline systolic blood pressure values or ? 90 mmHg and bradycardia was defined as lower than 50/min heart rate. There was no significant difference in demographic data, operation time and the levels of blockage between all groups. The systolic, diastolic and mean blood pressure values were significantly lower in Group I than Group II. Although hypotension rate was 4-12% in Group I and 9.1-17.6% in Group II, there was no significant statistical difference between the groups. According to the baseline values, heart rates were lower in Group I than Group II. İnspite of bradycardia in Group I, there was no bradycardia reported in Group II. Consequently, we confirmed that, administration of crystalloid and colloid for preloading decreases the incidence of hypotension after spinal anesthesia. However the long lasting vasculer extension effect and earlier recovery of haemodynamic changes the colloids are more effective than crystalloids.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Spinal Anestezi, Sıvı Tedavisi, Kolloid, İzotonik, Anesthesia Spinal, Fluid Therapy, Colloids, Isotonic Solutions
