Gebelikte Anestezi
Özet
Gebelikte anestezi uygulamaları, travayda mide boşalmasının yavaşlamasına bağlı aspirasyon riskinin yanı sıra plasenta previa, ablasyo plasenta ve preeklampsi gibi obstetrik faktörler nedeniyle çeşitli riskler barındırmaktadır. Günümüzde genel anestezinin yalnızca acil endikasyonlarda tercih edilmesiyle anestezi kaynaklı maternal mortalite oranları azalmış olup, ölümlerin en sık nedeni genel anestezide entübasyon başarısızlığı, rejyonel anestezide ise yüksek spinal/epidural bloklardır. Doğum ağrısı ve stres, uteroplasental dolaşımı olumsuz etkileyen stres hormonlarının salgılanmasını artırır; bu durum epidural analjezi ile engellenebilir. Nöroaksiyel yöntemin uygulanamadığı durumlarda meperidin, butorfanol, nalbufin, fentanil ve remifentanil gibi sistemik opioidler parenteral olarak kullanılabilir. Bölgesel analjezide pudendal ve paraservikal gibi minör bloklar ile spinal, epidural ve kombine spinal-epidural gibi majör bloklar yer alır. Lokal anestezikler santral sinir sistemi ve kardiyovasküler toksisiteye yol açabilir. Spinal bloğun en sık komplikasyonu vazodilatasyon kaynaklı hipotansiyon olup efedrin ile tedavi edilir; ayrıca dural delinme sonucu oluşan spinal baş ağrısında epidural kan yaması altın standart tedavidir. Sezaryen doğumlarda nöroaksiyel analjezi %93 oranında tercih edilmektedir. Genel anestezi indüksiyonunda en çok propofol ve süksinilkolin kullanılırken, aspirasyon riskini en aza indirmek için Sellick manevrası, rutin antiasit kullanımı ve uygun açlık süreleri hayati önem taşır.
Anesthesia practices in pregnancy carry various risks due to the slowing of gastric emptying during labor, which increases the risk of aspiration, alongside obstetric events such as placenta previa, abruptio placentae, and preeclampsia. Today, anesthesia-related maternal mortality rates have declined because general anesthesia is only preferred in emergency indications; the most common cause of mortality in general anesthesia is intubation failure, whereas deaths related to regional anesthesia are frequently caused by high spinal or epidural blocks. Labor pain and stress significantly increase the secretion of stress hormones that negatively affect uteroplasental circulation, which can be prevented via epidural analgesia. When neuroaxial methods cannot be utilized, systemic opioids like meperidine, butorphanol, nalbuphine, fentanyl, and remifentanil can be administered parenterally. Regional analgesia includes minor blocks such as pudendal and paracervical blocks, and major blocks like spinal, epidural, and combined spinal-epidural blocks. Local anesthetics can lead to central nervous system and cardiovascular toxicity. The most common complication of spinal block is hypotension caused by sympathetic blockade-induced vasodilation, which is treated with ephedrine; furthermore, epidural blood patch is the gold standard treatment for spinal headaches resulting from dural puncture. Neuroaxial analgesia is preferred in approximately 93% of cesarean deliveries. While propofol and succinylcholine are most frequently preferred for general anesthesia induction, the Sellick maneuver, routine antacid administration, and adequate fasting periods are vital to minimize the risk of aspiration.
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