Gebelikte Meydana Gelen Fizyolojik Değişiklikler ve Obstetrik Anestezi Yönetimi
Synopsis
During pregnancy, significant anatomical and physiological changes occur in the maternal respiratory, cardiovascular, gastrointestinal, urinary, hematological, and endocrine systems to support the nutrition and development of the growing fetus. In the respiratory system, oxygen consumption and minute ventilation increase while functional residual capacity decreases, leading to a state of mildly compensated respiratory alkalosis. In the circulatory system, activation of the Renin-Angiotensin-Aldosterone system increases blood volume, plasma volume, heart rate, and cardiac output, whereas mean blood pressure decreases. Decreased gastrointestinal motility results in reflux and a three-fold increased risk of aspiration. In the urinary system, renal blood flow and glomerular filtration rate rise significantly, while in the hematological system, relative anemia due to increased plasma volume and an elevated risk of venous thromboembolism due to increased clotting factors are observed. Additionally, hormonal changes in the pituitary, thyroid, and adrenal glands affect insulin resistance and glucose metabolism. In obstetric anesthesia management, general and regional anesthesia methods are utilized. Although general anesthesia offers the advantage of rapid induction in emergency situations such as fetal distress, it carries disadvantages including an eight-fold increased risk of difficult intubation and a higher aspiration risk in pregnant patients. Therefore, in cases without contraindications, regional anesthesia techniques—such as spinal, epidural, or combined spinal-epidural anesthesia—should be primarily preferred as they ensure maternal and fetal safety, effective pain control, and minimal drug toxicity.
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