IS HYPOTHERMIA PREVENTABLE DURING CESAREAN SECTION UNDER SPINAL ANESTHESIA?

SPİNAL ANESTEZİ İLE SEZARYEN AMELİYATI UYGULANAN GEBELERDE HİPOTERMİ ÖNLENEBİLİR Mİ?

Abstract

Objective: To investigate the effect of different active warming methods on maternal hypothermia in pregnants undergoing elective cesarean section with spinal anesthesia, and to determine the conditions that may develop secondary to hypothermia in mothers and newborns. Method: This prospective study was performed at an academic tertiary healthcare unit between May 2012 and December 2014. Healthy pregnants who were scheduled to undergo cesarean section under spinal anesthesia consisted the study group. A total of 84 healthy parturients involved in the study. They were randomly assigned to receive either forced-air warmer (Group B) or warmed intravenous (IV) fluid (Group M) or both (Group BM). Core temperature measured at the tympanic membrane, and hypothermia was accepted as a body core temperature below 35°C. Results: Demographic, obstetric, and surgical features were similar between study groups (p>0.05). None of the patients was hypothermic throughout the study. Core temperature was significantly higher in Group BM at all measurements (p=0.001). Thermal comfort scores were more stable in Group BM (minimum-maximum: 94-100) ( p=0.026). There were no differences in the incidence of intraoperative shivering between study groups. Conclusion: This study has demonstrated that the patients had less heat loss and were more comfortable after cesarean delivery with the combined application of both forced air warming and warmed IV fluids.

Özet

Amaç: Spinal anestezi ile elektif sezaryen uygulanan gebelerde farkl› ›s›tma yöntemlerinin maternal hipotermiye olan etkisini araflt›rmak; annede ve yenido¤anda hipotermiye ikincil geliflebilecek durumlar› ortaya koymak ve söz konusu ›s›tma yöntemlerini karfl›laflt›r›larak de¤erlendirmek. Yöntem: May›s 2012 ile Aral›k 2014 tarihleri aras›nda üçüncü basamak akademik sa¤l›k kurumunda gerçeklefltirilen bu prospektif çal›flmaya elektif sezaryen ile do¤um endikasyonu konulan ve spinal anestezi uygulamas›n› kabul eden miyad›nda gebeler dahil edildi. Toplam 84 sa¤l›kl› gebe çal›flmaya al›nd› ve gebeler rastgele olarak hava üflemeli ›s›tma sistemi ile ›s›t›lan (Grup B), intravenöz (IV) s›v›lar› ›s›t›larak verilen (Grup M) ve hava üflemeli ›s›tma sistemi uygulan›rken ayn› zamanda IV s›v›lar› da ›s›t›lan (Grup BM) olmak üzere 3 gruba ayr›ld›. S›cakl›k ölçümleri timpanik yol ile yap›ld› ve 35°C’nin alt› hipotermi olarak kabul edildi. Bulgular: Demografik, obstetrik ve cerrahi özellikler bak›m›ndan gruplar aras› fark yoktu (p>0.05). Hastalarda hipotermi izlenmezken, BM grubu tüm vücut ›s›s› ölçümlerinde daha yüksek de¤erlere sahipti (p=0.001). BM grubunda ›s› konfor vizüel analog skalas› (VAS) skoru daha stabil seyrederken (minimum-maksimum: 94-100) (p=0.026), intraoperatif titreme insidans› gruplar aras›nda farkl›l›k göstermedi. Sonuç: Bu çal›flma ile hava üflemeli ›s›tma sistemi ve IV s›v›lar›n ›s›t›larak kullan›m›n›n birlikte uygulanmas› ile gebelerin cerrahi sonras› dönemde daha az ›s› kayb›na u¤rad›klar› ve daha konforlu olduklar› gösterilmifltir.