Abstract
Amaç: Her
yıl gebe kadınların %1-2’si gebelik dışı nedenlerle operasyon
geçirir. Gebelik esnasında en sık gebelik dışı cerrahi
müdahaleye gerek duyulan hastalık apandisittir. Gebede gelişen
fizyolojik değişiklikler nedeniyle cerrahi ve anestezi
prosedürlerine cevap anne ve fetüs açısından riskler içerir.
Biz bu çalışmada gebelik sırasında obstetrik dışı cerrahi
müdahale için en uygun anestezi yönetimini ve komplikasyonlar
açısından dikkat edilmesi gerekenler etkenleri incelemeyi
hedefledik.
Materyal
ve Metod: Ocak
2012- Eylül 2015 yılları arasında hastanemize başvuran gebe
olup apandisit teşhisi konulan hastalar retrospektif olarak
incelendi. Hastaların anestezi yöntemleri, anestezi yönetimi,
fetal ve maternal komplikasyonlar kaydedildi.
Bulgular: Kayıtlar
incelendiğinde 2012 ocak ve 2015 eylül tarihleri arasında gebe
olup karın ağrısı ile hastaneye başvuran ve apandisit teşhisi
alan 19 hasta olduğu gözlendi.19 hastanın 17 tanesine
apendektomi operasyonu yapılmış olduğu görüldü. Apendektomi
yapılan olguların 4 tanesine spinal anestezi yapıldığı, 13
hastanın ise genel anestezi aldığı gözlendi.
17
hastanın 16 sında anne ve bebek açısından sorun çıkmazken 31
haftalık gebeliği olan bir olgunun 4 gün sonra preterm eylem
nedeniyle sezaryana alındığı ve sağlıklı bir bebek dünyaya
getirdiği kayıtlardan anlaşıldı. 17 hastanın bir tanesinin 37
hafta gebelik sırasında apandisit tanısıyla genel anestezi
altında sezaryana alındığı ve sezaryan sonrasında apendektomi
operasyonunun yapılmış olduğu görüldü.
Sonuç: Gebe
hastalarımızda gebelik dışı cerrahi gerektiğinde anne ve
fetüs açısından komplikasyonları önlemek için hazırlıkların
ve değerlendirmenin çok iyi yapılması anne ve bebeğin
perioperatif ve postoperatif çok iyi takip edilmesi gerekmektedir.
Keywords
References
- 1. Naughton NN, Cohen SE. Nonobstetric surgery during pregnancy. En: Chestnut DH, editor. Obstetric anesthesia: Principles and practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004: 255-72.
- 2. Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med 2011; 32: 1–13. 3. Van De, Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol 2007; 73: 235–40. 4. Visser BC, Glasgow RE, Mulvihill KK, Mulvihill SJ. Safety and timing of nonobstetric abdominal surgery in pregnacy. Dig Surg. 2001; 18: 409-17.
- 5. Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol 2009; 52: 586-96.
- 6. Cheek TG, Baird E. Anesthesia for nonobstetric surgery: maternal and fetal considerations. Clin Obstet Gynecol 2009; 52: 535-45. 7. Al-Qudah MS, Amr M, Sroujieh A, Issa A. Appendectomy in pregnancy: the experience of a university hospital. J Obstet Gynaecol 1999; 19: 362–4.
- 8. Kuczkowki KM. Nonobstetric surgery in the paturient anesthesic consideration. J Clin Anesth 2006; 18: 5-7.
- 9. Fanzago E. Anesthesia for nonobstetric surgery in pregnant patients.Minerva Anestesiol 2003; 69: 416-27.
- 10. ACOG Committee on obstetric practice. Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104: 647–51. 11. Barron WM. Medical evaluation of the pregnant patient requiring non-obstetric surgery. Clin Perinatol 1985; 12: 481–96.
- 12. Bajwa SJ, Bajwa SK. Anaesthetic challenges and management during pregnancy: Strategies revisited Anesth Essays Res 2013; 7: 160–7.
- 13. Goodman S. Anaesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol. 2002; 26: 136–45.
Abstract
Objective: Every
year, 1-2% of pregnant women undergo non-obstetric surgery.
Appendicitis is the most frequent non-obstetric disease requiring
surgery during pregnancy. Because of the physiological
changes of pregnancy, response to surgical and anesthetic procedures
carry risks for mother and fetus. In this study, we aimed to
investigate the most appropriate anesthetic technique for management
of non-obstetric surgery and the
factors that should be considered in terms of complications.
Material
and Method: Pregnant
patients diagnosed with appendicitis between January 2012 and
September 2015 were retrospectively investigated. Anesthetic
techniques, anesthetic management, fetal and maternal complications
were recorded.
Results: In
hospital records between January 2012 and September 2015, 19 patients
were diagnosed with appendicitis among pregnant patients who referred
to the hospital with abdominal pain. 17 patients had appendectomy.
Four of the appendectomy cases were operated under spinal anesthesia
and 13 patients were operated under general anesthesia. In 16
patients, no maternal or fetal complication was observed. One patient
who had appendectomy under general anesthesia at 31weeks of gestation
underwent caesarean section 4 days after surgery because of preterm
labor and a healthy baby was born. One out of 17 cases with
appendectomy was at 37 weeks of gestation and she has appendectomy
after caesarean delivery.
Conclusion: When
non-obstetric surgery is needed in pregnant patients, to prevent
maternal and fetal complications preoperative preparation and
evaluation should be done properly and mother and fetus should be
observed closely in the perioperative and postoperative period.
Keywords
References
- 1. Naughton NN, Cohen SE. Nonobstetric surgery during pregnancy. En: Chestnut DH, editor. Obstetric anesthesia: Principles and practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004: 255-72.
- 2. Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med 2011; 32: 1–13. 3. Van De, Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol 2007; 73: 235–40. 4. Visser BC, Glasgow RE, Mulvihill KK, Mulvihill SJ. Safety and timing of nonobstetric abdominal surgery in pregnacy. Dig Surg. 2001; 18: 409-17.
- 5. Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol 2009; 52: 586-96.
- 6. Cheek TG, Baird E. Anesthesia for nonobstetric surgery: maternal and fetal considerations. Clin Obstet Gynecol 2009; 52: 535-45. 7. Al-Qudah MS, Amr M, Sroujieh A, Issa A. Appendectomy in pregnancy: the experience of a university hospital. J Obstet Gynaecol 1999; 19: 362–4.
- 8. Kuczkowki KM. Nonobstetric surgery in the paturient anesthesic consideration. J Clin Anesth 2006; 18: 5-7.
- 9. Fanzago E. Anesthesia for nonobstetric surgery in pregnant patients.Minerva Anestesiol 2003; 69: 416-27.
- 10. ACOG Committee on obstetric practice. Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104: 647–51. 11. Barron WM. Medical evaluation of the pregnant patient requiring non-obstetric surgery. Clin Perinatol 1985; 12: 481–96.
- 12. Bajwa SJ, Bajwa SK. Anaesthetic challenges and management during pregnancy: Strategies revisited Anesth Essays Res 2013; 7: 160–7.
- 13. Goodman S. Anaesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol. 2002; 26: 136–45.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | April 4, 2018 |
| Published in Issue | Year 2018 Volume: 49 Issue: 1 |
