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    The effects of solutions of hypertonic saline, hydraxyethyl starch and ringer lactate on hypotension before spinal or combined spinal epidural anesthesia in cesarean sections
    (AVES İbrahim KARA, 2007) Gülhaş N.; Kadir But A.; Köro?lu A.; Yapici E.; Erdil F.; Özean Ersoy M.
    Aim: We aimed to compare the effectiveness of different hydration fluids on prevention of maternal hypotension during spinal or combined spinal cpidural anaesthesia (CSEA). Materials and Methods: Sixty nine patients undergoing elective caesarcan section were included in the study. 3% Hypertonie saline solution (4 ml kg-1), 6% hydroxyethyl starch HES (5 mL kg -1) and lactated Ringer's solution (15 mL kg-1) were administered to Group HS (n=23), Group HES (n=23) and Group LR (n=23), respectively. The patients were performed CSEA with 0.5% hyperbaric bupivacainc 2.2 mL. For electrolyte measurements, serum samples were obtained before preloading the solutions and after CSEA, and from the umbilical cord after delivery. Results: There were no significant differences among the groups in the incidence of hypotension (in groups HS, HES, and LR, % 56, % 47, % 60, respectively) and the amount of ephedrine consumption. Maternal sodium, chloride and osmolarity values after preloading were higher in Group HS than in Group HES (p<0.05). Maternal glucose value after preloading was higher in Group LR than in Group HS and HES (p<0.05). Maternal potassium values were similar among groups. Sodium and nsmnlarity values of the umbilical cord were higher in Group HS than in Group HES and LR (p<0.05). The values of umbilical venous1 pH were similar among groups. Conclusion: Although the incidence of maternal hypotension and the amount of ephedrinc consumption were not different among the loading solutions, we hold the opinion that due to hypertonic saline may allow smaller preloading volume it may be an alternative.
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    Hemodynamic effects of bupivacaine and ropivacaine in cesarean section
    (AVES İbrahim KARA, 2006) Öztürk E.; But A.; Gülhaş N.; Begeç Z.; Do?an Z.; Yapici E.; Ersoy M.Ö.
    Aim: Local anesthetics for spinal aneaesthesia, provides a comfortable anaesthesia with their sensorial and motor block effect. However symphatic block causes hypotension in patients and this hypotension may cause nausea, vomiting and decrease in uterine blood flow, The purpose of this study is to compare the hemodynamic effects of equivalent doses of each ropivacainc and bupivaciane given intratecally in combination with fentanyl for elective cesarean section. Materials and Methods: Tthirty-six ASA I-II patients undergoing elective cesarean section were enrolled the study. After administration of 15 mL kg ringers lactate on sitting position combined spinal-epidural anesthesia performed. Patients randomly allocated in group B (n=18) (bupivacaine heavy 11 mg) and group R (n=18) (ropivacaine heavy 11 mg) and 25 ?g Fentanyl added to local anesthetics. Systolic arterial pressure (SAP), heart rate (HR) and sensorial block levels were recorded during the operation. Ephedrine infusion was used to obtaining a stable hemodynamia during the operation. Results: Total ephedrine infusion and total ephedrine consumption was greater in group R than in group B (p<0.01). SAP values at 2, 4, 6, 8, 10 min in Group B were significantly lower than baseline value (p<0.05). HR values at 2, 4, 6, 8, min in Group R were significantly higher compared to the baseline value (p<0.05). HR values were significantly higher than baseline value at all times except HR 20 in group B. Mean sensorial block level was (T6) in Group R and (T4) in Group B (p=0.001). Additional local anesthetic was administered the 8 patients in only group R through epidural catheter (p=0,001). No patients in group B needed to additional local anesthetics Conclusion: Lower sensorial block levels were obtained with ropivacaine when compared to the similar doses of bupivacaine. It was concluded that bupivacaine is more potent than ropivacaine in spite of opioid addition.