Anestéziológia a intenzívna medicína 1/2014

Vplyv celkovej anestézie na aktuálny stav matky a novorodenca pri cisárskom reze

MUDr. Lucia Fabušová Ondrová, MUDr. Stanislava Richterová, PhD., MUDr. Odona Fabušová, prof. MUDr. Ján Danko, CSc.

Cisársky rez patrí k najstarším pôrodníckym operačným metódam, jeho počet každoročne narastá. Moderná anestéziológia ponúka nové možnosti zlepšenia kvality pôrodu a profitovania z bezbolestného pôrodu v epidurálnej analgézii. Pri aplikácii akejkoľvek anestéziologickej techniky musíme vždy dbať na bezpečnosť matky a plodu a pamätať na možné riziká a komplikácie spojené s každou metódou. Naša práca je prospektívnou longitudinálnou štúdiou, do ktorej bolo zaradených 100 tehotných žien s jednoplodovou graviditou bez vážneho predchorobia. Tehotné boli rozdelené do dvoch skupín podľa priebehu pôrodu. V prvej skupine boli tehotné, ktoré porodili deti cisárskym rezom v celkovej anestézii z indikácie hypoxie plodu a v druhej skupine boli tehotné, ktoré porodili deti spontánne v epidurálnej analgézii. V obidvoch skupinách, v sledovanej aj kontrolnej, sme sa zamerali na meranie koncentrácie hypoxických parametrov u matky a plodu a na odhaľovanie možných rizík spojených s cisárskym rezom v celkovej anestézii. Na zhodnotenie priebehu pôrodu a na včasnú diagnostiku možných neonatálnych komplikácií sme stanovovali parametre acidobázy a krvných plynov. Naša štúdia sa zamerala aj na meranie hladín stresových hormónov, kortizolu, aldosterónu, ako aj prolaktínu, folátu a troponínu I u matky aj novorodenca. Výsledky meraní a laboratórnych analýz boli štatistiky vyhodnotené a porovnané medzi oboma skupinami tehotných. U žiadnej z tehotných, ani u novorodencov obidvoch skupín, sme nezaznamenali ťažkú hypoxiu. V našej práci sme nezistili negatívny vplyv celkovej anestézie na matku a novorodenca. Všetky rodičky rodiace cisárskym rezom v celkovej anestézii vykazovali normálny perioperačný aj postoperačný priebeh bez známok hypoxie. Novorodenci obidvoch skupín vykazovali primeranú adaptáciu v prvých minútach po pôrode.

Kľúčové slová: hypoxia, celková anestézia, cisársky rez, markery hypoxie, stresové hormóny.

Influence of general anesthesia on the current status of the mother and newborn during cesarean

Sectio cesarean belongs to the one of the oldest operation methods and the number of it grows intensively every year. Modern anesthesiology besides offering new possibilities of better quality of delivery presents a painless delivery by means of epidural analgesia. By means of application of any kind of anesthesiology technique it is necessary to take into consideration safety of mother and fetus as well as to have in mind any potential threat and complication regarding its use. The presented work is of a prospective and longitude character including investigation of 100 pregnant women with one fetus gravidity without any serious illnesses. Pregnant women were divided into two groups depending on the course of delivery. The first group included pregnant women who gave the birth by means of the total anesthesiology connected with the indication of fetus hypoxia. The second group included pregnant women who gave the birth spontaneously by means of epidural anesthesiology. During the examination and control stages in both groups the attention was paid on the measurement of hypoxia parameters regarding mother and fetus, and at the same time, we try to find out potential risks connected with the sectio cesarean which is done by using of total anesthesiology. Parameters of acid basis and blood gases were stated in order to prevent potential neonatal complications and for earlier diagnoses of hypoxia. Besides that, our study was concentrated on the measurement of the level of stress hormones as cortizol, aldosteron and hormones such as prolactin, folate and troponin I both regarding mother as well as neonates. Results of quantity measurement and laboratory analyses are statistically evaluated comparing both groups of pregnant women. There was no evidence of the serious hypoxia as regards of pregnant women and neonates in any of the examined groups. There were no negatives found out on the mother or neonates which might be caused by the application of the total anesthesiology. All women giving the birth by sectio cesarean applying total anesthesiology confirmed a normal preoperative as well as postoperative course without any observation of hypoxia. During the first minutes after the birth an acceptable adaptation was evident for neonates of both groups.

Keywords: hypoxia, total anesthesiology, sectio cesarean, hypoxia markers, stressful hormones.