The Relatıonshıp Between Abdominal Cırcumference And Columna Vertebralıs Length Wıth Intraoperatıve Hypotensıon In Cesarean Cases Wıth Spınal Anesthesıa

Abstract Introduction: Most pregnant women develop varying degrees of abdominal hypertension due to the enlarged uterus . Increased abdominal circumference and shorter columna vertebralis length have been found to be associated with increased with increased abdominal pressure and an enlarged uterus. We hypothesized that this was associated with the incidence of hypotension after spinal anesthesia. We conducted this study to investigate the relationship between abdominal circumference and columna vertebralis length and intraoperative hypotension in cesarean section operations under spinal anesthesia. Materials And Methods: This study was conducted in Gazi Yaşargil Training and Research Hospital, Obstetrics and Gynecology annex building as a prospective observational study after ethics committee approval. Patients who were 18 years of age or older, had elective cesarean section under spinal anesthesia, had ASA (American Society of Anesthesiologists) I-II, were over 150 cm tall, and had a term (37-42 weeks) singleton pregnancy were included in the study. High-risk pregnancies (placenta previa, abruptio placenta, eclampsia, preeclampsia), multiple pregnancies, patients with additional disease related to other systemic diseases including cardiovascular disease, patients with spinal anesthesia contraindications, and a total of 102 patients were included in the study. Abdominal circumference, columna vertebralis lengths, and symphysis-fundus distance were measured after the patients' name-surname, protocol number, age, height, weight, body mass index, gestational week, and parity values were recorded. The patients were seated and the standard 11 mg Heavy Marcaine injection rate was 1 mL/sec to each patient with a 26 G – 27 G Quincke spinal needle through the L3-L4 interspinous space. After the procedure, the patients were placed on the operating table in the supine position and the operating table was deviated 10 degrees to the left. Heart rate, mean arterial pressure and saturation were recorded as 1 minute values. Afterwards, the 3rd minute, 5th minute, 10th minute, 15th minute and 30th minute values were recorded. Sensory block examination was evaluated with pinprick test and motor block levels were evaluated with modified Bromage scoring and recorded. A decrease of 30% from the systolic blood pressure value measured before spinal anesthesia or a decrease in the systolic blood pressure value below 90 mmHg was considered as hypotension and 10 mg of ephedrine was administered simultaneously to all patients with hypotension. After surgery, newborn APGAR score, newborn weight, time to zero Bromage score, time until sensory blockage regressed to T10, and presence of nausea and vomiting were recorded. Results: A significant correlation was found between the length of the vertebral column and the level of sensory block in patients after spinal anesthesia. There is a significant relationship between the length of the columna vertebralis and the time elapsed until the sensory block level regresses to T10. There was no correlation between abdominal circumference and and symphysis fundus distance and hypotension. However, a significant relationship was found between abdominal circumference and nausea. Conclusıon: There are multiple mechanisms associated with intraoperative hypotension after spinal anesthesia. Abdominal circumference and columna vertebralis length are important parameters for measuring and providing prediction.