Obstetrik Anestezide; Spinal Anestezi Eğitiminde Ultrason Kullanımının Değerlendirilmesi

Abstract

KAYBAL O. Evaluation of the Use of Ultrasound in Spinal Anesthesia Education for Obstetrics Anesthesia, Hacettepe University Medical Faculty, Department of Anesthesiology and Reanimation, Residency Thesis, Ankara, 2020. Obstetric patients are a specific patient group in terms of neuroaxial block interventions compared to other patient groups. Pre-operational ultrasonographic imaging ensures more accuracy and less needle interventions by providing reliable and correct information for successful neuroaxial localization such as fixing the midline, deciding on optimal interstitial spaces. In this study; we aimed to assess benefits of lumbar ultrasound (USG) use during spinal anesthesia training for obstetrics anesthesia to be involved with the training schedule in terms of a successful spinal anesthesia implementation. 120 patients were involved to this randomized and prospectively planned study in ASA II-III group with singleton pregnancy to which elective caesarean operation is implemented under spinal anesthesia. Two anesthesia assistants with different seniority given lumbar USG training participated in the study. Patients involved in the study; were divided into 4 groups as ultrasonography group (UG) and palpation group (PG) for both participants. These groups; were evaluated in terms of success of both methods, effect of the seniority on success, palpation difficulty level, entry level, total number of entries, number of needle orientation, needle insertion time, block success, Visual Analogue Scale (VAS) difficulty level, complication development and patient satisfaction levels. It was identified that the most significant factor affecting the block success is increased body weight and body mass index as independent from anesthesia experience and the method implemented. In both methods no difference was observed between two implementers in terms of entry level, total number of entries, and number of needle orientation, needle insertion time, block level, need for additional analgesics, block success, complication development VAS difficulty scale and patient satisfaction levels. With sufficient training and experience, it has been shown that palpation method is as successful as the application with USG. Training activities involving more and different seniority assistants should be planned in order to demonstrate applicability of spinal USG training to assistants with different seniorities. Key Words: Spinal anesthesia, ultrasound, cesarean delivery, obstetric anesthesia