sakeisro kveTa:

arCevani

xuTidan erTi axalSobili ibadeba sakeisro kveTis

operaciis meSveobiT da sami aseTi SemTxvevidan

or SemTxvevaSi operacia ar aris winaswar

dagegmili. SesaZloa gagiCndeT survili

gadaxedoT mocemul buklets, maSinac ki

rodesac Tqven TviTon ar emzadebiT aseTi

operaciisTvis

Cesarean section:your choice of

anaesthesia

anesTeziis Tqveni

First Edition. March 2003 GEORGIAN \

bavSvis dabadeba aris dauviwyari STabeWdileba mSobiaroba sakeisro kveTis meSveobiT

SesaZloa iyos iseTive damakmayofilebeli da dadebiTi emociebis momtani, rogorc mSobiaroba bunebrivi gziT. Tu Tqven gWirdebaT sakeisro kveTa arc erT SemTxvevaSi ar unda CaTvaloT,rom ar gagimarTlaT. gaxsovdeT rom yvelaze mTavari Tqveni da Tqveni Svilis usafrTxoebaa. arsebobs situaciebi, rodesac swored sakeisro kveTa aris saukeTeso meTodi am usafrTxoebis uzrunvelsayofad.

Aarsebobs anesTeziis(gautkivarebis) ramodenime saxe sakeisro kveTis operaciis dros.Mmocemuli bukleti axsnis sxvadasxva variantebs. amasTan erTad, Tqven SegiZliaT gaakeToT anesTeziis arCevani Tqvens anesTeziologTan erTad. meanobaSi momuSave anesTeziologebi gvevlinebian eqimebad, romlebic specializebuli arian gautkivarebis da orsulTa da axalSobilTa usafrTxoebis sferoSi qirurgiuli Carevis dros.

xandaxan Tqveni sakeisro kveTis operacia SeiZleba winaswar iqnas dagegmili. Aamas ewodeba gegmiuri sakeisro kveTa. Ooperacia rekomendebulia, rodesac gvaqvs garTulebebis ganviTarebis momatebuli riski fiziologiuri mSobiarobis dros. Aamis erTerTi magaliTia iseTi SemTxveva,rodesac nayofs uWiravs araswori mdebareoba saSvilosnoSi orsulobis gvian vadaze. sxva SemTxvevebSi sakeisro kveTa keTdeba saswrafo CvenebiT, Cveulebriv ukve mSobiarobis procesSi. Ees aris e.w. gadaudebeli sakeisro kveTa. mocemuli operaciis Catareba SesaZloa saWiro gaxdes samSobiaro moqmedebis sisutis dros, nayofis mdgomareobis uecari gauaresebis SemTxvevaSi an am orive mizezis erTdroulad arsebobisas. Eeqimi mean-ginekologi TqvenTan erTad ganixilavs mizezebs, ris gamoc saWiroa sakeisro kveTa, miTxovs Tqvens Tanxmobas aRniSnul Carevaze.

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anesTeziis saxeebi arsebobs anesTeziis ori ZiriTadi

saxe: erT SemTxvevaSi pacientis cnobiereba naTelia(fxizladaa), meore SemTxvevaSi pacienti mZinare mdgomareobaSia. sakeisro kveTis operaciebis umravlesoba keTdeba e.w. regionaruli anesTeziiT. Aam dros qali fxizel mdgomareobaSia. misi sxeulis qveda naxevari muclis CaTvliT aris ugrZnobi tkivilis mimarT. aseTi anesTezia aris ufro usafrTxo, rogorc dedis aseve axalSobilisTvis. Uufro metic, igi aZlevs saSualebas dedas da bavSvis mamas(Tu mas aqvs mSobiarobaze daswrebis survili), erTad eziaron TavianTi pataris am qveynad movlinebis moments.

arsebobs regionaruli anesTeziis sami

saxe 1. spinaluri anesTezia-es meTodi yvelaze

ufro xSirad gamoiyeneba. Mmisi Sesruleba SeiZleba rogorc gegmiuri,aseve saswrafo sakeisro kveTis dros.zurgis tvinidan gamomavali nervebi imyofeba garsebis gansakuTrebul futliarSi, romelic Seicavs siTxes da yvelaferi es erTad mdebareobs xerxemlis arxSi. adgilobrivi saanesTezio saSualebis Seyvana xdeba swored am siTxiT savse futliarSi Zalin Txeli nemsis meSveobiT. spinaluri anesTezia dgeba ufro swrafad da moiTxovs saanesTezio saSualebis SedarebiT mcire dozas.

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2. epiduruli anesTezia-am SemTxvevaSi Txeli plastikuri milis(kaTeteris) Seyvana xdeba zemoT xsenebuli siTxiani futliaris gareT,sadac gadis nervebi, romlebic atareben saSvilosnodan momaval tkivilis impulsebs.

epiduruli anesTezia agreTve xSirad gamoiyeneba mSobiarobis

gautkivarebisaTvis. Aam dros ixmareba adgilobrivi saanesTezio

saSualebis dabali koncentraciis xsnarebi, Tu saWiroa sakeisro

kveTa epiduruli anesTeziis gaRrmaveba xdeba igive,magram ufro

maRali koncentraciis xsnaris SeyvaniT. spinalur anesTeziasTan SedarebiT

epidurul anesTezias Wirdeba analogiuri preparatis ufro didi doza da

misi moqmedeba viTardeba ufro nela. E epiduruli anesTezia SesaZloa gaRrmavdes

saanesTezio saSualebis damatebiTi doziT, Tuki aris amis

aucilebloba. 3.kombinirebuli spinalur-epiduruli anesTezia-

aris Serwyma ori zemoT aRniSnuli anesTeziis meTodis. spinaluri anesTezia gamoiyeneba saxeldobr sakeisro kveTis operaciis gautkivarebisTvis,xolo epiduruli-saWiroebis SemTxvevaSi preparatis damatebiTi dozis Sesayvanad,agreTve postoperaciul periodSi tkivilis kupirebisTvis

zogadi anesTezia (narkozi) Tu Tqven CagitardebaT zogadi anesTezia,Tqven geZinebaT operaciis msvlelobisas. dResdReobiT zogadi anesTezia(narkozi) sakeisro kveTis dros naklebad gamoiyeneba vidre es adre xdeboda. zogadi anesTezia SeiZleba saWiro gaxdes garkveul eqstremalur situaciebSi, rodesac regionaruli anesTezia ama Tu im mizezis gamo arasasurvelia an pacients urCevia eZinos operaciis dros.

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TiToeuli saxis anesTeziis Cvenebebi da ukuCvenebebi aRwerilia mocemul bukletSi. dasawyisSi,Cven vfiqrobT, TqvenTvis ukeTesi iqneba icodeT Tu rogor xdeba momzadeba sakeisro kveTisTvis da ra aris amisaTvis saWiro. winasaoperacio gamokvleva Tqven unda miakiTxoT saavadmyofos manamde, sanam uSualod operaciisTvis moTavsdebiT(hospitalizdebiT) klinikaSi. dasawyisSi Tqven gagsinjaven da gagikeTeben analizebs. Ggarda amisa mogiyvebian Tu ras unda elodeT da risTvis unda moemzadoT. aseTi gamokvlevis Semdeg bevri pacienti saxlSi midis da brundeba saavadmyofoSi dilas, operaciis dRes, magram xandaxan saWiroa saavadmyofoSi moTavseba operaciis wina saRamos. Tqven SesaZloa daginiSnon abebi kuWis wvenis mJavianobis dasaqveiTeblad da gulis revis Tavidan asacileblad. Aam abebis miReba saWiroa operaciis wina saRamos da operaciis dilas gamoRviZebisTanave. Tqven aucileblad agixsnian rogor miiRoT wamali. anesTeziologis gasinjva sakeisro kveTis operaciis win Tqven aucileblad gagsinjavT eqimi anesTeziologi. is gaecnoba Tqvens samedicino baraTs da Seagrovebs informacias gadatanili anesTeziebis mimdinareobis Sesaxeb, Tuki isini arsebobda. zogierT SemTxvevaSi SeiZleba saWiro gaxdes damatebiTi gamokvleva. Ggarda amisa anesTeziol;ogi TqvenTan erTad SearCevs anesTeziis meTods da gipasuxebT TqvenTvis saintereso SekiTxvebze.

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Ooperaciis dRes Mmeani kidev erTxel gadaamowmebs operaciis dros da darwmundeba imaSi,rom Tqven miiReT daniSnuli wamali. Operaciis dRes Tqven dagWirdebaT saoperacio aris gaparsva. majaze an wvivis midamoSi(koWTan) Tqven gagikeTeben samajurs,sadac miTiTebuli iqneba Tqveni saxeli. Bbebiaqali dagexarebaT specialuri windebis CacmaSi, romlebic Tavidan agacilebT qveda kidurebis venebSi Trombebis(sisxlis koltebis) warmoqmnas. Tqven mogcemen specialur perangs,romliTac gaemgzavrebiT saoperacioSi. survilis mixedviT bavSvis mamas SeuZlia daeswros mSobiarobis process. aseT SemTxvevaSi masac aZleven Sesabamis tansacmels. saoperacioSi Tqven sxeulze dagamagreben specialur sensorebs,raTa ganisazRvros arteriuli wneva, pulsi, sisxlis JangbadiT gajereba; yvelaferi es absoluturad umtkivneuloa. adgilobrivi saanesTezio saSualebiT kanis gautkivarebis Semdeg eqimi anesTeziologi venaSi SegiyvanT nems-kaTeters, dagidgamT wveTovans, ris Semdegac iwyeba uSualod anesTezia.

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ra moxdeba Tu TqvenTvis saWiro gaxda regionaruli anesTeziis Catareba

Tqven gTxoven dajdomas an dawolas gverdze

da zurgis maqsimalurad moxras.

anesTeziologi daamuSavebs zurgis kans

specialuri sadezinfeqcio xsnariT. Aam dros

Tqven SeigrZnobT sicives. Semdeg eqimi

moZebnis wertils welis midamoSi-Sua xazze

da igrZnobT msubuq Cxvletas,romelic keTdeba

kanis

spinaluri anesTeziis dros zurgSi xdeba Zalian Txeli nemsis Seyvana,rogorc wesi, es umtkivneuloa.zog SemTxvevaSi nemsis moZraobasTan erTad Tqven SeiZleba igrZnoT msubuqi Cxvleta romelime fexSi an gqondeT eleqtruli denis dartymismagvari SegrZneba,romelic

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vrceldeba fexis mimarTulebiT. Tqven aucileblad unda auwyoT eqims amis Sesaxeb, amasTan metnaklebad SeinarCunoT umoZraoba proceduris Sesrulebis dros. rogorc ki nemsi aRmoCndeba swor mdebareobaSi Seiyvanen adgilobriv saanesTezio saSualebas da damatebiT preparats,romelic xsnis tkivils. Cveulebriv mTeli procedura ikavebs ramodenime wuTs,magram zogjer ar aris advili nemsis swor poziciaSi Cayeneba mokle droSi. aseT SemTxvevaSi manipulacia grZeldeba SedarebiT metxans. Eepiduruli anesTeziis dros Ggamoiyeneba ufro msxvili nemsi, raTa misi meSveobiT moxdes kaTeteris(Txeli milis) Seyvana epidurul sivrceSi. rogorc spinaluri anesTeziisas, am SemTxvevaSic SesaZlebelia igrZnoT msubuqi Cxvleta an eleqtrodenis dartymis SegrZneba, romelic vrceldeba qveda kiduris mimarTulebiT. saWiroa SeinarCunoT umoZraoba,sanam anesTeziologi asrulebs manipulacias. rogorc ki moxdeba kaTeteris Seyvana eqimi dagrTavT nebas SeicvaloT pozicia. Tu Tqven ukve Seyvanili gaqvT kaTeteri ufro adre,mSobiarobis gautkivarebis mizniT, maSin sakeisro kveTis operaciis gasautkivareblad SeyavT wamlis ufro didi doza. iseT SemTxvevebSi, rodesac operacia imdenad saswrafoa,rom ar aris mosacdeli dro epiduruli anesTeziis efeqtis misaRebad,Tqven SeiZleba CagitardeT sxva saxis gautkivareba. spinaluri da epiduruli anesTeziis moqmedebis dawyebaze metyvelebs siTbos da simZimis SegrZneba qveda kidurebSi; agreTve dabuJeba,romelic TandaTan gavrceldeba zemoT,Tqveni sxeulis gaswvriv. eqimi anesTeziologi Seamowmebs ramdenad farTod gavrcelda gautkivarebis zona da xarT Tu ara mzad operaciisTvis.xandaxan kargi anesTeziis misaRebad saWiro xdeba sxeulis mdebareobis cvlileba.Tqven xSirad gagizomaven arteriul wnevas. Ooperaciis dawyebamde CagitardebaT

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Sardis buStis kaTeterizacia, raTa Tqveni Sardis buSti mudmivad iclebodes operaciis dros. kaTeteri dasaSvebia buStSi arsebobdes momdevno dilamde, igi ar SegiqmniT diskomforts, Tqven ar SewuxdebiT moSardvis dros. Ooperaciis dawyebamde Tqven dagawvenen zurgze da marcxena mxares qvemodan dagideben patara morgvs. Rebinebis SegrZnebis arsebobis SemTxvevaSi aucileblad unda gaafrTxiloT aneTeziologi.amis xSiri mizezia arteriuli wnevis daqveiTeba.eqimi dagexmarebaT da Caatarebs Sesabamis mkurnalobas. bavSvis amoyvanamde Tqven mogiwevT Jangbadis sunTqva specialuri saxis niRbis meSveobiT,raTa uzrunvelyofil iqnas nayofis normaluri momarageba JangbadiT.

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Ooperacia Ooperaciis dros gamoiyeneba specialuri farda,romelic yofs qirurgiuli Carevis zonas pacientis saxisgan. Aam dros anesTeziologi mudmivad imyofeba Tqvens gverdiT. Tqven SeiZleba moisminoT,Tu rogor emzadebian mean-ginekologebi operaciisTvis. Kkanis ganakveTi Cveulebriv keTdeba ramdenadme qvemoT bikinis xazisgan. Operaciis msvlelobisas Tqven SeiZleba igrZnoT zewola, magram ver igrZnobT tkivils. zogierTi pacienti am dros arsebul SegrZnebas ase gamoxatavs “TiTqos Signidan gbanen mucels.”anesTeziologi permanentulad Seafasebs Tqvens mdgomareobas operaciis dros da gaakeTebs damatebiT gautkivarebas Tuki es saWiro iqneba. iSviaTad Sesaloa gaCndes zogad anesTeziaze(narkozze) gadasvlis saWiroeba. Operaciis dawyebidan nayofis amoyvanamde dro sul raRac aTiode wuTs moicavs. dabadebisTanave bebiaqali pediatrTan erTad wmends da aTvalierebs axalSobils,ris Semdegac dedas(aseve mamas,Tuki iq imyofeba) SeuZliaT axalSobilis ayvana. Ddabadebis Semdeg venaSi SeyavT preparati-oqsitocini,raTa moxdes saSvilosnos SekumSva da placentis dabadeba.agreTve infeqciuri garTulebebis Tavidan asacileblad Tqven Segiyvanen antibiotiks. Ooperaciis dasrulebisTvis saWiroa daaxloebiT naxevari saaTi. Aamis Semdgom SeiZleba swor nawlavSi Seiyvanon sanTeli, gautkivarebis mizniT. rodesac operacia dasrulebulia Tqven migaRebineben naxevrad mjdomare mdgomareobas da gadagiyvanen palataSi,sadac gamoRviZebamde garkveuli periodis ganmavlobaSi xdeba Tqvenze dakvirveba. Aam dros bavSvi da Tqveni partniori dasaSvebia imyofebodnen Tqvens gverdiT. bavSvs awonian da Tqven SegiZliaT

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daiwyoT misi ZuZuTi kveba. palataSi yofnis dros preparatebi,romlebic Seyvanil iqna anesTeziis msvlelobisas TandaTanobiT wyveten TavianT moqmedebas,amis gamo SeiZleba gagiCndeT qveda kidurebSi Cxvletis SegrZneba,ramodenime saaTSi ki aamoZravebT fexebs. tkivilgamayuCebeli saSualebebi, romlebic Seiyvanes spinaluri an epiduruli anesTeziis dros imoqmedebs kidev ramodenime saaTs. gaafrTxileT bebiaqali rodesac dagWirdebaT damatebiTi gautkivareba.

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10

ra moxdeba im SemTxvevaSi, Tu Tqven

dagWirdebaT zogadi anesTezia(narkozi)? dasawyisSi mogcemen wamals kuWis wvenis mJavianobis dasaqveiTeblad da zogadi anesTeziis dawyebamde Cagidgamen kaTeters Sardis buStSi. Semdeg anesTeziologi gasunTqebT Jangbads niRbiT ramodenime wuTis ganmavlobaSi. rogorc ki qirurgTa brigada mzad iqneba muSaobisTvis anesTeziologi venaSi SegiyvanT wamals, romelic gamoiwvevs Zils. CaZinebamde anesTeziologis medda msubuqad dagaWerT xels yelze-wina nawilSi. Ees ileTi saWiroa kuWis mJave SigTavsis filtvebSi moxvedris Tavidan asacileblad. CageZinebaT Zalian swrafad,ris Semdegac Tqven Cagidgamen specialur mils traqeaSi(piridan), raTa Tavidan acilebul iqnas kuWis SigTavsis moxvedra filtvebSi da sanarkoze aparatis meSveobiT moxdes Tqveni sunTqvis SenarCuneba. anesTeziologi gaagrZelebs wamlebis Seyvanas,romlebic uzrunvelyofen Zilis gagrZelebas da bavSvis usafrTxod amoyvanas. O

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operaciis dasrulebisas Tqven gamoiRviZebT. SeiZleba igrZnoT diskomforti yelis midamoSi,traqeaSi milis arsebobis gamo,romelsac Semdeg amoiReben. Ggarda amisa SeiZleba gqondeT tkivili Wrilobis areSi,Zilianoba da gulis revis SegrZneba garkveuli drois manZilze.Tqven male daubrundebiT Cveul mdgomareobas,gadagiyvanen gamosaRviZebel palataSi,sadac SegiZliaT Tqveni partnioris da axalSobilis naxva.Tqven SemogTavazeben specialur aparats-e.w. “pacientis mier kontrolirebadi gautkivareba”,romelic uzrunvelyofs tkivilis kupirebas Rilakze daWeris meSveobiT, roca Tqven es dagWirdebaT. Tu aseTi mowyobiloba ar arsebobs Tqven aucileblad eubnebiT bebiaqals tkivilis arsebobis SemTxvevaSi.

Ggarkveuli mizezebi,romelTa drosac upiratesoba eniWeba narkozs

dgomareobebi, romalTa drosac darRveulia sisxlis Sededeba. Aam dros ar aris sasurveli regionaruli anesTezia.

Tu operacia imdenad saswrafoa,rom ar aris dro regionaruli anesTeziis Casatareblad.

xerxemlis deformaciebi an zurgis midamos daavadebebi,romlebic arTuleben an SeuZlebels xdian regionaruli anesTeziis Catarebas.

iseTi iSviaTi SemTxvevebi,rodesac spinalurma da epidurulma anesTeziam ar mogvca saWiro efeqti.

Ggautkivareba operaciis Semdeg Aarsebobs rigi meTodebisa sakeisro kveTis operaciis Semdgomi tkivilebis Tavidan asacileblad:

regionaruli: meTodebi-spinaluri an epiduruli anesTeziis dros dasawyisSi SeiZleba gamoyenebul iqnas xangrZlivi moqmedebis tkivilgamayuCebeli preparatebi.

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zogierT pacients utoveben epidurul

kaTeters operaciis Semdgomi gautkivarebis warmoebisaTvis.

sanTlebi,romlebic Tavsdeba swor

nawlavSi operaciis bolos.

Mmorfinis an misi msgavsi preparatis Seyvana kunTSi.

intravenuri gadasxmis sistemis

meSveobiT wveTebis raodenobis da Sesabamisad preparatis dozis regulireba.(pacientis mier kontrolirebadi gautkivareba).

tabletirebuli saxiT bebiaqalma

SesaZloa mogceT diklofenaki an paracetamoli.

regionaruli anesTeziis upiratesoba narkozTan SedarebiT

spinaluri da epiduruli anesTezia

usafrTxoa TqvenTvis da Tqveni bavSvisTvis;

gaqvT saSualeba SeigrZnoT bavSvis

dabadebis wuTebi;

Tqven ar geqnebaT Zilianoba operaciis Semdeg;

saSualeba geZlevaT ufro adre daiwyoT bavSvTan urTierToba da misi ZuZuTi kveba;

saSualeba gaqvT ukeTesad

uzrunvelyoT operaciis Semdgomi gautkivareba;

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regionaruli anesTeziis naklovanebebi narkozTan SedarebiT

spinalur da epidurul anesTezias

SeuZlia gamoiwvios arteriuli wnevis daqveiTeba,Tumca mkurnaloba am SemTxvevaSi ar aris rTuli;

regionuli anesTeziis Sesrulebas

Wirdeba ufro meti dro,vidre pacientis daZinebas zogadi anesTeziis dros;

garkveul SemTxvevebSi regionuli

anesTeziis Semdeg SeiZleba aRiniSnos araswori siarulis manera;

iSviaTad regionuli anesTezia

SeiZleba iyos uefeqto da saWiro gaxdes gadasvla zogad anesTeziaze;

regionulma anesTeziam garda amisa SeiZleba kidev gamoiwvios:

fexis areSi dabuJebis an Cxvletis SegrZneba(ufro xSirad spinaluri anesTeziis dros).es SeiZleba aReniSnos 10000-dan erT pacients da gagrZeldes ramodenime kviris an Tvis manZilze.

kanis qavili operaciis dros,

romelic emorCileba mkurnalobas .

Tavis tkivili (1000-dan erT pacientze an ufro iSviaTad), agreTve eqvemdebareba mkurnalobas;

adgilobrivi mtkivneuloba zurgis

midamoSi Cxvletis adgilas,romelic grZeldeba ramodenime dRes. amaSi araferi uCveulo ar aris.

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Aarc spinaluri da arc epiduruli anesTezia ar iwvevs qronikul tkivils zurgis areSiG

samwuxarod zurgis areSi tkivilebi xSirad awuxebT qalebs mSobiarobis Semdgom periodSi, gansakuTrebiT maSin,rodesac am simptomebs adgili hqonda orsulobamde an orsulobis periodSi. Tumca spinaluri da epiduruli anesTezia ar aZlierebs am tkivilebs

sakeisro kveTiT bavSvis dabadeba usafrTxoa da SeiZleba iyos dadebiTi emociebis wyaro. bevri qali irCevs yofnas naTeli cnobierebis pirobebSi am operaciis dros,sxvebs ki WirdebaT narkozi zemoT ganxiluli mizezebis gamo.Cven vimedovnebT,rom es bukleti dagexmarebaT gaakeToT Tqveni gacnobierebuli arCevani anesTeziis meTodisa sakeisro kveTis operaciis dros.

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bibliografia: sakeisro kveTa regionaluri anesTeziiT: Kennedy BW, Thorp JM, Fitch W, Millar K. The theatre environment and the awake patient. J Obstet Gynaecol 1992;12:407-411. Ying LC, Levy V, Shan CO, Hung TW, Wah WK. A qualitative study of the perceptions of Hong Kong Chinese women during caesarean section under regional anaesthesia. Midwifery 2001;17:115-22. anesTeziis sxvadasxva meTodis SedarebiTi Sefaseba: Shibli KU, Russell IF. A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anesth 2000; 9: 160-7. Riley ET, Cohen SE, Macario A, Desai JB, Ratner EF. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg 1995;80:709-12. Davies SJ, Paech MJ, Welch H, Evans SF, Pavy TJG. Maternal experience during epidural or combined spinalepidural anesthesia for cesarean section: a prospective randomized trial. Anesth Analg 1997;85:607-13. Morgan PJ, Halpern S, Lam-McCulloch J. Comparison of maternal satisfaction between epidural and spinal anesthesia for elective Cesarean section. Can J Anaesth 2000;47:956-61. anesTeziis gavlena nayofze: Marx GF, Luykx WM, Cohen S. Fetal-neonatal status following caesarean section for fetal distress. Br J Anaesth 1984; 56: 1009-1013. Abboud TK. Nagappala S. Murakawa K et al. Comparison of the effects of general and regional anesthesia for cesarean section on neonatal neurologic and adaptive capacity scores. Anesth Anal 1985; 64: 996-1000. Ong BY, Cohen MM, Palahniuk RJ. Anesthesia for Cesarean section - effects on neonates. Anesth Analg 1989;68:270-5. Evans CM, Murphy JF, Gray OL, Rosen M. Epidural

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versus general anaesthesia for elective Caesarean section. Effect on Apgar score and acid-base status of the newborn. Anaesthesia 1989;44:778-82. Mahajan J, Mahajan RP, Singh MM, Anand NK. Anaesthetic technique for elective caesarean section and neurobehavioural status of newborns. Int J Obstet Anesth 1993;2:89-93. Hodgson CA. Wauchob TD. A comparison of spinal and general anaesthesia for elective caesarean section: Effect on neonatal condition at birth. Int J Obstet Anesth 1994; 3: 25-30. Ratcliffe FM, Evans JM. Neonatal wellbeing after elective caesarean delivery with general, spinal and epidural anaesthesia. Eur J Anesthesiol 1998; 10: 175-81. Kolatat T. Somboonnanonda A. Lertakyamanee J. Chinachot T. Tritrakarn T. Muangkasem J. Effects of general and regional anesthesia on the neonate (a prospective, randomized trial). J Med Assoc Thailand 1999; 82: 40-5. Dick W, Traub E, Kraus H, Tollner U, Burghard R, Muck J. General anaesthesia versus epidural anaesthesia for primary Caesarean section: A comparative study. Eur J Anaesthesiol 1992;9:15-21. gautkivareba sakeisro kveTis operaciis Semdgom: Morrison J D, McGrady E M. Postoperative pain relief. Chapter in: Reynolds F (ed). Regional analgesia in obstetrics: a millenium update. London: Springer- Verlag, 2000. Graham D, Russell IF. A double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with spinal anaesthesia for elective caesarean section. Int J Obstet Anesth 1997; 6: 224-30. Husaini SW, Russell IF. Intrathecal diamorphine compared with morphine for postoperative analgesia after Caesarean section under spinal anaesthesia. Br J Anaesth 1998;81:135-9. Van de Velde M. What is the best way to provide postoperative pain therapy after caesarean section? Curr Opinion Anaesthesiol 2000;13:267-70.

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anesTeziis garTuleba: Tavis tkivili: Reynolds F. Dural puncture and headache. Chapter in: Reynolds F (ed). Regional analgesia in obstetrics: a millenium update. London: Springer-Verlag, 2000. zurgis tkivili: Russell R, Reynolds F. Back pain, pregnancy and childbirth. [Editorial]. Br Med J 1997;314:1062-3. Nerve damage: Holdcroft A, Gibberd FB, Hargrove RL, Hawkins DF, Dellaportas CI. Neurological complications associated with pregnancy. Br J Anaesth 1995;75:522-6. Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetric regional anaesthesia. Int J Obstet Anesth 2000: 9, 99-124. Paech MJ, Godkin R, Webster S. Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10,995 cases. Int J Obstet Anesth 1998;7:5-11. damatebiT: Reynolds F (ed). Regional analgesia in obstetrics: a millennium update. London: Springer-Verlag, 2000. Russell R, Porter J, Scrutton M. Pain Relief In Labour. Ed F Reynolds. London: BMJ Publishing, 1997.

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madlierebis niSnad

informacias, romelsac Seicavs es bukleti gaaCnia sarwmuno mtkicebulobiTi baza; publikaciebi, romlebzec dafuZnebulia es gamocema, motanilia bolo sam furcelze da Sedgenilia “sameano anesTeziologTa asociaciis” sainformacio komitetis wevrebis mier: Dr Michael Wee (chairman), Prof Felicity Reynolds,

Dr Michael Bryson, Mrs Carol Bates (RCM representative),

Mrs Cathy Groeger (AIMS representative), Mrs Christina

Campbell (Consumer representative), Mrs Shaheen

Chaudhry (Consumer representative), Dr Michael Kinsella,

Dr Geraldine O’Sullivan, Dr Roshan Fernando.

damatebiTi informacia moipoveba internetis qselSi Semdeg misamarTze:

www.youranaesthetic.info

sameano anesTeziologTa asociaciis

mier Seqmnilia videofilmi saxelwodebiT-“Your anaesthetic for Caesarean section”,romelic warmoadgens mocemuli gamocemis damatebas.

Bbukletis egzemplarebis saWiro raodenoba da videofilmi SegiZliaT SeukveToT sameano anesTeziologTa asociaciis samdivnoSi saitis meSveobiT:

www.oaa-anaes.ac.uk

an misamarTze: OAA Secretariat PO Box 3219, Barnes London SW13 9XR Tel: +44 (0)20 8741 1311 Fax: +44 (0)20 8741 0611 E-mail: secretariat@oaa-anaes.ac.uk

pirveli redaqcia 2003 wlis marti