Anaesthesia for Caesarean section: Regional anaesthesia

Operative Complications ◽

Spinal Epidural ◽

The Relationship

Regional anaesthesia is the technique of choice for CS, provided no contra-indications exist. The relationship between increased use of regional techniques and decreased maternal mortality is well recognized, with evidence suggesting it to be 16 times safer than GA. The use of three commonly practised techniques; epidural top-up, spinal, and combined spinal–epidural anaesthesia are described in detail in this chapter. Pain during CS surgery is the most common complaint and litigation made against obstetric anaesthetists. The importance and conduct of thorough block assessment prior to commencement of surgery and its documentation is emphasized with a ‘top tips’ list. Management of a failed block is described for all three techniques, together with strategies to treat common intra-operative complications e.g. hypotension and respiratory difficulty.

Comparison of effect of isobaric bupivacaine vs hyperbaric bupivacaine on haemodynamic variables in thorcic combined spinal epidural anaesthesia for laparoscopic cholecystectomies

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184056 ◽

2018 ◽

Vol 6 (10) ◽

pp. 3413

Author(s):

Loveleen Kour ◽

Kuldip C. Gupta

Keyword(s):

General Anaesthesia ◽

Spinal Anaesthesia ◽

Epidural Anaesthesia ◽

Regional Anaesthesia ◽

Hyperbaric Bupivacaine ◽

Group I ◽

Operative Complications ◽

Lumbar Spinal ◽

Background: Regional anaesthesia has always been an attractive option for laparoscopic surgeries in patients who are not fit for general anaesthesia. Also, regional anaesthesia has certain advantages over general anaesthesia like lesser oropharyngeal morbidity, lesser blood loss and decreased chances of thrombosis. Lumbar spinal anaesthesia has been synonymous with the term regional anaesthesia for laparoscopic surgeries for quite some time now. In the light of recent works by Imbelloni and Zundert, thoracic spinal anaesthesia has been shown to be a promising alternative not only for healthy patients but for high risk patients as well. Baricity defines the density of the drug with respect to CSF density. This undoubtedly makes it is one of the most important factors that influence drug distribution in the subarachnoid space. Drugs of differing baricities have been studied previously in lumbar spinal anaesthesia. We aimed at studying the behaviour of isobaric and hyperbaric bupivacaine using a different approach which in this study was thoracic combined spinal epidural anaesthesia. Authors evaluated the haemodynamic changes as well as neurological and any other post operative complications that occurred in any of the patients.Methods: There were 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy who were chosen for this study. They were randomly divided into two equal groups - group I and group H. Thoracic combined spinal epidural anaesthesia (CSE) was performed at T9-T10 / T10-T11 interspace. Patients in group I received 1.5ml of isobaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl and group H patients were given 1.5ml of hyperbaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl.Results: There was no significant difference among the haemodynamic variables between the two groups and no neurological complication was seen in any patient.Conclusions: Thoracic combined spinal epidural anaesthesia allows haemodynamic stability in laparoscopic cholecystectomies with minimal neurological and post operative complications irrespective of baricity of the drug used.

Combined spinal-epidural anaesthesia for Caesarean section in a paraplegic woman: difficulty in obtaining the expected level of block

European Journal of Anaesthesiology ◽

10.1046/j.1365-2346.2000.00682.x ◽

2000 ◽

Vol 17 (5) ◽

pp. 329-331 ◽

Cited By ~ 2

Author(s):

M. Agostoni ◽

E. Giorgi ◽

P. Beccaria ◽

A. Zangrillo ◽

G. Valentini

Keyword(s):

Caesarean Section ◽

Epidural Anaesthesia ◽

Combined spinal-epidural anaesthesia for urgent caesarean section in a parturient with Stevens-Johnson syndrome

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2016.12.002 ◽

2017 ◽

Vol 30 ◽

pp. 78-79 ◽

Cited By ~ 2

Author(s):

A. Ahiskalioglu ◽

A.M. Yayik ◽

O.D. Erguney ◽

E.O. Ahiskalioglu ◽

H.A. Alici

Keyword(s):

Caesarean Section ◽

Epidural Anaesthesia ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Effect of pre-administration with aminophylline on the occurrence of post-dural puncture headache in women undergoing caesarean section by combined spinal-epidural anaesthesia

Journal of International Medical Research ◽

10.1177/0300060518803231 ◽

2018 ◽

Vol 47 (1) ◽

pp. 420-426

Author(s):

Chao-Jie Yang ◽

Tao Chen ◽

Xin Ni ◽

Wan-You Yu ◽

Wei Wang

Keyword(s):

Side Effects ◽

Caesarean Section ◽

Epidural Anaesthesia ◽

Dural Puncture ◽

Demographic Data ◽

Operation Time ◽

Post Dural Puncture Headache ◽

Group A ◽

Objective To investigate the effect of the pre-administration with aminophylline on the occurrence of post-dural puncture headache (PDPH) in women undergoing caesarean section by combined spinal-epidural anaesthesia (CSEA). Methods The study enrolled women undergoing elective caesarean sections with CSEA and randomly allocated them into two groups; for 30 min immediately after the infant was delivered, group A received 250 mg aminophylline intravenously and group B received an equal volume of normal saline. Demographic data, operation time, intraoperative blood loss, intraoperative transfusion volume and the occurrence of PDPH during the first 7 days after the operation were recorded. Side-effects such as hypersensitivity, convulsion and arrhythmia were also recorded in the patients and infants in group A within 24 h after aminophylline administration. Results A total of 120 patients aged 24–38 years (pregnancy range, 38–42 weeks) were randomly allocated into two groups ( n = 60). The incidence of PDPH in group A was significantly lower than group C (two of 59 [3.4%] versus 10 of 58 [17.2%], respectively). There were no related side-effects within 24 h after aminophylline administration in group A. Conclusions Intraoperative intravenous infusion of 250 mg aminophylline reduced the incidence of PDPH after caesarean section under CSEA with no side-effects.