Effects of Delayed Supine Positioning after Induction of Subarachnoid Block on Post-spinal Hemodynamic Changes Compared to Traditional Subarachnoid Block: prospective observational randomized controlled dose response clinical study

Abstract Background This is a prospective observational study to examine if the delayed supine positioning after induction of subarachnoid block will be of value in minimizing hemodynamic derangement following subarachnoidblock for knee Arthroscopein the teaching hospital of Misr University for science and technology Methods Fifty healthy patients are undergoing knee Arthroscope under spinal Anesthesia were randomized into 2 groups Group A(immediate supine position after Subarachnoid block) and Group B (delayed supine position after Subarachnoid block by 2.5 minutes) each group includes 25 patients. After the injection of local anaesthetic, Heart rate (HR), non-invasive blood pressure (Systolic Blood pressure (SBP), diastolic Blood pressure (DBP) and mean blood pressure(MBP)) were measured at 3 min intervals for the first 15 min following administration of local anaesthetic, and then every 5 min until completion of the surgical intervention. Results Hemodynamic readings (SBP, DBP, MBP, HR) showed more stability in Group(B) than Group(A), group(A) showed higher anesthetic sensory level but adequate anesthetic sensory level to perform Knee Arthroscope surgery was achieved in group (B) Conclusion Under the conditions of this study delayed supine positioning after induction of SAB for 2.5 minutes is of great value in gaining an adequate level of anesthesia with more hemodynamic stability and less vasopressor need as a management of hypotension compared to the conventional SAB in Knee Arthroscope surgery.

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Two different volume of local anaesthetic in subarachnoid block for Minipercutaneous Nephrolithotomy in prone position

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v1i1.7249 ◽

2012 ◽

Vol 1 (1) ◽

pp. 10-15

Author(s):

BR Shrestha ◽

S Khadgi ◽

S Shrestha ◽

P Thapa

Keyword(s):

Prone Position ◽

Local Anaesthetic ◽

Spinal Block ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Subarachnoid Block ◽

Number Of Patients ◽

Group A ◽

The Difference ◽

Group B

Aims: To see the maximum sensory level in supine and prone position after subarachnoid block in patients undergoing Minipercutaneous Nephrolithotomy with two different volumes of local anaesthetic. Methods: Prospective randomized comparative study in 500 patients undergoing Minipercutaneous Nephrolithotomy for finding out the extensiveness of sensory level spread after spinal anaesthesia using two different volumes of local anaesthetic before and after keeping patients in prone position. Patients were divided into two groups: Group A (three ml hyperbaric Bupivacaine) and Group B (four ml hyperbaric Bupivacaine) consisted of 250 patients each. Spinal block was performed in sitting position. Sensory level and hemodynamic measurements were carried out at different time points while patients were on supine and on prone position. Results: Patients attaining T4 sensory level at five minutes in Group B was significantly higher than in Group A (p=0.001). After 10-15 minutes of spinal block, greater number of patients in Group B reached T4 sensory level while being in supine position than those in Group A and the difference was statistically significant (p=0.000). After keeping the patients in prone position for in 10-15 minutes the number of patients reaching T4 level was found to be significantly higher in group A than in Group B (p=0.063). Decrease in heart rate and blood pressure in prone position were significant from baseline value and while during supine (p<0.05). Conclusion: Prone positioning extends the sensory level of subarachnoid block to higher level (T4) when three ml of hyperbaric solution is used. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7249 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.10-15

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Clinical Comparative Study of Effect of Two Different Doses of Phenylephrine on Spinal Induced Hypotension during Cesarean Section

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47b33147 ◽

2021 ◽

pp. 482-489

Author(s):

S. Hiruthick ◽

K. V. L. Sanjana

Keyword(s):

Blood Pressure ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Prospective Observational Study ◽

Bolus Dose ◽

Systolic Pressure ◽

Induced Hypotension ◽

Group A ◽

Group B ◽

Different Doses

Background and Aims: During Cesarean section, hypotension occurs in the most of parturients, following spinal anesthesia. This prospective observational study was undertaken to determine the efficacy of two different Bolus Doses of Phenylephrine for Prevention of Spinal-Induced Hypotension during Cesarean Section. Materials and Methods: A total of 120 parturients undergoing cesarean section were divided into two groups of group A and group B with sixty in each group. Group A received phenylephrine 75 mcg IV bolus, while Group B received phenylephrine 100 mcg IV bolus, immediately after giving spinal anesthesia. For the next 20 minutes, systolic blood pressure (SBP), diastolic blood pressure (DSP), mean arterial pressure (MAP), and heart rate (HR) were recorded every 2 minutes, and APGAR scores at 1 and 5 minutes were recorded. Results: There was no difference between the two groups in terms of preventing hypotension, with 16.6% in Group A and 16.6% in Group B. In the first 2–6 minutes, however, the rise in systolic pressure in Group B was higher than in Group A. Group B (46.66 %) had a higher rate of bradycardia than Group A (25 %). Conclusion: Both phenylephrine dosages were equally effective in preventing hypotension following spinal anesthesia. However, Prophylactic bolus dose of phenylephrine 75 mcg was found to be effective for the management of spinal-induced hypotension and should be preferred over 100 mcg which causes significant bradycardia and reactive hypertension.

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Clinical Study on the Effects of Different Positions on Supine Hypotensive Syndrome in Cesarean Section after Lumbar Anesthesia

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i3.1214 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Chunyan Zhao ◽

Yi Tang ◽

Cibo Chen ◽

Bingchun Xia

Keyword(s):

Blood Pressure ◽

Cesarean Section ◽

Supine Position ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Significant Difference ◽

Group A ◽

Hypotensive Syndrome ◽

Group B

Aim: To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia. Methods: 600 full-term parturient were randomly divided into 4 groups. The patented positioning pads (patent number: ZL 2017 2 0618886.5) in our department was used in the left-leaning position. The parturient lied in a supine position for anesthesia in, and then the group of positioning pads was placed after turning into the lateral position. The parturient were divided into group A (supine position), group B (left-leaning to 10 °), group C (left-leaning to 20 °), and group D (30 °). Observation index: Main index: Comparison of maternal blood pressure changes and neonatal blood gas analysis in the supine position without using a position pad and with the use of patent positioning pads in different tilt angles (10°, 20°, 30°). Minor index: 1) the use and frequency of vasoactive drugs, whether a left-leaning operating bed or uterine displacement is required; 2) the consciousness of the parturient; 3) newborn’s Apgar scores of 1 minute, 5 minutes, and 10 minutes after birth; 4) whether the obstetrician can perform the operation smoothly in the corresponding left leaning position. Results: The blood pressure at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered in group A and group B were significantly different from those in group C (P<0.05). There were significant differences at different timings in group A and group B, and the decline was more significant at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered (P<0.05). The pH value of blood gas analysis of newborns in group A, group B and group C was between 7.25 and 7.37, and there was no significant difference between the three groups (P?0.05). Conclusion: The use of positioning pads can prevent the adverse effects of supine hypotensive syndrome on parturient and newborns to a certain extent.

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DECREASE IN PAIN OF PROPOFOL INJECTION AFTER ORAL CLONIDINE

The Professional Medical Journal ◽

10.29309/tpmj/2007.14.02.4879 ◽

2007 ◽

Vol 14 (02) ◽

pp. 218-224

Author(s):

MUHAMMAD ANSAR MAQSOOD ◽

Dr Aurangzeb ◽

ANJUM ANWAR QADRI ◽

Muhammad Bakhsh ◽

M. ASGHAR KHAN

Keyword(s):

Blood Pressure ◽

Rating Scale ◽

Military Hospital ◽

Oral Clonidine ◽

Non Invasive ◽

Arterial Blood ◽

Class 1 ◽

Group A ◽

Group B ◽

Anaesthesia Care

Objective: To assess the potential of oral Clonidine premedication indecreasing patient discomfort during the injection of Propofol. Design: This was a comparative study of 80 ASA class1 and II. Place and Duration of study: This study was carried out at Combined Military Hospital, Kharian. Patients andMethods: This was a study of 80 ASA class 1 and 2 patients of similar age group. Patients selected were from amongstthose undergoing elective gynaecological surgery, specifically Diagnostic Dilatation and Curettage. These patients wereselected by non-probability convenience sampling. The patients were randomly assigned, by means of a random table,to one of the two groups of 40 patients each. Group ‘A’ patients were given oral Clonidine, 300mg two hours beforeinduction of anaesthesia by Propofol injection. Group B’ patients were given 0.01 to 0.02mg/kg plain Lidocaine justbefore Propofol induced anaesthesia. Non-invasive systolic arterial blood pressure (ni-SBP), non-invasive diastolicarterial blood pressure (ni-DBP) and heart rate were recorded in the ward about 120 min [before administration of oralClonidine in group-A] in both groups. Measurements were repeated in the operating theatre before induction ofanaesthesia. Patients in Group-A were given one tablet Catapres [Clonidine, 300mg] with a sip of water, two hoursbefore induction of anaesthesia and they were observed in the Post Anaesthesia Care Unit during this period, whiletheir pulse and blood pressure were monitored. Patients in group-B were not premedicated with Clonidine. They wereinjected 0.01 to 0.02mg/kg injection plain lidocaine, through the injection port of an 18-gauge cannula, as premedicationjust before propofol monitoring was done as for group-A. Before administration of propofol, the patient was requestedto rate immediately any sensation of pain during injection as none (0), mild (1), moderate (2) or severe (3), also calledthe Verbal Rating Scale (VRS). Results: The results showed both groups to have similar pain score, and differenceswere deemed statistically not significant by the analysis. Conclusion: Our results imply that Clonidine makes anexcellent premedication with Propofol for short gynaecological procedures.

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Effect of magnesium sulphate on quality of subarachnoid block in terms of onset and duration of motor and sensory block, APGAR score of the neonate and haemodynamic status of the patient

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v24i2.19800 ◽

2014 ◽

Vol 24 (2) ◽

pp. 41-47

Author(s):

Shahadat Hossain ◽

Montosh Kumar Mondal ◽

Beauty Rani Roy ◽

Jesmin Akter ◽

AKM Akhtaruzzaman ◽

...

Keyword(s):

Blood Pressure ◽

Magnesium Sulfate ◽

Magnesium Sulphate ◽

Apgar Score ◽

Motor Block ◽

Onset Time ◽

Sensory Block ◽

Subarachnoid Block ◽

Group A ◽

Group B

Background In obstetrics, pregnancy induced hypertension is still a burning question and complicates a large number of pregnancies in developing countries. Chance of hypotension is more in patients getting magnesium sulfate with subarachnoid block but it may be managed with adequate preloading and by pressor agent ephedrine. Objectives This study was designed to observe the effect of magnesium sulphate on quality of subarachnoid block in terms of onset and duration of motor and sensory block, APGAR score of the neonates and haemodynamic status of the patients. Methods Sixty parturients undergoing caesarian sections under subarachnoid block were enrolled for the study. They were divided into two groups. Group-A include normal parturient undergoing caesarian section and group-B include pre-celamptic parturient treated with magnesium sulphate within 1 to 2 hours before block. After recording of base line haemodynamic status (BP, HR, SPO2) all patients received subarachnoid block with 2 ml (10 mg) hyperbaric bupivacaine at L3-4 level. Onset of sensory block was assessed by using pinprick, onset of motor block was assessed by onset time of weakness of lower limb and onset time of complete paralysis of lower limb after SAB. Duration of motor block was assessed by modified bromage scale. Height of the block was assessed by using pin prick at the intercostals space in the mid axillary line after 5 minute of SAB. Neonatal assessment was done by using apgar score in 1 and 5 minutes after delivary of baby. Blood pressure was recorded normally at 2 min interval until 15 minutes then every 5 minutes interval till the surgical procedure is completed. Results Duration of motor block in group B is significantly higher 276 ± 44.92 min compared with group A which was 197.96 ± 24.25 min (P = 0.000). Duration of sensory block in group B also significantly higher with 308.76 ± 61.43 min compared with group A which was 264 ± 30.57 min, and (P = 0.001). Changes in systolic blood pressure in group B patient is more and highly significant (P < .05), for upto 60 min. But changes in diastolic blood pressure in-group B was only highly significant with group A for upto 9 minutes. APGAR score was significantly low both in 1 minute and 5 minutes, in group B patients which was 5.80 ± .61 at 1 minute and 7.73 ± .827 at 5 minutes and in group A which was 6.60 ± .85 at 1 minute and 8.30 ± .595 (mean ± SD) at 5 minutes. Onset of sensory block and onset of motor block revealed on significant difference between groups. Conclusions Chance of hypotension is more in patients getting magnesium sulfate but it may be managed with adequate preloading and by pressor agent ephedrine. APGAR score of baby of magnesium sulfate getting patient is low but it is acceptable. DOI: http://dx.doi.org/10.3329/jbsa.v24i2.19800 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(2): 41-47

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Bioinformatics Study on Serum Triglyceride Levels for Analysis of a Potential Risk Factor Affecting Blood Pressure Variability

Current Bioinformatics ◽

10.2174/1574893614666190109152809 ◽

2019 ◽

Vol 14 (5) ◽

pp. 376-385 ◽

Cited By ~ 2

Author(s):

Lin Xu ◽

Jiangming Huang ◽

Zhe Zhang ◽

Jian Qiu ◽

Yan Guo ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Blood Pressure Variability ◽

Partial Correlation ◽

Pearson Correlation ◽

Target Organ Damage ◽

Serum Triglyceride ◽

Hypertensive Patients ◽

Group A ◽

Group B

Objective: The purpose of this study was to establish whether Triglycerides (TGs) are related to Blood Pressure (BP) variability and whether controlling TG levels leads to better BP variability management and prevents Cardiovascular Disease (CVD). Methods: In this study, we enrolled 106 hypertensive patients and 80 non-hypertensive patients. Pearson correlation and partial correlation analyses were used to define the relationships between TG levels and BP variability in all subjects. Patients with hypertension were divided into two subgroups according to TG level: Group A (TG<1.7 mmol/L) and Group B (TG>=1.7 mmol/L). The heterogeneity between the two subgroups was compared using t tests and covariance analysis. Results: TG levels and BP variability were significantly different between the hypertensive and non-hypertensive patients. Two-tailed Pearson correlation tests showed that TG levels are positively associated with many BP variability measures in all subjects. After reducing other confounding factors, the partial correlation analysis revealed that TG levels are still related to the Standard Deviation (SD), Coefficient of Variation (CV) of nighttime systolic blood pressure and CV of nighttime diastolic blood pressure, respectively (each p<0.05). In the subgroups, group A had a lower SD of nighttime Systolic Blood Pressure (SBP_night_SD; 11.39±3.80 and 13.39±4.16, p=0.011), CV of nighttime systolic blood pressure (SBP_night_CV; 0.09±0.03 and 0.11±0.03, p=0.014) and average real variability of nighttime systolic blood pressure (SBP_night_ARV; 10.99±3.98 and 12.6±3.95, p=0.024) compared with group B, even after adjusting for age and other lipid indicators. Conclusion: TG levels are significantly associated with BP variability and hypertriglyceridemia, which affects blood pressure variability before causing target organ damage.

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The Effect of Prophylactic Ephedrine on Systemic Hypotension Caused by Induction of Anaesthesia with Propofol and Sufentanil in Elderly Hypertensive Patients: A Prospective Randomized, Double-blind Placebo-controlled Clinical Trial

10.22514/sv.2020.16.0081 ◽

2020 ◽

Keyword(s):

Blood Pressure ◽

General Anesthesia ◽

Normal Saline ◽

Saline Group ◽

Normal Saline Group ◽

Hypertensive Patients ◽

Group A ◽

Elderly Hypertensive ◽

Elderly Hypertensive Patients ◽

Group B

Objective: To study the effectiveness of prophylactic ephedrine to prevent hypotension caused by induction of anesthesia with propofol and sufentanil in elderly hypertensive patients. Methodology: 70 elderly ASA grade II-III hypertensive patients undergoing elective general anesthesia were randomized into two groups to receive either intravenous ephedrine,100 ug/kg in 5ml normal saline (Group B), or an equal volume of normal saline (Group A) before induction. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were recorded at T0 (after entry to the operating room), T1 (1 min after induction), T2 (2 min after induction), T3 ( 3 min after induction), T4 (4 min after induction), T5 (when intubated), T6 (2 min after intubation), and T7 (at the start of the procedure), as well as the incidence of hypotension and bradycardia. Results: SBP, DBP and HR were not significantly different at T0 and were significantly different at T1 to T7 after anesthesia induction. There were statistically significant effect on hypotension and bradycardia between the two groups and group B have a lower risk of hypotension and bradycardia relative to group A. SBP and DBP decreased significantly after induction in both groups. HR decreased significantly in group A while increased in group B. Conclusion: Ephedrine pretreatment can minimize hypotension and bradycardia caused by propofol and sufentanil during the induction of general anesthesia in elderly patients with hypertension.

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