A Comparative Study of Low-Dose Hyperbaric Spinal Lidocaine 0.5% Versus 5% for Continuous Spinal Anesthesia

Background and ObjectivesConcerns of cauda equina syndrome have discouraged clinicians to use 5% lidocaine for continuous spinal anesthesia. Earlier reports indicated that single-shot spinal lidocaine 0.5% is effective for minor gynecologic and perianal surgery. In the present study, we evaluate the anesthetic and hemodynamic effects of low dose hyperbaric 0.5% lidocaine for continuous spinal anesthesia and compare with those of the 5% lidocaine solution in patients undergoing urologic surgery.MethodsSpinal anesthesia was induced via an indwelling subarachnoid catheter in 42 elderly male patients (range, 57-84 years) undergoing transurethral prostate and bladder procedures. Patients were randomly assigned to receive an initial 30-mg bolus of hyperbaric lidocaine in the form of either 6 mL of 0.5% solution or 0.6 mL of 5% solution. Additional 30-mg boluses (to a total of 90 mg) were given, if necessary, to establish initial sensory block to T10 or higher and lower limb paralysis. Supplemental doses of 30 mg or less were given during surgery, as needed. Dermatomal level of sensory anesthesia and degree of motor blockade were assessed at regular intervals by a blinded observer. Heart rate and blood pressure (mean systolic and diastolic) values were monitored at regular intervals.ResultsForty patients were studied successfully. Both hyperbaric 0.5% and 5% lidocaine provided adequate surgical anesthesia in 75% (30/40) of patients after a single 30-mg dose. A median peak sensory level of T5 (range, T2-T9) achieved within 11.1 ± 4.5 minutes in patients receiving the 0.5% solution was significantly higher than the peak sensory level of T7 (range, T4-T12) in the 5% group (P = .043). The duration of surgical anesthesia after a 30-mg dose was similar in both groups—48.1 ± 12.1 minutes versus 50.8 ± 16.5 minutes respectively. Of the 30 patients (15 in each group) who received 30 mg initially, 25 required repeat lidocaine dosing through the catheter during surgery. The maximum decrease in heart rate and blood pressure values was within 10% and 20%, respectively, of baseline values in both groups. In the remaining patients (10/40), anesthesia was achieved successfully in five patients in the 0.5% group and three patients in the 5% group after two 30-mg lidocaine boluses (60 mg) and two patients in the 5% group after three 30-mg boluses (90 mg).ConclusionsContinuous spinal anesthesia produced by 0.5% lidocaine with 7.5% dextrose is as effective as that produced by the 5% lidocaine solution in elderly patients undergoing urologic surgery. An initial 30-mg bolus delivered via indwelling subarachnoid catheter was sufficient to achieve surgical anesthesia for approximately 50 minutes in most patients. Hemodynamic effects of the two lidocaine solutions were also comparable.

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Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

Journal of Chitwan Medical College ◽

10.3126/jcmc.v9i2.24560 ◽

2019 ◽

Vol 9 (2) ◽

pp. 79-82

Author(s):

Bharati Devi Sharma Regmi ◽

Gopendra Prasad Deo ◽

Subin Shrestha ◽

Sabita Shrestha ◽

Renuka Tamrakar Mishra

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Low Dose ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Significant Difference ◽

Elective Cesarean

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the incidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section. Methods: Seventy-four pregnant women aged 20-35 years old which underwent elective cesarean section at Chitwan Medical College were randomized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group received 12mg 0.5% bupivacaine. Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypotension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conventional dose of spinal bupivacaine group. Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomiting in comparison to bupivacaine alone.

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Continuous Spinal Anesthesia with a Microcatheter and Low-Dose Bupivacaine Decreases the Hemodynamic Effects of Centroneuraxis Blocks in Elderly Patients

Anesthesia & Analgesia ◽

10.1213/00000539-199308000-00011 ◽

1993 ◽

Vol 77 (2) ◽

pp. 275-280

Author(s):

Walter Klimscha ◽

Christian Weinstabl ◽

Wilfried Ilias ◽

Nikolaus Mayer ◽

Ahmad Kashanipour ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Anesthesia ◽

Low Dose ◽

Hemodynamic Effects ◽

Continuous Spinal Anesthesia

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Continuous Spinal Anesthesia with a Microcatheter and Low-Dose Bupivacaine Decreases the Hemodynamic Effects of Centroneuraxis Blocks in Elderly Patients

Anesthesia & Analgesia ◽

10.1213/00000539-199377020-00011 ◽

1993 ◽

Vol 77 (2) ◽

pp. 275-280 ◽

Cited By ~ 60

Author(s):

Walter Klimscha ◽

Christian Weinstabl ◽

Wilfried Ilias ◽

Nikolaus Mayer ◽

Ahmad Kashanipour ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Anesthesia ◽

Low Dose ◽

Hemodynamic Effects ◽

Continuous Spinal Anesthesia

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Hemodynamic Effects of Intrathecal Magnesium Sulphate as an Adjuvant for Spinal Anesthesia in Pre-Eclamptic Patients

QJM ◽

10.1093/qjmed/hcaa039.037 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R H Elkabarity ◽

R M M Ali ◽

J N Naseef ◽

M M F Hanna

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Caesarean Section ◽

Systolic Blood Pressure ◽

Magnesium Sulfate ◽

Spinal Anesthesia ◽

Magnesium Sulphate ◽

Hemodynamic Effect ◽

Motor Blockade ◽

Hemodynamic Effects

Abstract Background pre-eclampsia is defined as a disorder that occurs in pregnancy after twenty weeks of gestation which manifests as hypertension and proteinuria with at least one maternal organ dysfunction involvement with an incidence of 5-10% of all pregnancies. Aim of the Work our study will examine the hemodynamic effects of adding two different doses of magnesium sulphate to bupivacaine in patients with severe preeclampsia undergoing caesarean section using spinal anesthesia. Patients and Methods: type of Study Prospective comparative study; it was done after approval of the Research Ethics Committee of Anesthesia, Intensive Care and Pain Management Department, Ain Shams University. Study Setting Ain Shams University Hospitals, Cairo, Egypt. Study Period 3 months. Study Population Pregnant females with severe preeclampsia undergoing caesarian section. Results results of this study indicated that the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section. But the addition of 100 mg magnesium sulfate lead to a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade compared to the addition of 50mg magnesium sulphate. Also there is no significant difference between the addition of 50 &100mg on shivering, nausea and vomiting, sedation, postoperative pain score (at 2,4 and 8 hours) and APGAR score (at 1 and 5 min). Conclusion the addition of magnesium sulfate at a dose of 100mg compared to the dose of 50 mg to bupivacaine in our study, showed that increasing the dose of magnesium sulfate had no significant hemodynamic effect (systolic blood pressure, diastolic blood pressure and heart rate) on severe preeclamptic patients undergoing caesarean section.

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Low Dose Spinal Anesthesia Bupivakain 0,5% 5 mg dengan Adjuvan Fentanyl 50 mcg untuk Pasien dengan Uncorrected Tetralogy of Fallot yang Menjalani Seksio Sesarea

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v2i2.15 ◽

2020 ◽

Vol 2 (2) ◽

pp. 93-9

Author(s):

Ruddi Hartono ◽

Sri Rahardjo ◽

Yusmein Uyun

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Ventricular Septal Defect ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Tetralogy Of Fallot ◽

Vascular Resistance ◽

Low Dose ◽

Septal Defect ◽

Fetal Distress

Pasien hamil dengan uncorrected tetralogy of fallot yang menjalani seksio sesarea merupakan tantangan tersendiri bagi dokter anestesi. Tetralogy of Fallot terdiri dari ventricular septal defect, hipertrofi ventrikel kanan, overriding aorta dan stenosis pulmonal. Prinsip anestesi pada pasien ini adalah mempertahankan systemic vascular resistence (SVR) dan menghindari peningkatan pulmonary vascular resistance (PVR). Pasien Ibu hamil, 19 tahun dengan berat badan 50 kg, tinggi badan 150 cm, G3P000Ab200 Gravida 36–37 minggu, tunggal hidup, fetal distress dan tali pusat menumbung dengan tetralogy of fallot, akan dilakukan seksio sesarea cito. Penatalaksanaan anestesi pasien ini dengan low dose spinal anesthesia bupivakain 0,5% 5 mg dan adjuvan fentanyl 50 mcg. Hemodinamik stabil setelah tindakan spinal. Tekanan darah sebelum dilakukan spinal 100/60 mmHg dengan laju nadi 67 kali per menit dan saturasi oksigen 80% menggunakan non rebreathing mask (NRBM) 10 liter per menit. Tekanan darah pada saat operasi dimulai adalah 96/57 mmHg dan laju nadi 77 kali per menit serta saturasi 78% menggunakan NRBM 10 liter per menit. Setelah bayi dilahirkan, hemodinamik stabil hingga akhir operasi, tidak ditemukan periode hipotensi yang berat dan tidak digunakan obat vasopressor selama operasi. Pasien dipindahkan ke ICU untuk observasi pasca operasi selama 2 hari. Selama perawatan di ICU, kondisi pasien tetap stabil dan kemudian dipindahkan ke ruang perawatan biasa. Low dose spinal anesthesia mencegah risiko hipotensi karena intensitas blok simpatis yang lebih minimal sehingga penurunan SVR dapat dihindari. Teknik ini dapat digunakan sebagai alternatif pembiusan pada pasien dengan tetralogy of fallot tetapi tergantung kondisi pasien saat akan dilakukan pembiusan. Low Dose Spinal Anesthesia Bupivacaine 0,5% 5 mg with Adjuvant Fentanyl 50 mcg for Cesarean Section Patient with Uncorrected Tetralogy of Fallot AbstractCesarean delivery in parturient with uncorrected tetralogy of fallot poses significant challenge for anesthesiologist. Tetralogy of Fallot consists of ventricular septal defect, right ventricular hypertrophy, overriding aorta and stenosis pulmonum. Main principle of anesthesia for tetralogy of fallot is maintenance of systemic vascular resistance dan avoidance of increasing pulmonary vascular resistance. Parturient, 19 years old, body weigt 50 kg, height 150 cm, G3P000Ab200 36 – 37 weeks, fetal distress and umbilical cord prolapse with tetralogy of fallot will perform cesarean section. Patient anesthesized with low dose spinal anesthesia using bupivacaine 0,5% 5cmg with adjuvant fentanyl 50 mcg. Haemodynamic before spinal with blood pressure is 100/60 mmHg, heart rate 67 beat per minute (BPM), saturation is 80% using 10 liter of oxygen non rebreathing mask (NRBM) . Blood pressure during incision 96/57 mmHg heart rate 77 BPM with saturation 78% using 10 liter of NRBM. Haemodynamic is stable after baby is born until the operation is done, without any episode of severe hypotension and there is no using of vasopressor drugs. Patient is moved to ICU after the operation for further observation and for 2 days periode the haemodynamic is stable and then patient is moved to regular ward. Low dose spinal anesthesia avoid the incidence of hypotension by causing less intense blocked sympathetic system than traditional dose and thus providing a stable SVR. This technique could be an alternative for anesthesizing for parturient with tetralogy of fallot but its depend on patient condition before operation.

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Methane, a gut bacteria-produced gas, does not affect arterial blood pressure in normotensive anaesthetized rats.

10.1101/2021.03.31.437828 ◽

2021 ◽

Author(s):

Ewelina Zaorska ◽

Marta Gawrys-Kopczynska ◽

Ryszard Ostaszewski ◽

Dominik Koszelewski ◽

Marcin Ufnal

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Blood Pressure ◽

Acute Administration ◽

Hemodynamic Effects ◽

Arterial Blood ◽

Anaesthetized Rats ◽

Carbohydrate Fermentation ◽

Oxidative Effects ◽

Lines Of Evidence

Methane is produced by carbohydrate fermentation in the gastrointestinal tract through the metabolism of methanogenic microbiota. Several lines of evidence suggest that methane exerts anti-inflammatory, anti-apoptotic and anti-oxidative effects. The effect of methane on cardiovascular system is obscure. The objective of the present study was to evaluate the hemodynamic response to methane. A vehicle or methane-rich saline were administered intravenously or intraperitoneally in normotensive anaesthetized rats. We have found no significant effect of the acute administration of methane-rich saline on arterial blood pressure and heart rate in anaesthetized rats. Our study suggests that methane does not influence the control of arterial blood pressure. However, further chronic studies may be needed to fully understand hemodynamic effects of the gas.

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Effects of Patients' Position on Blood Pressure and Heart Rate during Spinal Anesthesia for Axillo-femoral Bypass Surgery

Korean Journal of Anesthesiology ◽

10.4097/kjae.2006.51.6.675 ◽

2006 ◽

Vol 51 (6) ◽

pp. 675 ◽

Cited By ~ 1

Author(s):

Soo Kyoung Park ◽

Young Kug Kim ◽

Sung Lyang Chung ◽

Ji Hyun Chin ◽

Chung Lee ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Spinal Anesthesia ◽

Bypass Surgery

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Sedative and physiologic effects of tiletamine–zolazepam following buccal administration in cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19827116 ◽

2019 ◽

Vol 22 (2) ◽

pp. 108-113 ◽

Cited By ~ 2

Author(s):

Pablo Nejamkin ◽

Verónica Cavilla ◽

María Clausse ◽

Florencia Landivar ◽

Augusto M Lorenzutti ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Low Dose ◽

Sedation Score ◽

High Dose ◽

Physiological Effects ◽

Chemical Restraint ◽

Hemoglobin Saturation ◽

Baseline Systolic Blood Pressure ◽

Over Time

Objectives The aim of this study was to describe the sedative and some physiological effects of tiletamine–zolazepam following buccal administration (BA) in cats. Methods Seven healthy spayed European shorthair cats (three males, four females) were studied twice in this randomized, blinded, crossover study. Each cat received two doses of tiletamine–zolazepam by BA: the low-dose (LD) group consisted of 5 mg/kg of each drug, and the high-dose (HD) group consisted of 7.5 mg/kg of each. Baseline systolic blood pressure (SAP), heart rate (HR), respiratory rate (RR) and a sedation score were recorded prior to administration of each treatment. The same variables plus the percentage of hemoglobin saturated with oxygen as measured by pulse oximetry (SpO2) were recorded at predefined intervals for the next 2 h. Results All cats completed the study. No retching or vomiting were observed. Hypersalivation was observed in 0/7 and 3/7 for LD and HD groups, respectively ( P = 0.2). There were significant changes in scores over time for posture, response to clippers and response to manual restraint for both groups, without differences between groups. RR, HR and SAP changed significantly over time. SAP and RR were significantly lower for the HD than for the LD group. No values for hemoglobin saturation <95% were observed. Conclusions and relevance BA of tiletamine–zolazepam at the doses studied here is a simple and effective method for chemical restraint in cats, where the LD group had a lower impact on SAP and RR than the HD group.

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Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

Anesthesiology ◽

10.1097/aln.0000000000000601 ◽

2015 ◽

Vol 122 (4) ◽

pp. 736-745 ◽

Cited By ~ 103

Author(s):

Warwick D. Ngan Kee ◽

Shara W. Y. Lee ◽

Floria F. Ng ◽

Perpetua E. Tan ◽

Kim S. Khaw

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cardiac Output ◽

Systolic Blood Pressure ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Adrenergic Receptor ◽

Neonatal Outcome ◽

Computer Controlled ◽

Double Blinded

Abstract Background: During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. Methods: In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml. The primary outcome compared was cardiac output. Blood pressure heart rate and neonatal outcome were also compared. Results: Normalized cardiac output 5 min after induction was greater in the norepinephrine group versus the phenylephrine group (median 102.7% [interquartile range, 94.3 to 116.7%] versus 93.8% [85.0 to 103.1%], P = 0.004, median difference 9.8%, 95% CI of difference between medians 2.8 to 16.1%). From induction until uterine incision, for norepinephrine versus phenylephrine, systolic blood pressure and stroke volume were similar, heart rate and cardiac output were greater, systemic vascular resistance was lower, and the incidence of bradycardia was smaller. Neonatal outcome was similar between groups. Conclusions: When given by computer-controlled infusion during spinal anesthesia for cesarean delivery, norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine. Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients.

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