scholarly journals Comparision of hemodynamic changes, movement, duration of surgery and pain between lateral and supine posision after spinal anesthesia in transurethral lithotrips

2018 ◽  
Vol 8 (1) ◽  
pp. 11-16
Author(s):  
Faramarz Alibeigi ◽  
Mona Hosseini ◽  
Mohammadreza Shabanian ◽  
Alireza Shabanian ◽  
Gholamreza Shabanian
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Repeated Measures ◽  
Vital Signs ◽  
Lateral Position ◽  
Hemodynamic Changes ◽  
Double Blind ◽  
Lateral Group ◽  
Double Blind Clinical Trial ◽  
Duration Of Surgery

Introduction: Patient position during surgery is an important issue that can affect vital indices. Objectives: This study was conducted to compare hemodynamic changes, movements, surgery length, and pain during transurethral lithotripsy (TUL) in supine and lateral positions. Patients and Methods: This double-blind clinical trial was conducted on 76 patients who were candidate for TUL, randomized to two groups of 38 for each. In the lateral group, after inducing spinal anesthesia, the patients were positioned lateral and in supine group, the patients were positioned supine immediately after injecting anesthetic. Vital signs were recorded at six intervals; 5 minutes before anesthesia and 1, 5, 10, 15, and 20 minutes after anesthesia. In addition, movements and pain during surgery were assessed. Data analysis was conducted by descriptive statistics, independent t test, and repeated measures ANOVA in SPSS 22. Results: There were significant differences in changes in systolic blood pressure, diastolic blood pressure, and mean arterial pressure at different intervals between the two groups in such a way that hemodynamic stability was greater in the lateral group (P<0.05). There were no significant differences in changes in heart rate at all studied intervals between the two groups (P>0.05). Surgery length, movement and pain during surgery were not significantly different between the two groups (P < 0.05). Conclusion: Hemodynamic changes especially blood pressure were less remarkable in patients undergoing spinal anesthesia in TUL at lateral position than those in supine position. Additionally, no significant differences in patients’ movement and surgery, and surgery length between the two positions was detected.

scholarly journals The Levels and Duration of Sensory and Motor Blockades of Spinal Anesthesia in Obese Patients That Underwent Urological Operations in the Lithotomy Position

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Taner Ciftci ◽  
Ali Bestemi Kepekci ◽  
Hatice Pınar Yavasca ◽  
Hayrettin Daskaya ◽  
Volkan İnal
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Spinal Anesthesia ◽  
Tissue Blood Flow ◽  
Spinal Block ◽  
Lithotomy Position ◽  
Obese Patients ◽  
Hemodynamic Changes ◽  
Nonobese Patients ◽  
Transurethral Prostate Resection

Obesity has a significant effect on the cephalic spread of a spinal block (SB) due to a reduction in cerebrospinal fluid (CSF). SB is controlled by the tissue blood flow in addition to the CSF. Some positions and techniques of surgery used can cause changes in hemodynamics. We investigated effects of hemodynamic changes that may occur during Transurethral prostate resection (TUR-P) and lithotomy position (LP) at the SB level in obese versus nonobese individuals. Sixty patients who had undergone TUR-P operation under spinal anesthesia were divided into a nonobese (BMI<25 kg/m2, Group N) or obese (BMI≥30 kg/m2, Group O) group. SB assessments were recorded afterthe LP. SB at 6 and 120 min and the peak SB level were compared between two groups. Hemodynamics were recorded after LP. Peak and 6 min SB levels were similar between the groups, while 120 min SB levels were significantly higher for Group O (P<0.05). Blood pressure (BP) after the LP was significantly higher for Group N (P<0.05). LP and TUR-P increased the BP in Group N when compared to Group O. The increase in hemodynamics enhances the blood flow in the spinal cord and may form similar SB levels in nonobese patients to those in obese patients. However, SB time may be longer in obese patients.

scholarly journals The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults - a controlled randomized trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Miodrag Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Final Analysis ◽  
Controlled Study ◽  
Senior Adults ◽  
Hemodynamic Changes ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Registration Number ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients

Abstract Background We studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Methods A prospective, randomized, double-blind, placebo-controlled study. After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA. Results Seventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA. Trial registration ISRCTN registry with registration number ISRCTN44377602, retrospectively registered on 15 June 2017.

scholarly journals The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Trial

2019 ◽  
Author(s):  
Miodrag Vojislav Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Final Analysis ◽  
Controlled Study ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Study Objective ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients ◽  
Study Intervention

Abstract ABSTRACT Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

scholarly journals A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia

2015 ◽  
Vol 53 (2) ◽  
pp. 107-115
Author(s):  
A. Cardesin ◽  
C. Pontes ◽  
R. Rosell ◽  
Y. Escamilla ◽  
J. Marco ◽  
...  
Keyword(s):  
Sinus Surgery ◽  
Double Blind ◽  
Intraoperative Bleeding ◽  
Hypotensive Anaesthesia ◽  
Video Recordings ◽  
Double Blind Clinical Trial ◽  
Duration Of Surgery ◽  
Vas Scores ◽  
Surgical Field ◽  
Operating Surgeon

Background: Significant bleeding during functional endoscopic naso-sinusal surgery (FESS) impairs recognition of anatomical references and may negatively affect surgical outcome. Anaesthesia including clonidine as an adjuntive hypotensive agent may reduce intraoperative bleeding. Methods: A randomised comparison of clonidine-based vs remifentanil-based hypotensive anaesthetic regimen was conducted in patients undergoing FESS. The main assessment was the proportion of subjects with Boezaart scores of surgical field bleeding, as blindly assessed from video recordings by a third surgeon not involved in patient care. Results: A total of 47 subjects underwent FESS and were randomised to clonidine or remifentanil. A significantly lower proportion of patients in the clonidine arm had blindly-assessed Boezaart scores higher than 2, with significantly lower mean blind Boezaart scores at 60 minutes and at 120 minutes. Similar findings were reported by the operating surgeon, and when Wormald and VAS scores were used. Objective estimates of bleeding and the duration of surgery and anaesthesia did not differ between groups. Conclusion: The use of clonidine- based controlled hypotensive anaesthesia achieves lower surgical field bleeding during FESS.

Phenylephrine Added to Prophylactic Ephedrine Infusion during Spinal Anesthesia for Elective Cesarean Section

2001 ◽  
Vol 95 (3) ◽  
pp. 668-674 ◽  
Author(s):  
Frédéric J. Mercier ◽  
Edward T. Riley ◽  
Willard L. Frederickson ◽  
Sandrine Roger-Christoph ◽  
Dan Benhamou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Elective Cesarean ◽  
American Society ◽  
Spinal Hypotension

Background Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy. Methods Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with 6 mg ephedrine bolus doses. Results Hypotension occurred less frequently in the ephedrine-phenylephrine group than in the ephedrine-alone group: 37% versus 75% (P = 0.02). Ephedrine (36+/-16 mg, mean +/- SD) plus 178+/-81 microg phenylephrine was infused in former group, whereas 54+/-18 mg ephedrine was infused in the latter. Median supplemental ephedrine requirements and nausea scores (0-3) were less in the ephedrine-phenylephrine group (0 vs. 12 mg, P = 0.02; and 0 vs. 1.5, P = 0.01, respectively). Umbilical artery pH values were significantly higher in the ephedrine-phenylephrine group than in the group that received ephedrine alone (7.24 vs. 7.19). Apgar scores were similarly good in both groups. Conclusion Phenylephrine added to an infusion of ephedrine halved the incidence of hypotension and increased umbilical cord pH.

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