scholarly journals Anesthetic management of obese and morbidly obese parturients

2021 ◽  
Vol 16 (4) ◽  
pp. 313-321
Author(s):  
Sang Tae Kim
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Anesthetic Management ◽  
Operation Time ◽  
Rapid Onset ◽  
The Body ◽  
Morbidly Obese ◽  
Single Shot ◽  
Cesarean Sections

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

scholarly journals Increasing the effciency of spinal anesthesia in a cesarean section in pregnant women with diabetes mellitus

2021 ◽  
pp. 33-41
Author(s):  
U. V. Rymasheuski ◽  
I. I. Kanus ◽  
V. E. Aletski
Keyword(s):  
Diabetes Mellitus ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Gestational Age ◽  
Motor Block ◽  
Dynamic Assessment ◽  
Original Method ◽  
Cesarean Sections ◽  
Hyperbaric Solution

Objective. To increase the effciency of spinal anesthesia (SA) in operative delivery of pregnant women with type 1 diabetes mellitus (DM).Materials and methods. A dynamic assessment of the clinical effciency of spinal anesthesia in cesarean sections was performed in 123 pregnant women with DM. The level of the sensor and motor block was determined depending on the dose of a 0.5% hyperbaric solution of bupivacaine calculated according to the original method.Results. The SA method in cesarean sections in pregnant women with diabetes mellitus has been proposed taking into account the dosage of a hyperbaric solution of bupivacaine depending on the patient`s height and gestational age. The application of this method provided the development of the necessary degree of the sensory and motor block by the eight minute and created the requisite conditions for a cesarean section.Conclusion. The proposed method of the calculation of the hyperbaric solution dosage for subarachnoid anesthesia taking into account the patients` height and gestational age makes it possible to ensure the necessary degree of the sensor block at the level of 4-5 thoracic segments and suffcient relaxation in the surgical area during a cesarean section.

scholarly journals Anestesi Spinal untuk Seksio Sesarea pada Wanita Hamil dengan Obesitas Morbid

2021 ◽  
Vol 4 (1) ◽  
pp. 43-7
Author(s):  
Alfathah Bania Lubis ◽  
Tatat Agustian ◽  
Djoni Kusumah Pohan ◽  
Alexander Siagian
Keyword(s):  
Pregnant Woman ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
The Body ◽  
Obese Women ◽  
Anesthesia Technique ◽  
Morbid Obese

Obesitas adalah keadaan tubuh yang terjadi akibat akumulasi lemak yang abnormal atau berlebih sehingga dapat menimbulkan banyak implikasi klinis dalam tatalaksana anestesi. Wanita hamil dengan berat badan lebih dan obesitas merupakan kondisi yang berisiko tinggi dan terbukti berhubungan dengan peningkatan komplikasi dalam kehamilan. Wanita dengan obesitas sangat penting diberikan edukasi untuk menurunkan berat badan dalam merencanakan kehamilan dan perlu diinformasikan tentang peningkatan risiko termasuk persalinan dengan bedah sesar. Seorang wanita 34 tahun G2P0A1 hamil 41 minggu dengan obesitas morbid dengan tinggi badan 156 cm dan berat badan 124 kg dengan nilai indeks massa tubuh (IMT) 50,9 kg/meter2. Pasien menjalani seksio sesarea dengan teknik anestesi spinal, dengan puncture di L3-4 median, menggunakan obat levobupivakain 15 mg + fentanyl 25 mcg. Operasi berlangsung 1 jam 15 menit, perdarahan 350 ml, hemodinamik stabil. Lahir bayi laki-laki, BB 3100 gram, PB 51 cm, APGAR score 8-9-10. Pemilihan teknik anestesi pada wanita hamil dengan obesitas yang akan menjalani seksio sesarea dilakukan dengan jenis anestesi regional yaitu anestesi spinal dengan pertimbangan dapat mengurangi terpaparnya obat-obatan terhadap bayi, mengurangi risiko aspirasi pneumonia dan memungkinkan proses lahirnya bayi dalam keadaan ibu sadar, dapat digunakan untuk mengatasi nyeri pasca operasi, dan juga dapat menghindari risiko bila dilakukan dengan teknik anestesi umum. Simpulan: Wanita hamil dengan berat badan lebih dan obesitas perlu penilaian kondisi dan perencanaan anestesi yang tepat untuk menurunkan risiko seksio sesarea   Spinal Anesthesia for Caesarean Section in Pregnant Woman with Morbid Obese Abstract Obesity is a state of the body that occurs due to abnormal or excess fat accumulation that can cause many clinical implications in the management of anesthesia. Overweight and obese pregnant women are at high risk and have been shown to be associated with increased complications in pregnancy. Obese women are very important to be educated to lose weight in planning pregnancy and need to be informed about increased risks including delivery by cesarean section. A female, 34 years old G2P0A1, 41 weeks pregnant with morbid obese, 156 cm tall and weight of 124 kg, with BMI 50,9 kg/meter2. Carried out in spinal anesthesia technique with puncture in L3-4 median, using levobupivacain 15 mg + fentanyl 25 mcg. The operation lasted for 1 hour and 15 minutes, with 350 ml bleeding, hemodynamically stable. Born a baby boy, BW 3100 gram, BL 51 cm, APGAR score 8-9-10. Anesthesia technique for pregnant woman with obese who will undergo Caesarean Section is regional anesthesia type called spinal anesthesia with consideration to reduce drug intake for baby, lessen chance of pneumonia aspiration and enable birth process while mother still awake, can be used for overcome post-operation pain, and to avoid risk if done by general anesthesia. Conclusion: overweight and obese pregnant women need proper condition assessment and anesthetic planning to reduce the risk of cesarean section.

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nada Mohamed Bahaa Eldin Mostafa Abdel Rahman ◽  
Khaled Mohammed Maghawry ◽  
Raham Hasan Mostafa ◽  
Ahmed Wagih Ezzat
Keyword(s):  
Side Effects ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Intrathecal Injection ◽  
Group Versus ◽  
Rapid Onset ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Elective Cesarean ◽  
Fentanyl Group

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.

scholarly journals Atypical Endometrial Hyperplasia Arising in a Cesarean Section Scar: A Mechanism of Malignant Transformation

2019 ◽  
Vol 12 (1) ◽  
pp. 317-321
Author(s):  
Marta Monist ◽  
Dorota Lewkowicz ◽  
Maciej Jóźwik ◽  
Marek Gogacz ◽  
Michał Bogusiewicz ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Malignant Transformation ◽  
Endometrial Hyperplasia ◽  
Morbidly Obese ◽  
Cesarean Sections ◽  
Recurrent Pain ◽  
Palpable Mass ◽  
Scar Endometriosis ◽  
Abdominal Scar ◽  
Atypical Endometrial Hyperplasia

The incidence of scar endometriosis in Cesarean sections varies between 0.03 and 0.4%. However, the recently increased rate of Cesarean sections worldwide may be causing an increase in occurrence of scar endometriosis. This report presents anatomopathological evidence of an early-stage malignant transformation in endometriotic tissue from a post-Cesarean scar and briefly reviews possible underlying mechanisms. A 40-year-old woman with a body mass index of 42.7 was referred to the gynecological department with recurrent pain and presence of a palpable mass in her Cesarean section scar. She had undergone this procedure 7 years earlier and began experiencing discomfort and pain at the incision site 6 months postoperatively. Surgical treatment was instituted with complete removal of the lesion. Anatomopathological examination revealed endometriotic tissue intertwined with atypical endometrial hyperplasia and fibrosis. At 2 years’ follow-up, she was asymptomatic, both clinically and based on ultrasound examination. Endometriotic foci inoculated within an abdominal scar may undergo malignant transformation. Long-lasting abdominal scar endometriosis, in morbidly obese women, requires special attention from the physician.

The effect of intra-abdominal pressure on sensory block level of single-shot spinal anesthesia for cesarean section: an observational study

2015 ◽  
Vol 24 (1) ◽  
pp. 35-40 ◽  
Author(s):  
T. Ozkan Seyhan ◽  
M. Orhan-Sungur ◽  
B. Basaran ◽  
M. Savran Karadeniz ◽  
F. Demircan ◽  
...  
Keyword(s):  
Observational Study ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Abdominal Pressure ◽  
Single Shot ◽  
Block Level

scholarly journals Retrospective Evaluation of Anesthetic Management in Cesarean Sections of Pregnant Women with Placental Anomaly

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Aykut Urfalıoglu ◽  
Gözen Öksüz ◽  
Bora Bilal ◽  
Seyma Teksen ◽  
Feyza Calışır ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Placenta Previa ◽  
Anesthetic Management ◽  
Fresh Frozen Plasma ◽  
University Hospital ◽  
Mechanical Ventilation Duration ◽  
Intraoperative Management ◽  
Fresh Frozen ◽  
Group A

Background. In this study, patients who underwent cesarean section and had placenta previa and placenta accreta were examined and compared in terms of haemorrhagic indicators and perioperative anesthetic management. Methods. A retrospective study was conducted in a university hospital in Kahramanmaras, Turkey. It included 95 pregnant women who had placental anomaly and underwent cesarean section between December 15, 2014, and February 15, 2016. Results. The pregnant women were divided into two groups: Group P (previa) (n = 67) and Group A (accreta) (n = 28). The types of anesthesia administered were general anesthesia (GA), which was administered to 50 patients (74.6%) in Group P and 27 patients (96.4%) in Group A, and spinal anesthesia (SA), which was administered to 17 patients (25.4%) in Group P and one patient (3.6%) in Group A.. The mean blood loss was 685.82 ± 262.82 in Group P and 1582.14 ± 790.71 in Group A, and the given amount of crystalloid was higher in Group A with an average of 1628.57 ± 728.19 ml. The use of erythrocyte and fresh frozen plasma solution was higher in Group A than Group P. Eleven patients were intubated and taken to the Intensive Care Unit (ICU) in Group A. Postoperative mechanical ventilation duration was significantly higher in Group A (75.14 ± 43.84 h) (p<0.001). ICU stay was longer in Group A with 2.80 ± 1.13 days. (p<0.001). Conclusion. The intraoperative management and the availability of postoperative ICU conditions are important in placental anomalies cases. The communication between operation team with regard to the development of a standard protocol for these cases will be of great benefit in reducing morbidity and mortality.

scholarly journals The Commonest Indications of Cesarean Sections at Ghalib Teaching Hospital in Year 2017; Cross-sectional Study

2021 ◽  
Author(s):  
Mohammad Rafi Fazli ◽  
Amena Mansouri ◽  
Hania Wahidi
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Teaching Hospital ◽  
Cross Sectional Study ◽  
High Rate ◽  
Cesarean Sections ◽  
Sectional Study ◽  
Cross Sectional ◽  
Previous Cesarean

Abstract Background: In the past few decades, the rate of cesarean section (CS) has increased worldwide which is common in high income countries. Although cesarean section has lots of socioeconomic impacts in the career of mothers and babies especially in LMICs like Afghanistan, it is also increasing in such countries. In compare to vaginal delivery the cesarean section has higher risks for maternal health. The most important aim of this study is to search the commonest indications of cesarean section at the only teaching hospital in west region of Afghanistan, Ghalib Teaching Hospital in 2017.Material and Method: This was a cross-sectional study. Among 456 pregnant women who came to Ghalib Teaching Hospital, 287(63%) had vaginal delivery and 169 (37%) had cesarean section delivery in 2017. Data was collected reviewing medical records; patients discharge certificate and a questionnaire which consisted of the data like; history of previous cesarean sections, age, and so on. Data was analyzed by epi info 7.Results: the prevalence of cesarean section in Ghalib Teaching Hospital was 37%, the median age was 28 years old, the mean age was 23.83 and the most ages were between 21-25 (42.5%). The commonest indications were severe oligohydramnios (29.5%) followed by previous cesarean section (12.4%) and elective cesarean section 10.9% (on maternal request). The least indication was cephalopelvic disproportion (3.09%). In our research we had more than one indication about 10.3%.Conclusion: according to the research the commonest indication of cesarean section was severe oligohydromnios which shows emergency indication among pregnant women. As the women in Afghanistan want many children so they usually do not consider having cesarean section deliveries. Cesarean section on maternal request also has high rate which needs appropriate guidelines and also policies to decrease this high rate of selective cesarean section. In our research 52.1% of indications of CS was fetal factors. This shows in LMICs many fathers have valued to the health of babies instead of mothers. It is highly needed to inform fathers to know about health of both babies and mothers.

scholarly journals Posicionamento do paciente para raquianestesia: construção e validação de álbum seriado

2018 ◽  
Vol 31 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Sarah de Lima Pinto ◽  
Kenya Waleria de Siqueira Coêlho Lisboa ◽  
Nelson Miguel Galindo Neto ◽  
Larissa Alves Sampaio ◽  
Mirna Fontenele de Oliveira ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Content Validity ◽  
Validity Index ◽  
Content Validity Index

Resumo Objetivo: Construir e validar álbum seriado educativo para gestantes que serão submetidas à cirurgia cesariana, acerca do posicionamento durante a raquianestesia. Métodos: Estudo metodológico realizado com a elaboração do álbum seriado, validação com 22 enfermeiros de centro cirúrgico, 22 anestesistas e 3 juízes da área de comunicação e posterior avaliação do material por gestantes. Utilizou-se o Level Content Validity Index superior a 0,8 para a validação de conteúdo e o teste binomial para verificação da proporção de concordância. Resultados: O álbum seriado possui 15 páginas, contém orientações sobre vantagens, desvantagens e posições para a raquianestesia. A média do Level Content Validity Index foi de 0,94 pelos enfermeiros, 0,93 pelos anestesistas e 0,97 pelos juízes da área de comunicação. Houve unanimidade pelas gestantes na aprovação do material. Conclusão: O álbum seriado foi construído e validado e pode ser utilizado pela enfermagem junto a gestantes que serão submetidas à cesariana sob raquianestesia. Abstract Objective: Construct and validate an educational flipchart for pregnant women who are to be submitted to a cesarean section on positioning during spinal anesthesia.

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