scholarly journals The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

2018 ◽  
Vol 7 (3) ◽  
pp. 1205
Author(s):  
Shashi Dinkar Minj ◽  
Rameshwari Beck ◽  
Ajit Kumar ◽  
Praveen Tiwari ◽  
Raj Kumar Chandan ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Spinal Anaesthesia ◽  
Combination Group ◽  
Single Term ◽  
Combined Use ◽  
Number Of Patients ◽  
Group A ◽  
Successful Technique ◽  
Group B

Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anaesthesia for cesarean section fails to obtain any sensory or motor block.Methods: This study is aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to caesarean section under spinal anaesthesia following preload with either crystalloid or colloid. This study was carried out on 100 healthy pregnant women with single term foetus and not in labor admitted at the labor room of Gynecological department of RIMS. Blood pressure, Pulse rate, O2 Saturation and episodes of hypotension were recorded every 5 minutes from the spinal block.Results: The study showed that maximum number of caesarean sections here performed for the indication of foetal distress which is seen in 44%, 48%, 52%, and 48% in Group A, Group B, Group C and Group D respectively. This is followed by scar tenderness and obstructed labour. In Group A maximum number of patients developed hypotension during 11-20 minutes duration which is 13 (61.9%) followed by 5 (23.8%) patients during first 10 minutes.Conclusions: The study concludes that the combined use of volume preloading to compensate for vasodilatation and vasopressor to counteract arterial dilatation is a very effective method in reducing the incidence, severity and duration of spiral hypotension. The combination group with decreased volume of preload and reduced dose of vasoconstrictor provides better haemodynamic stability when compared to preloading of vasoconstrictors alone.

scholarly journals TO DETERMINE EFFICACY OF GRANISETRON VERSUS PLACEBO FOR REDUCING SHIVERING IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION UNDER SPINAL ANAESTHESIA

2021 ◽  
Vol 71 (2) ◽  
pp. 530-34
Author(s):  
Sana Abbas ◽  
Bilal Yasin ◽  
Basit Mehmood Khan ◽  
Umer Hayat ◽  
Beenish Abbas ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Elective Caesarean Section ◽  
Patient Comfort ◽  
Military Hospital ◽  
P Value ◽  
Intravenous Bolus ◽  
Lower Segment ◽  
Group A ◽  
Group B

Objective: To determine the efficacy of granisetron versus placebo (saline) for reducing shivering in patients undergoing lower segment caeserian section under spinal anaesthesia. Study Design: Comparative cross - sectional study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital Rawalpindi, from Apr to Sep 2019. Methodology: Total 178 patients undergoing lower segment ceaserian section under spinal anaesthesia with age ranges from 18-40 years of American Society of Anaesthesiologists status I & II with full term pregnancy scheduled for elective caesarean section under spinal anaesthesia. Group A (n=92) received an intravenous bolus of 1 mg granisetron in a 10ml syringe and Group B (n=86) received intravenous bolus of normal saline in a 10ml syringe, drugs were administered immediately before spinal anaesthesia by anaesthetist as coded syringes. Heart rate, blood pressure, core body temperature and shivering scores were measured at 0 minutes, 30 minutes and 60 minutes, average surgery time recorded to be 60 minutes. Results: None of the patients in group A (drug group) exhibited appreciable post spinal shivering whereas 25 (29%) in group B (placebo) had clinically significant shivering necessitated administration of other established pharmacological agents to abort shivering in order to ensure patient comfort and satisfaction with statistically significant p-value of <0.05. Conclusion: Prophylactic injection granisetron was efficacious against post spinal shivering, moreover provides worth while relief of nausea and vomiting which is dilemma with most of the drugs employed for control of post spinal shivering.

scholarly journals A comparative study between dexmedetomidine and dexamethasone as an intrathecal adjuvant for prevention of perioperative shivering in cesarean section

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdul Mohsen Abdul Naiem Ismaiel ◽  
Omar Mohamed Taha El Safty ◽  
Ashraf El Sayed El-Agamy ◽  
Omar Mohamed Zafer Mohamed ◽  
Mohamed Mourad Mohsen Mohamed Ali
Keyword(s):  
Cesarean Section ◽  
Statistical Difference ◽  
Sensory Block ◽  
List Type ◽  
Hyperbaric Bupivacaine ◽  
Analgesic Requirement ◽  
Number Of Patients ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background One of the most common problems in parturients receiving regional anesthesia during cesarean section is shivering. It usually interferes with the readings of the oxygen plethysmography (SpO2) and electrocardiogram (ECG). It expands the needs for oxygen and increases creation of carbon dioxide about four folds. The aim of this work is to compare the efficacy of dexamethasone and dexmedetomidine in prevention of perioperative shivering when added to hyperbaric bupivacaine intrathecally in cesarean sections (CS) and their effect on the intraoperative hemodynamics, intensity of the block, sedation, and postoperative analgesic requirement. Results Study included 60 obstetric patients who fulfilled all the inclusion criteria and were randomized into 2 equal groups, each consisting of 30 patients, namely group A (dexmedetomidine group) and B (dexamethasone group). Group A patients received 5 μg dexmedetomidine with 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. Group B patients received 8 mg dexamethasone then 12.5 mg hyperbaric bupivacaine 0.5% intrathecally. The comparison included assessment of intra- and postoperative hemodynamics, duration of surgery, assessment of sensory and motor block, assessment for shivering and sedation, and assessment of adverse events. This study showed that there were a small number of patients complaining of shivering (five patients in group A and seven patients in group B) with no statistical difference between both groups in the incidence and intensity of shivering. Time to two segment regression (minutes) was longer in group B compared to group A, and also, time to first analgesic rescue was longer in group B compared to group A. For sedation intensity, there was statistical difference between both groups as all patients in group A were sedated compared to six patients only in group B. There was no statistical difference between both groups as regards incidence of adverse effects. Conclusion We concluded that both drugs can be added safely to bupivacaine, and both dexmedetomidine and dexamethasone decreased the incidence and the intensity of shivering. Dexamethasone was found to prolong the duration of sensory block and delay opioid requirements post-operatively, while dexmedetomidine is more effective in sedating the patients intra- and postoperatively.

scholarly journals Comparison of Ondansetron and Granisetron for prevention of PONV following elective LUCS

2009 ◽  
Vol 20 (2) ◽  
pp. 61-65 ◽  
Author(s):  
Md Raihan Uddin ◽  
Lutful Aziz ◽  
SN Samad Choudhury
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Postoperative Period ◽  
Elective Caesarean Section ◽  
Study Groups ◽  
Early Postoperative Period ◽  
Control Group ◽  
Group A ◽  
Group B ◽  
Oral Ondansetron

The aim of the study was to compare the antiemetic effects of oral ondansetron (8mg) and granisectron (2mg) for prevention of PONV following elective caesarean section. Ninety parturients scheduled for elective caesarean section under spinal anaesthesia were randomly allocated into three groups. Group A (n=30) were received vitamin tab, group B (n=30) parturients were received oral ondansectron (8mg) & group C (n=30) parturients were received oral granisetron (2mg). Anesthetic procedure was common to all groups. Emetic episodes in early postoperative period (1st 24 hrs.) were recorded and compared in different study groups. Emetic episodes were observed in six parturients (20%) in group A (control), 3 parturients in group B (3%) and 3 parturients in group C (3%). So to conclude, minimal emetic episodes were observed in early postoperative period in parturients who had received ondensetron or granisetron than the control group. Keywords: LUCS, PONV, Ondansetron, and Granisetron. Journal of BSA, Vol. 20, No. 2, July 2007 p.61-65

scholarly journals Comparison of Blood Loss in Manual and Spontaneous Removal of Placenta in Caesarean Section

2020 ◽  
pp. 80-84
Author(s):  
Sabeen Ashraf ◽  
Azra Saeed Awan ◽  
Hina Tabassum ◽  
Omair Ashraf ◽  
Touseef Fatima ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Analysis Data ◽  
Research Committee ◽  
Chi Square ◽  
Chi Square Test ◽  
Group A ◽  
Group B

Background: Efforts should be made to minimize the blood loss at the time of cesarean section. The techniques used to reduce the blood loss include finger splitting versus scissor cutting of incision, in situ stitching versus exteriorization and stitching of uterus and finally spontaneous or manual removal of the placenta. Objective: The main objective of this study is to correlate the frequency of loss of blood between the placenta removed manually and spontaneously during cesarean section. Methods: Randomized controlled trial in the department of Obstetrics and Gynecology, Fauji Foundation Hospital, Rawalpindi. The sample is collected through Consecutive (non- probability) sampling. The study was conducted after approval from the hospital ethical and research committee. Informed written consent was taken from all the patients. The patients were divided into two groups, group A and group B randomly by using random table numbers. Group A had spontaneous placental delivery. Group B had manual placental delivery. Each patient was examined thoroughly and detailed history was taken. Data Analysis: Data was analyzed using SPSS 20 for windows. The frequency and percentage of blood loss were measured. A chi-square test was applied to correlate the blood loss between the two groups. p values <0.05 were considered statistically significant. Effect modifiers like age, gestational age, parity were controlled by stratification. Results: The blood loss was compared between both groups using the chi-square test not assuming null-hypothesis. The blood loss was comparatively high in-group in which the placenta was removed manually (p=0.007). Keywords: Caesarean Section, Placenta removal, Spontaneous, Manual, Blood loss.

scholarly journals Comparison between Tramadol and Meperidine for Treating Shivering in Patients undergoing Surgery under Spinal Anaesthesia

2020 ◽  
Vol 22 (1-2) ◽  
pp. 27-32
Author(s):  
Sulav Acharya ◽  
N Dhakal
Keyword(s):  
Spinal Anaesthesia ◽  
Treatment Efficacy ◽  
Marked Improvement ◽  
Response Rate ◽  
Hemodynamic Effects ◽  
Physical Status ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
To Receive

Shivering during regional anesthesia is a common problem and is distressing for patients with variety of complications. Therefore this study was conducted to compare the efficacy, potency, hemodynamic effects and side effects of tramadol with that of meperidine for the control of shivering during Spinal Anaesthesia. Sixty patients of ASA physical status I or II, aged 18 to 65 years, undergoing routine surgery under spinal anaesthesia and developed shivering intraoperatively were randomly allocated to receive 0.5 mg/kg meperidine intravenously (Group A, n=30) or 0.5 mg/kg tramadol intravenously (Group B, n=30). Treatment that stopped shivering was considered to have been successful. The response rate was 100 % in both the groups. The time that elapsed from treatment to the time shivering ceased was 5.37±2.20 minutes for meperidine group and 5.87±2.92 minutes for tramadol group (p>0.05). The number of patients who assessed treatment efficacy as no, partial or marked improvement was 0, 2 and 28 for meperidine group and 0, 3 and 27 for tramadol group (p>0.05). Only two patients receiving meperidine developed pruritis and both the grops were similar in terms of Haemodynamic response. The result of this study concluded that tramadol (0.5 mg/kg) is as effective as meperidine (0.5 mg/kg) for treating post anaesthetic shivering with high safety profile.

scholarly journals Efficacy of Equal Volume of Ringer Lactate Versus 3.5% Polymer of Degraded Gelatine Solution (Haemaccel) as Preloading Fluid for Prevention of Hypotension after Spinal Anaesthesia for Lower Segment Cesarean Section

2012 ◽  
Vol 10 (1) ◽  
pp. 1-5
Author(s):  
BR Kunwar ◽  
P Bhattacharyya ◽  
NB KC
Keyword(s):  
Body Weight ◽  
Cesarean Section ◽  
Spinal Anaesthesia ◽  
Relative Volume ◽  
Ringer Lactate ◽  
Lower Segment ◽  
Lower Segment Cesarean Section ◽  
Short Period ◽  
Group A ◽  
Group B

Introduction: Systemic hypotension is frequently and immediately seen after spinal anaesthesia. Historically Ringer lactate is used to substitute the acute relative volume loss after spinal anesthesia, although it remains in intravenous circulation for a short period. The preloading with 5% albumin and gelatine have become popular and effective as they remain intravascular for a longer duration providing sustained normotension. The aim of this study was to assess the efficacy of equal volume of Ringer lactate and Haemaccel as a preloading fluid for the prevention of hypotension after spinal anaesthesia in patients undergoing Lower Segment Cesarean Section. Methods: This was a prospective comparative study in which Patients were randomly allocated in to Group A and group. Group A patients were preloaded with Ringer lactate 10ml/kg body weight and Group B were preloaded with Haemaccel 10 ml/kg body weight within a period of 5-10 minutes before spinal anaesthesia. After giving the block, blood pressure (systolic, diastolic and mean) were recorded every 2.5 minutes for initial 20 minutes and every 5 minutes during the rest of the period of surgery. Onset of hypotension along with other parameters were recorded and analysed using SPSS ver. 13. Results: All together 100 patients were enrolled in the study, 50 in Group A (Ringer lactate) and 50 in Group B (Haemaccel). The episodses of hypotension was higher in patients who received Ringer lactate as preloading fluid than who received haemaccel as preloading fluid (42% versus 24%). Conclusion: Preloading with Haemaccel gives better hemodynamic stability and lesser incidence of hypotension than that of Ringer lactate. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6405 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 1-5

scholarly journals Comparison of Fentanyl and Dexmedetomidine as Intrathecal Adjuvants to Spinal Anaesthesia for Abdominal Hysterectomy

2018 ◽  
Vol 56 (213) ◽  
pp. 848-855 ◽  
Author(s):  
Binod Gautam ◽  
Sushila Tabdar ◽  
Ujma Shrestha
Keyword(s):  
Spinal Anaesthesia ◽  
Visceral Pain ◽  
Sensory Block ◽  
Abdominal Hysterectomy ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Number Of Patients ◽  
First Choice ◽  
Group A ◽  
Group B

Introduction: Spinal anaesthesia, although advantageous for conducting abdominal hysterectomy, is not the first choice amongst surgeons for fear of intra-operative visceral pain. Intrathecal adjuvants may improve quality of spinal anaesthesia. This study aims to compare efficacy of intrathecal Fentanyl and Dexmedetomidine to reduce visceral pain during abdominal hysterectomy performed under spinal anaesthesia. Methods: Sixty women undergoing abdominal hysterectomy for benign indications were randomly assigned to two equal groups in a double-blind fashion. Fentanyl 25 micrograms in group A or Dexmedetomidine 10 micrograms in group B was co-administered with hyperbaric Bupivacaine 15 milligrams for spinal anesthesia. Surgery through Pfannenstiel incision proceeded once sensory block reached eighth thoracic dermatome. The intra-operative visceral pain was assessed using a five-point scale: none, mild, intermediate, severe, and failed spinal anaesthesia. Duration of analgesia and peri-operative events were studied for 24 hours. Chi-square test, Mann-Whitney U-test and Student’s t-test were used for analysis. Level of significance used was P<0.05. Results: Fifty eight participants completed the study. Demographic variables and sensory block were similar between groups. General anaesthesia was not required in both groups. Significantly greater number of patients in group A required medications for visceral pain with Relative Risk of 2.8 (1.16-6.7). Pruritus and shivering occurred significantly higher in group A. Hypotension was significantly higher in group B. Post-operatively, group B patients showed a significantly longer duration of analgesia. Conclusions: Dexmedetomidine is better than Fentanyl as an intrathecal adjuvant to spinal anaesthesia in minimizing visceral pain during abdominal hysterectomy and in prolonging post-operative analgesia.

scholarly journals Effect of oxytocin on haemodynamic change during caesarean section under spinal anaesthesia - A comparison between intravenous bolus or infusion technique

2014 ◽  
Vol 24 (2) ◽  
pp. 48-52
Author(s):  
Golam Murshid ◽  
Idris Ali ◽  
Amirul Islam ◽  
Sabina Yeasmeen ◽  
Nurul Islam ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Infusion Pump ◽  
Uterine Bleeding ◽  
Remote Areas ◽  
Haemodynamic Changes ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Infusion Technique

Background Subarachnoid block for caesarean section is very acceptable technique and it rates are steadily increasing in recent years. It is now spreading up to remote areas. Infusion technique of oxytocin is safe during caesarean section under spinal anaesthesia. Objective To compare the haemodynamic changes caused by oxytocin given as an I/V bolus or infusion to decrease uterine bleeding in caesarean section. Method A total number of sixty patients ASA grade I were selected. Thirty patient in each group. In group A, parturient received oxytocin 5IU of I/V in bolus and group B, infusion of oxytocin 5IU diluted with 5ml normal saline given I/V over 2 min by using infusion pump. The study period was started just before oxytocin given and it was continued for a further 10 min. Systolic and diastolic BP, MAP, heart rate, uterine bleeding were recorded in every 1 min. Result The mean difference of all haemodynamic parameters at 2 to 5 mins of administration of oxytocin were statistically significant (p <0.05). Conclusion The haemodynamic changes were more marked in I/V bolus of oxytocin than infusion technique. DOI: http://dx.doi.org/10.3329/jbsa.v24i2.19801 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(2): 48-51

scholarly journals COMPARISON BETWEEN TRAMADOLAND MEPERIDINE FOR TREATING SHIVERING IN PATIENTS UNDERGOING SURGERY UNDER SPINAL ANAESTHESIA

2020 ◽  
pp. 67-69
Author(s):  
Prabhat Kumar Choudhary ◽  
Sadab Faisal Ansari ◽  
Namita Saraswat ◽  
Debarshi Jana
Keyword(s):  
Spinal Anaesthesia ◽  
Treatment Efficacy ◽  
Marked Improvement ◽  
Response Rate ◽  
Hemodynamic Effects ◽  
Physical Status ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
To Receive

Shivering during regional anesthesia is a common problem and is distressing for patients with variety of complications. Therefore this study was conducted to compare the efficacy, potency, hemodynamic effects and side effects of tramadol with that of meperidine for the control of shivering during Spinal Anaesthesia. Sixty patients of ASA physical status I or II, aged 18 to 65 years, undergoing routine surgery under spinal anaesthesia and developed shivering intraoperatively were randomly allocated to receive 0.5 mg/kg meperidine intravenously (Group A, n=30) or 0.5 mg/kg tramadol intravenously (Group B, n=30). Treatment that stopped shivering was considered to have been successful. The response rate was 100 % in both the groups. The time that elapsed from treatment to the time shivering ceased was 5.37±2.20 minutes for meperidine group and 5.87±2.92 minutes for tramadol group (p>0.05). The number of patients who assessed treatment efficacy as no, partial or marked improvement was 0, 2 and 28 for meperidine group and 0, 3 and 27 for tramadol group (p>0.05). Only two patients receiving meperidine developed pruritis and both the grops were similar in terms of Haemodynamic response. The result of this study concluded that tramadol (0.5 mg/kg) is as effective as meperidine (0.5 mg/kg) for treating post anaesthetic shivering with high safety profile.

scholarly journals Maternal Outcomes of Expectant Management In comparison with Induction of Labour within twenty four hours of Premature Rupture of Membranes (PROM).

2020 ◽  
Vol 27 (08) ◽  
pp. 1565-1569
Author(s):  
Saima Ashraf ◽  
Hajira Sultana ◽  
Saima Yasmin Qadir ◽  
Muhammad Khalid
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Expectant Management ◽  
Induction Of Labour ◽  
Maternal Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Group A ◽  
Group B

Objective: this study is conducted to compare the maternal outcomes of expectant management versus induction of labour within 24 hours of premature rupture of membranes. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynaecology Department, Nishtar Hospital, Multan. Period: From 15 March 2018 to 15 September 2018. Material & Methods: A total of 130 pregnant women with parity 0 – 4 having singleton pregnancy, ≥37 weeks pregnant and having premature rupture of membranes were taken in the study. Women having previous caesarean section, with history of hypertension or diabetes, features suggestive of chorioamnionitis, preterm pre-labour rupture of membranes and women with foetal distress were excluded from the study. Two groups were made. In Group (A) women were subjected to expectant management in which patients were observed for uterine contractions for a period of 24 hours. In Group (B) women were induced with tab dinoprostone 2 doses each 3 mg given 6 hours apart. Information regarding caesarean section, vaginal delivery and chorioamnionitis was recorded on a specially designed proforma. Results: In this study age range was from 18 to 35 years while in both groups most patients were 28 – 35 years old. In Group (A) mean gestational age was 38.246 ± 0.84 weeks while in Group (B) it was 37.953 ± 0.95 weeks. In Group (A) mean parity was 1.076 ± 1.16 and in Group (B) it was 1.815 ± 1.16. in Group (A) 2.092 ± 0.67 hours was mean duration of PROM while in Group (B) it was 2.092 ±0.67 hours. Mean BMI in Group (A) was 26.088 ±3.80 kg/m2 and in Group (B) it was 26.361 ±4.33 kg/m2. In Group (A), 24 patient (36.9%) delivered vaginally while 42 (64.6%) patient delivered vaginally in Group (B). 41 patients (63%) had cesarean section in Group (A) while in Group (B) 23 patients (35.4%) had cesarean section. Chorioamnionitis was seen in 14 patients (21.5%) in Group (A) while 3 patients (4.6%) had chorioamnionitis in Group (B). Conclusion: Our study concluded that induction of labour with twenty four hours of premature rupture of membranes does causes a reduction in occurrence of chorioamnionitis. By this approach patients are usually delivered within 24 hours and caesarean section rate is not increased. This approach also causes a reduction in augmentation of labour by oxytocin.

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