scholarly journals Comparison of haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for elective caesarean section

2017 ◽  
Vol 5 (3) ◽  
pp. 851 ◽  
Author(s):  
Nutan Dileeprao Kharge ◽  
Ashish Mali ◽  
Pinakin Gujjar
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Motor Block ◽  
Elective Caesarean Section ◽  
Lateral Position ◽  
Sensory Level ◽  
Sitting Position ◽  
Hemodynamic Parameters ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference

Background: Spinal anaesthesia avoids the problems associated with general anaesthesia such as airway manipulation, polypharmacy, postoperative respiratory problems, and cognitive dysfunction. It can be given in lateral and sitting positions. The aim of the present study was to compare the effect of induction position for spinal anaesthesia in elective caesarean section on hemodynamic, sensory and motor block characteristics and patient satisfaction.Methods: 120 ASA physical status I and II patients undergoing elective caesarean section were randomized to receive spinal anaesthesia in the lateral position or the sitting position. Hyperbaric bupivacaine (0.5%) was injected into the spinal space while the patients were either in sitting or lateral position at L3-L4 level. Effects on hemodynamic parameters, sensory block and motor block characteristics and patient satisfaction were analysed.Results: Demographic characteristics did not seem to have any impact on the overall outcome of the study. Induction position for spinal anaesthesia does not affect the hemodynamic parameters and incidence of side effects when adequate preloading is done. There was no statistically significant difference in the sensory level and motor level achieved. However lateral position appears to be more comfortable than sitting position (P <0.001).Conclusions: Inducing position for spinal anaesthesia did not affect haemodynamic stability and block characteristics in both the groups except that patients feel more comfortable in lateral position.

COMPARISON OF VARIOUS PARAMETERS AFTER INDUCTION OF SPINAL ANAESTHESIA FOR CAESAREAN SECTION IN SITTING AND LATERAL POSITION

2021 ◽  
pp. 22-24
Author(s):  
Krishna Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Blood Pressure ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Elective Caesarean Section ◽  
Lateral Position ◽  
Sitting Position ◽  
Number Of Patients ◽  
Position Group

Background: Hypotension is one of the common complications in patients undergoing surgeries under spinal anesthesia. This phenomenon is comparatively more in pregnant women undergoing caesarean section under spinal anesthesia due to anatomical variations in the spinal cord and physiological changes in pregnant women. Maternal position may inuence the spread of the local anaesthetic drug. So, in this study we have aimed to compare incidence of hypotension and various other parameters like onset of sensory and motor blockade, total number of mephentermine incremental doses (5mg/dose) required in each group to correct hypotension after induction of spinal anesthesia in sitting and lateral position for caesarean sections. Methods: Seventy American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomnly divided into two groups by closed envelope technique to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). In Lumbar (L3interspace, lumbar puncture was done after taking aseptic precautions, plain bupivacaine 0.5% heavy 10 or 12 mg according to the height was injected after conrming free ow of cerebro spinal uid. After this, they were placed in the supine position immediately with right wedge providing for left lateral uterine displacement to avoid supine hypotension syndrome. Maternal blood pressure was measured every minute for 5 minutes, every two min for 10 min and 5 minutely thereafter. Hypotension was dened as a fall in systolic blood pressure >20% of the baseline value or a value <90 mmHg. Results: Statistical studies showed that number of patients who received spinal anesthesia in lateral position had signicantly more incidences of hypotension (19 incidences) compared to those who received in sitting position ( 10 incidences) with P value being (P= 0.048). And also there was faster onset (average time) of action (sensory and motor) in Group L(5 minutes for sensory and 6.2 minutes for motor) than compared to Group S (7 minutes for sensory and 7.4 minutes for motor) but not statistically signicant ( P= 0.361 for sensory and 0.639 for motor). We also observed that, total number of incremental doses (5mg/dose) of mephentermine used were more in patients who received spinal anaesthesia in lateral position (n= 10 increments) than compared to those who received in sitting position( n=5 increments) but it was not statistically signicant (P=0.145). Conclusion: Spinal anesthesia given in lateral position of the patients for caesarean section causes signicantly more incidences of hypotension than that given in sitting position. And there were no signicant differences with respect to onset of sensory and motor block and mephentermine requirement between the groups.

scholarly journals Comparison of the Hypotension in Lateral Verses Sitting Positions during Induction of Spinal Anaesthesia for Caesarean Section

2021 ◽  
pp. 173-178
Author(s):  
Muhammad Arshed ◽  
Hafiza Khatoon ◽  
Kenza Nadeem ◽  
Tahir Ali ◽  
Hira Asad ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Lateral Position ◽  
Surgical Intensive Care Unit ◽  
P Value ◽  
Sitting Position ◽  
Singleton Pregnancy ◽  
Surgical Intensive Care ◽  
Significant Difference ◽  
Position Group

Objective: To compare the hypotension in lateral verses sitting positions during induction of spinal anaesthesia for caesarean section. Study Design: This is a Randomized control trial (RCT) study. Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of health sciences Karachi, from December 2018 to June 2019. Materials and Methods:  All women age 18 to 45 underwent elective caesarian section having ASA I and II, singleton pregnancy on ultrasound with parity ≤3 were enrolled. Patients were randomized to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S) through lottery methods. Using the L3-4 interspace, patients received intrathecal plain bupivacaine, 10mg or 12 mg according to their height, after which they was placed immediately in the supine position with left uterine displacement. Maternal blood pressure was measured with the help of Non-invasive BP apparatus. BP was recorded at baseline then every 5 min till 30 minutes by anesthetist who was unaware of parturient group. Any single or more reading of SBP of <90 mmHg was considered as Hypotension. Results: Mean age of the patients in lateral group was 31.49 ±10.87 years and mean age of the patients in sitting group was 31.80 ±10.77 years (p-value 0.869). Majority of the patients 35 (62.5%) with hypotension were presented with sitting position. Chi square test was applied and statistically significant difference was observed between groups (p-value 0.012).  Conclusion: We concluded that less frequency of hypotension was observed when spinal anaesthesia for caesarean section using plain bupivacaine in the lateral position.

scholarly journals Bupivacaine 0.5% vs. levobupivacaine 0.5% for epidural anaesthesia for caesarean section: a comparative study

2018 ◽  
Vol 7 (2) ◽  
pp. 343 ◽  
Author(s):  
Heena D. Pahuja ◽  
Megha P. Tajne ◽  
Anjali R. Bhure ◽  
Savita M. Chauhan
Keyword(s):  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Motor Block ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Epidural Block ◽  
Elective Cesarean Section ◽  
Significant Difference ◽  
Elective Cesarean ◽  
Mean Time

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.

Efficacy of different infusion rates of oxytocin for maintaining uterine tone during elective caesarean section: A randomised double blind trial

2021 ◽  
pp. 0310057X2098448
Author(s):  
Medha Mohta ◽  
Rohit B Chowdhury ◽  
Asha Tyagi ◽  
Rachna Agarwal
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Spinal Anaesthesia ◽  
Postpartum Haemorrhage ◽  
Elective Caesarean Section ◽  
Double Blind Study ◽  
Double Blind ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Oxytocin Infusion

Most research in this field has focused on finding oxytocin doses for initiating uterine contractions. Only limited data are available regarding the optimal rate of oxytocin infusion to maintain adequate uterine tone. This randomised, double blind study included 120 healthy term pregnant patients with uncomplicated, singleton pregnancy undergoing elective caesarean section under spinal anaesthesia. Following an initial 1 IU bolus, the patients received oxytocin infusion at 1.25 IU/hour (group 1.25), 2.5 IU/hour (group 2.5) or 5.0 IU/hour (group 5) for four hours. Uterine tone was assessed as adequate or inadequate at various intervals. If found inadequate, additional uterotonics were administered. Estimated blood loss was mean (standard deviation) 499 (172) ml, 454 (117) ml and 402 (151) ml in groups 1.25, 2.5 and 5, respectively ( P value groups 1.25 versus 5 = 0.012). Oxytocin infusion at 5 IU/hour resulted in a significantly lower incidence of minor postpartum haemorrhage, defined as blood loss greater than 500 ml, than 1.25 IU/hour ( P = 0.009). No patient had major/severe haemorrhage (>1000 ml blood loss). No significant difference was seen in haemoglobin levels ( P = 0.677) and uterine tone. Fifteen, six and nine patients, respectively, required additional oxytocin ( P = 0.151). The incidence of tachycardia ( P = 0.726), hypotension ( P = 0.321) and nausea/vomiting ( P = 0.161) was comparable. To conclude, 5 IU/hour was more effective than 1.25 IU/hour in reducing total blood loss and the incidence of minor postpartum haemorrhage. Thus 5 IU/hour appears to be an optimal oxytocin infusion rate following 1 IU slow intravenous oxytocin injection for the maintenance of adequate uterine contraction in patients undergoing elective caesarean section under spinal anaesthesia.

scholarly journals Comparison of commonly used vasopressors for treating hypotension after spinal anaesthesia in elective lower abdominal surgery: a randomized, observational, case-control study

2019 ◽  
Vol 7 (5) ◽  
pp. 1479
Author(s):  
Pradeep Kumari ◽  
Sifna Tahir ◽  
Haveena Kumari ◽  
Altaf Ahmad Mir
Keyword(s):  
Blood Pressure ◽  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Time Intervals ◽  
Significant Difference ◽  
Single Bolus Dose ◽  
The Mean

Background: During caesarean section hypotension due to spinal block is secondary to the sympathetic blockade and aorto-caval compression by the uterus. It can have important consequences for the mother and may affect neonatal outcome. The present study was aimed to compare intravenous bolus doses of phenylephrine and ephedrine to treat maternal hypotension during spinal block for elective caesarean section.Methods: After fulfilling the inclusion criteria, 100 parturient were randomly allocated into two groups of fifty each. For spinal anesthesia lumber puncture was done and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally. In this observational study, patients who developed hypotension under spinal anesthesia were selected for the study. According to their group, patients received either ephedrine 6mg (Group E) or phenylephrine 75µg (Group P) as vasopressor. During the study, number of vasopressor boluses, hemodynamic response and time taken to recover from hypotension was noted.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. In 88% parturient single bolus dose of ephedrine was effective in treating hypotension while phenylephrine was effective in 78% parturient. There was no significant difference observed in total number of boluses used. No significant difference was seen in mean systolic blood pressure, mean diastolic blood pressure and mean arterial pressure over a given period of time in Group E and Group P. Mean systolic BP was less than 20% when compared to baseline in both the groups at different time intervals. In Group P the mean heart rate was significantly lower as compared to the Group E (p<0.05).Conclusions: Intravenous phenylephrine and ephedrine are both similar in performance in treating hypotension after spinal anesthesia for elective caesarean section and the hypotensive control offered is comparable.

scholarly journals Influence of injection rate of hyperbaric bupivacaine 0.75% on spinal anaesthesia in elderly patients with lower limb orthopaedic surgeries. A randomized controlled trial.

2019 ◽  
Vol 26 (08) ◽  
pp. 1251-1255
Author(s):  
Manzoor Ahmed Faridi (Retd) ◽  
Shaheen Mahmood ◽  
Muhammad Safi ur Rehman
Keyword(s):  
Elderly Patients ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Injection Rate ◽  
Ethical Review ◽  
Sensory Level ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine

To determine the effect of speed of hyperbaric bupivacaine (0.75%) injection on clinical characteristics of spinal anaesthesia in elderly patients undergoing lower limb orthopaedic surgeries. Study Design: Prospective, randomized, double-blind study. Setting: This study was conducted in the operating theatre of Fauji Foundation Hospital, Rawalpindi. Period: August 2018 - March 2019. Materials and Methods: 60 elderly patients undergoing lower limb orthopaedic surgery were randomized into two groups based on injection rate (fast and slow). 1.5 ml of 0.75% hyperbaric bupivacaine was injected over 5 seconds (fast group) and 50 seconds (slow group). Study was undertaken after taking permission from institutional ethical review committee. Level of sensory block, motor block, and systolic blood pressure were recorded at pre-specified intervals. Incidences of hypotensive episode, nausea, phenylephrine and antiemetic use were also documented. Results: Our study did not reveal any difference in maximum level of sensory block attained (fast = median T4, interquartile range [T4–T6] vs slow = T4 [T4–T6], P = 0.77). There was no difference in mean time (minutes) to reach T10 sensory level (fast = 2.5 ± 1.2 vs slow = 2.2 ± 0.8, P = 0.27); maximum sensory level (fast = 4.2 ± 1.5 vs slow = 3.8 ± 1.2, P = 0.26) and maximum motor block level (min) (fast = 5.9 ± 1.4 vs slow = 5.7 ± 1.2, P = 0.56). The rate of hypotension (fast = 8/30 vs slow = 4/30, P = 0.33), nausea (fast = 5/30 vs slow = 3/30, P = 0.99) and phenylephrine use (fast = 5/30 vs slow = 3/30, P = 0.71) and antiemetic requirement (fast = 1/30 vs slow = 2/30, P = 0.99) was also alike. Conclusion: There is no effect of injection speed of intrathecal (0.75%) bupivacaine on the clinical features of spinal anaesthesia in older patients undergoing lower limb orthopedic surgery.

scholarly journals SITTING VERSUS LATERAL POSITION FOR INDUCTION OF SPINAL ANESTHESIA IN ELDERLY PATIENTS – A RANDOMIZED CONTROLLED TRIAL

2017 ◽  
Vol 10 (2) ◽  
pp. 262
Author(s):  
Showkat Hussain Tali ◽  
Showkat Ahmad Bhat ◽  
Kumar Nm ◽  
Shagufta Yousuf
Keyword(s):  
Randomized Controlled Trial ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Block ◽  
Controlled Trial ◽  
Sensory Block ◽  
Lateral Position ◽  
Hemodynamic Parameters ◽  
Randomized Controlled

Objectives: To compare the effect of induction position (sitting versus lateral) for spinal anaesthesia in the elderly patient on hemodynamic, sensory block and motor block characteristics and patient satisfaction.Material and methods: Randomized controlled trial of patients undergoing spinal anaesthesia for lower abdominal, pelvic, lower limb and urological surgeries aged more than 60 years. Hyperbaric Bupivacain (0.05%) was injected into the spinal space while the patients were either in sitting or lateral position. Effects on hemodynamic parameters, sensory block and motor block characteristics and patient satisfaction were analysed.Results: Induction position for spinal anaesthesia does not affect the hemodynamic parameters and incidence of adverse effects when adequate preloading is done. There was no statistically significant difference in the sensory level and motor level achieved. However lateral position appears to be more comfortable for elderly patients (P= 0.03).Conclusions: Induction position for administration of spinal anaesthesia has no effect on hemodynamic parameters or block characteristics except that patients feel more comfortable in lateral position.Keywords: Spinal anesthesia, Induction position, Hyperbaric bupivacaine.

scholarly journals THE EFFICACY OF INTRATHECAL DEXAMETHASONE TO PREVENT EARLY COMPLICATIONS OF SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION

2020 ◽  
pp. 10-13
Author(s):  
Nataliya Pyasetska
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Postoperative Period ◽  
Elective Caesarean Section ◽  
Perioperative Period ◽  
Controlled Clinical Trial ◽  
Obese Women ◽  
Early Complications ◽  
Hyperbaric Bupivacaine ◽  
Group B

Spinal anaesthesia is commonly used for elective caesarean section. But it has some disadvantages and complications in intra- and postoperative period. The aim of this study was to explore the efficacy of intrathecal or intravenous dexamethasone to prevent some early complications of spinal anaesthesia such as arterial hypotonia, nausea, vomiting, bradycardia, shivering etc.  Material and methods: there were examined 154 healthy, not obese women, ASA I–II, 18–36 years old, 36–40 weeks of gestation, undergoing elective caesarean section under spinal anaesthesia. All patients were divided into three equal groups for randomized, prospective, double-blinded, placebo-controlled clinical trial. The women of each group received intrathecal hyperbaric bupivacaine 0.5 % 10 mg. Group B (n=51) additionally received intrathecal 1 ml of normal saline=placebo; Group BD (n=52) additionally received 4 mg (1 ml) intrathecal dexamethasone, and Group D (n=51) received 8 mg intravenous dexamethasone directly after spinal puncture. The patients were evaluated for blood pressure, heart rate, nausea, vomiting, shivering or other complications during intra- or postoperative period (24 h). The complications that required medicines correction were recorded and cured. Results: the addition of intrathecal dexamethasone in Group BD vs Group B significantly decreased frequency and manifestations of arterial hypotonia and nausea (Pearson's χ2 =0.486 and χ2=0.479, p<0.05) in intra- and postoperative period after the spinal anaesthesia in elective caesarean section. Intrathecal dexamethasone in Group BD vs Group B significantly reduced shivering (Pearson's χ2=0.316, p<0.05) in intra- and postoperative period, and significantly didn`t impact on vomiting and bradycardia. Conclusions: the addition of 4 mg intrathecal dexamethasone as an adjuvant for spinal anaesthesia can significantly decrease frequency and manifestations of arterial hypotonia and nausea, reduce shivering during perioperative period. The addition of 8 mg intravenous dexamethasone has not the same quality.

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