Comparison of the Mean Minimum Dose of Bolus Oxytocin for Proper Uterine Contraction during Cesarean Section

Background: Cesarean section is the most common midwifery operation. The aim of this study is to determine the mean minimum dose of bolus oxytocin for proper uterine contraction during cesarean section. Method: Patients were divided into two groups: elective cesarean section (n=41) and cesarean section due to difficulty in labor (n=42 patients). Patients underwent spinal anesthesia and oxytocin infusion was begun at 30 drops per minute (20 units of oxytocin per 1000 cc serum), and was also administered as a half-dose in cc to achieve effective contraction of the uterus. Meanwhile, the information of patients including systolic and diastolic blood pressure (SBP and DBP), heart rate and amount of bleeding during the operation was recorded in a questionnaire. Results: In the elective cesarean section group, the average SBP was about 117.10mmHg, average DBP 70.50 mmHg, the amount of bleeding during surgery was 623.63mL, and heart rate was 88.88bpm. In the cesarean section group due to difficulty in labor progress, SBP was 113.5 mmHg, DBP 62.69 mmHg, and bleeding was 573.81mL. In addition, 9 patients in the elective group and 3 patients in the lack of progress group, did not require bolus oxytocin. In the lack of a progress group, 8 patients needed more than 5 doses of oxytocin. In addition, about 10 (12%) of all patients had no side effects, and hypotension. Conclusion: Given that, the minimum effective dose of oxytocin in the elective cesarean section was 1IU, and in those in labor progress was 1-1.5IU, less oxytocin administration represents lesser side effects. It is recommended that patients who are candidates of cesarean section should be administered 1.5IU of oxytocin in the form of bolus.

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

QJM ◽

10.1093/qjmed/hcab086.088 ◽

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.

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Effect of Anesthesia Techniques on Pain Severity, Hemodynamic Changes, and Patients’ Satisfaction in Elective Cesarean Section

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i7.2328 ◽

2020 ◽

Author(s):

Abdollah Jafarzadeh ◽

Maryam Hadavi ◽

Gholamhossein Hasanshahi ◽

Mohsen Rezaeian ◽

Reza Vazirinejad ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Postoperative Pain ◽

Cesarean Section ◽

Diastolic Blood Pressure ◽

Elective Cesarean Section ◽

Hemodynamic Changes ◽

Apgar Scores ◽

Patients Satisfaction ◽

Elective Cesarean

The severity of postoperative pain and hemodynamic changes during and post-cesarean section have a direct effect on the neonatal and maternal condition. This study aimed to compare pain severity, hemodynamic changes, and patient satisfaction following two anesthesia techniques in elective cesarean section. In this blinded study, 60 women who were candidate for cesarean section were allocated into two equal groups of general anesthesia (GA) and spinal anesthesia (SA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and O2 Saturation at pre cesarean (T0), the uterine incision time (T1), end of surgery (T2), 6h (T3), 12h (T4), and 24 hours post-cesarean (T5) were measured. A Visual Analog Scale assessed post-cesarean pain, 6, 12, and 24 hours post-cesarean. Gender, birth weight, first- and fifth- minutes’ apgar score was recorded in the checklists. The VAS score was significantly higher in the GA group at 6h, 12h, and 24 hours post-cesarean (P=0.014, P=0.002, P=0.017, respectively). SBP and DBP at T1 in the GA group were significantly higher than in the S.A group (P<0.001). The heart rate at T0 and T1 in the GA group was lower than the SA group (P=0.001, P=0.045 respectively). The difference between the apgar scores of the two groups was not significant. SA for cesarean section was associated with lower postoperative pain, systolic and diastolic blood pressure. However, the two groups had no significant difference in terms of patients’ satisfaction and apgar scores. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):424-429.

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Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190017 ◽

2019 ◽

Vol 8 (2) ◽

pp. 372

Author(s):

Pravin Shah ◽

Ajay Agrawal ◽

Shailaja Chhetri ◽

Pappu Rijal ◽

Nisha K. Bhatta

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Postpartum Hemorrhage ◽

Elective Cesarean Section ◽

Controlled Study ◽

Control Group ◽

Estimated Blood Loss ◽

Elective Cesarean ◽

The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

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Fetal Heart Rate after Epidural Lidocaine and Bupivacaine for Elective Cesarean Section

Anesthesiology ◽

10.1097/00000542-199109000-00005 ◽

1991 ◽

Vol 75 (3) ◽

pp. 406-412 ◽

Cited By ~ 9

Author(s):

John R. Loftus ◽

R. Hal Holbrook ◽

Sheila E. Cohen

Keyword(s):

Heart Rate ◽

Cesarean Section ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Elective Cesarean Section ◽

Elective Cesarean

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Efficacy of Intravenous Ondansetron on Hemodynamic Complications in Women Undergoing Spinal Anesthesia for Cesarean Section: A Randomized Placebo Controlled Clinical Trial

Galen Medical Journal ◽

10.31661/gmj.v5i1.475 ◽

2016 ◽

Vol 5 (1) ◽

pp. 13-18

Author(s):

Pouran Hajian ◽

Bita Malekianzadeh ◽

Maryam Davoudi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Placebo Group ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Controlled Clinical Trial ◽

Sterile Water ◽

Elective Cesarean

Background: Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex. Material and Methods: One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting. Results: There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009). Conclusion: Ondansetron given intravenously with antiemetic dose (4 mg) decreases mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.[GMJ. 2016;5(1):13-18]

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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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Effect of Spinal Anesthesia versus General Anesthesia on Blood Glucose Concentration in Patients Undergoing Elective Cesarean Section Surgery: A Prospective Comparative Study

Anesthesiology Research and Practice ◽

10.1155/2019/7585043 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Khaled El-Radaideh ◽

Ala’’a Alhowary ◽

Mohammad Alsawalmeh ◽

Ahmed Abokmael ◽

Haitham Odat ◽

...

Keyword(s):

Blood Glucose ◽

Cesarean Section ◽

General Anesthesia ◽

Spinal Anesthesia ◽

Glucose Concentration ◽

Blood Glucose Concentration ◽

Elective Cesarean Section ◽

Elective Cesarean ◽

Prospective Comparative Study ◽

The Mean

Background. This prospective study compared the blood glucose concentration with spinal anesthesia or general anesthesia in patients undergoing elective cesarean section surgery. Methods. In total, 58 pregnant women who underwent elective cesarean section surgery were included in this prospective comparative study. Group S (n = 35) included patients who chose spinal anesthesia, and group G (n = 23) included patients who chose general anesthesia. The patients were allocated to the groups upon patients’ preference. For the group G, the blood glucose concentration (BGC) was obtained 5 minutes before induction, T1, and 5 minutes after induction T2. For the group S, the BGC was obtained immediately before the injection of the local anesthetic agent T1 and 5 minutes after the complete block T2. For both groups, BGC was measured 5 minutes before the end of surgery T3 and 30 minutes after the end of surgery T4. For BGC measurements, we used a blood glucose monitoring system with a lancet device to prick the finger. Results. There was no statistically significant difference in the mean blood glucose concentration between the groups S and G in T1 (78.3 ± 18.2 vs. 74.3 ± 14.7, p>0.05) and T2 (79.2 ± 18.3 vs. 84.9 ± 23.7, p>0.05). The mean BGC was statistically significantly higher in group G in comparison to group S in the times 5 minutes before (80.2 ± 18.1 vs. 108.4 ± 16.7, p<0.05) and 30 minutes after the end of surgery (80.9 ± 17.7 vs. 121.1 ± 17.4, p<0.05). Conclusion. There is a much lower increase in blood glucose concentration under spinal anesthesia than under general anesthesia. It is reasonable to suggest that the blood sugar concentration must be intraoperatively monitored in patients undergoing general anesthesia.

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Oxygen saturation trends in normal healthy term newborns: normal vaginal delivery vs. elective cesarean section

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0373 ◽

2018 ◽

Vol 46 (2) ◽

pp. 191-195 ◽

Cited By ~ 2

Author(s):

Rashi Bhargava ◽

Madhu Mathur ◽

Jyoti Patodia

Keyword(s):

Birth Weight ◽

Cesarean Section ◽

Oxygen Saturation ◽

Vaginal Delivery ◽

Neonatal Resuscitation ◽

Elective Cesarean Section ◽

Normal Vaginal Delivery ◽

Elective Cesarean ◽

Term Newborns ◽

The Mean

AbstractObjectives:To study the normal oxygen saturation trends and fetomaternal correlates in healthy term newborns within 30 min of life born by normal vaginal delivery (NVD) and elective cesarean section (CS).Materials and methods::A cross-sectional study was conducted on 200 healthy term newborns born by NVD and elective CS at a tertiary care centre. Routine care as per the Neonatal Resuscitation Program (NRP) 2015 (Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S543–60) protocol was given and pre-ductal arterial oxygen saturation was assessed by pulse oximetry at different intervals after birth.Results:The mean peripheral oxygen saturation (SpO2) was 85.4%, 90.8%, 94.1%, 95.7%, 96.7% and 97.4% at 5, 10, 15, 20, 25 and 30 min, respectively, after birth. Higher mean SpO2was observed in NVD compared to elective CS (P<0.005). The mean time for SpO2to reach >90% was 9.13 min in NVD and 12.31 min in elective CS (P<0.001). Maternal hemoglobin (Hb) (r=−0.15; P<0.01), birth weight (r=−0.125; P<0.05) and Apgar at 10 min (r=0.33; P<0.001) were significantly correlated with SpO2of newborns at 10 min of life.Conclusion:Our study defines normal SpO2levels in healthy term newborns in the first 30 min of life born by NVD and elective CS. Babies born by NVD had significantly higher SpO2levels and attained SpO2>90% faster than those born by elective CS. Maternal Hb, birth weight and Apgar at 10 min were significant factors affecting SpO2levels of newborns at 10 min of life.

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