scholarly journals EPHEDRINE FOR PREVENTION HYPOTENSION

2007 ◽  
Vol 14 (04) ◽  
pp. 610-615 ◽  
Author(s):  
ABDUL-HAMEED CHOHEDRI ◽  
SHAHRBANO SHAHBAZI ◽  
L KHOJESTE ◽  
Elahe Alahyari
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Maternal Blood ◽  
Double Blind Study ◽  
Double Blind ◽  
Prophylactic Dose ◽  
Anesthesia Group ◽  
Group A ◽  
Study Setting ◽  
Maternal Blood Pressure

Background/Aim:. To ameliorate post spinal anesthesia hypotensionin patients undergoing cesarean section. To compare the incidence of maternal hypotension associated withspinal anesthesia for cesarean section when intravenous (IV), intramuscular (IM) or oral prophylactic boluses ofephedrine were used. Design: Prospective randomized double blind study. Setting: Department of anesthesiology,Zainibiae Hospital, Shiraz University, Iran. Period: From: June 2004 to November 2005. Materials and Methods:60 ASA grade I-II pregnant mothers were enrolled. Spinal anesthesia was performed using 60-70 mg of 5% solutionof lidocaine. The patients were divided into three equal groups (n=20). Oral and IM ephedrine (25 mg) wasadministered to the first two groups 30 to 60 minutes before induction of anesthesia (Group A and B, respectively). Inthe last 20 patients, IV Ephedrine (25 mg) was administered immediately after induction of spinal anesthesia (GroupC). Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10-mg ephedrine boluses. Results: Both IM and IV prophylactic doses of ephedrine significantly decreased the incidenceof hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups,respectively vs. 9/20 in the oral ephedrine group (p < 0.05)]. Conclusion: Oral prophylactic dose of ephedrine is noteffective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore,we only recommend a single bolus of IV ephedrine with a dose of 25mg.

scholarly journals Norepinephrine versus ephedrine for hypotension prophylaxis during cesarean section under spinal anesthesia

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ashraf E. Elagamy ◽  
Aiman M. Kamaly ◽  
Mohamed I. Shahin ◽  
Mohamed Saleh
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Hypotensive Effect ◽  
Maternal Blood ◽  
Anesthetic Technique ◽  
Double Blind Study ◽  
Double Blind ◽  
Spinal Hypotension ◽  
Maternal Blood Pressure

Abstract Background Spinal anesthesia is the preferred anesthetic method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been tried to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. The aim of this prospective, randomized, double blind study is to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Methods In the present study, 120 pregnant female undergoing elective CS were randomly divided into “group E” for ephedrine and “group N” for norepinephrine, 60 female in each group. Standard spinal anesthetic technique using 25 spinal needle under complete aseptic technique with injection of 1.8–2.2 ml of heavy bupivacaine 0.5% plus 25 μg of fentanyl according to female height. Group E will receive 10 mg of i.v. diluted ephedrine as hypotension prophylaxis, and group N will receive 16 μg as hypotension prophylaxis at the time of intrathecal block. Measurements of intraoperative episodes of hypotension and their treatment with the same dose of the studied drug in each group, incidence of intraoperative nausea and vomiting, and APGAR score of baby at 1 and 5 min will be recorded. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure. Further, it was associated with lower numbers of hypotension episodes, but more frequency of bradycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

scholarly journals The effect of clonidine with bupivacaine on perioperative hemodynamics and post-operative analgesia in cesarean section cases

2021 ◽  
Vol 10 (8) ◽  
pp. 3049
Author(s):  
Priti Kumar ◽  
Sangeeta Arya ◽  
Sushil Kr. Singh ◽  
Sunil Kumar
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Intraoperative Hypotension ◽  
Elective Cesarean ◽  
Group A ◽  
Group B

Background: Cesarean section is the commonest procedure in Obstetric practice and postoperative pain can be a major factor for wound healing as well as mother and baby bonding. Spinal anesthesia is considered to be safest and easiest modality for cesarean section cases. Bupivacaine is the commonest drug given in spinal anesthesia, but many additive drugs have been introduced to cover post-operative analgesia. Clonidine is an alpha 2 agonist which can be used as an adjunct to heavy bupivacaine to extend analgesic effects.Methods: A randomized double-blind study was performed in 100 women undergoing elective cesarean section under spinal anaesthesia. After proper informed written consent patient undergoing cesarean section were divided by computerized method into group A (Given 10.0 mg 0.5% hyperbaric Bupivacaine) and Group B (Given 9.0 mg 0.5% hyperbaric bupivacaine and 30 μg clonidine).Results: Intraoperative hypotension is the most worrisome factor but it is transient and can be managed by ephedrine effectively. Intraoperative nausea and vomiting are slightly higher with clonidine as occurrence of hypotension is more. VAS scoring in post-operative period was better and need of first analgesic dose was much delayed in women been given clonidine with bupivacaine.Conclusions: Clonidine can be considered as adjunct in spinal anesthesia to extend post-op analgesic cover. 

Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

2020 ◽  
Vol 15 ◽  
Author(s):  
Arash karimi ◽  
Jahanbakhsh Nejadi ◽  
Mahnaz Shamseh ◽  
Nooshin Ronasi ◽  
Mehdi Birjandi
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Postoperative Nausea ◽  
Demographic Data ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Group A ◽  
Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

scholarly journals PREVENTION OF SHIVERING DURING LOWER SEGMENT CESAREAN SECTION;

2013 ◽  
Vol 20 (03) ◽  
pp. 409-415
Author(s):  
ASHFAQ AHMED ◽  
MOHAMMAD ASLAM
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Carbon Dioxide Production ◽  
Double Blind Study ◽  
Lower Segment ◽  
Chi Square ◽  
Double Blind ◽  
Lower Segment Cesarean Section ◽  
Group I ◽  
Group Ii

Objectives: To compare the efficacy of low-dose prophylactic use of ketamine with ketamine plus midazolam for theprevention of shivering caused by spinal anesthesia, during lower segment cesarean section. Main Outcome Measures: Heamodynamicmonitoring, avoidance of lactic acidosis/ increased carbon dioxide production and patient satisfaction. Design: Prospective RandomizedControlled trial. Place: Department of Anesthesia and ICU PNS Shifa Karachi. Duration of study: March 2010 to June 2010. Patients andMethods: 100 ASA-I & II consecutive patients who reported for LSCS in PNS Shifa Hospital were studied. In this double-blind study,patients were randomly allocated to receive ketamine alone (Group I, n= 50), and ketamine plus midazolam (Group II, n = 50). Afterstandardized Spinal anesthesia, a shivering was recorded at 5 min intervals for 15 minutes. Results: Shivering was observed in 9/50(18%) patients of group I (Ketamine only) as compared to only 2/50 (4%) patients in Group II (ketamine + midazolam) (p=0.025) whichis statically significant. The two groups were comparable regarding distribution of age (p=0.37), BMI (p=0.27) and duration of surgery.Results were analyzed by using chi square test. Conclusions: The efficacy of i.v. ketamine plus midazolam is better as compared to lowdosei.v. ketamine alone in preventing shivering in lower segment Cesarean Section patients, during spinal anesthesia.

scholarly journals Isobaric levobupivacaine a better and safer substitute for spinal anaesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries

2018 ◽  
Vol 6 (9) ◽  
pp. 3111
Author(s):  
Wasimul Hoda ◽  
Abhishek Kumar ◽  
Priodarshi Roychoudhury
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Double Blind ◽  
Sensory Blockade ◽  
Group A ◽  
Group B

Background: Bupivacaine being the drug of choice for spinal anaesthesia is associated with serious cardiac toxicity. Levobupivacaine and ropivacaine, both being the two S enantiomers of bupivacaine can be a safer alternatives with better cardiovascular safety. Hence, the clinical efficacy of both were assessed and compared in patients undergoing spinal anesthesia.Methods: A prospective randomized controlled double blind study was done in 68 adult posted for elective lower abdominal and lower limb surgeries under spinal anesthesia. They were randomized into 2 groups. About 3ml isobaric levobupivacaine 0.5% (15mg) was given in group A and 3ml isobaric ropivacaine 0.5% (15mg) was given in group B. Onset, duration of sensory and motor blocks, time for maximum sensory and motor block, time for 2 segment sensory regression and haemodynamic parameters were recorded and analyzed.Results: All patients achieved a sensory block of T10 dermatome. Onset of sensory blockade at T10 was similar in both groups, group A (5.71±1.31min) and group B (5.94±1.72min). Time from injection to two dermatomal regression was 129.68±15.54min in group A and 111.38±22.35min in group B. Onset of Bromage score of 1 in group A was 4.68±1.27min and in group B was 6.44±1.64min. The mean duration of motor and complete motor block was prolonged in group A patients (197.74±18.51min, 168.82±17.90 min) as compared to group B (131.88±20.41min, 106.71±10.85min).Conclusions: Isobaric levobupivacaine was found to be a better and safer substitute for spinal anesthesia in patients undergoing prolonged lower abdominal and lower limb surgeries.

scholarly journals Comparing the Effects of Low Dose of Ketamine, Tramadol, and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ali Mohammadzadeh Jouryabi ◽  
Seyedeh Hajar Sharami ◽  
Mandana Mansour Ghanaie ◽  
Abbas Sedighinejad ◽  
Vali Imantalab ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Gold Standard ◽  
Low Dose ◽  
Demographic Variables ◽  
Double Blind Study ◽  
Double Blind ◽  
Apgar Scores ◽  
Significant Difference ◽  
High Incidence

Background: Shivering frequently occurs in cesarean section (CS) under spinal anesthesia (SA), resulting in several complications. To date, pethidine has been considered as the gold standard for post-SA shivering control, but it is contraindicated in breastfeeding women. Methods: This randomized, double-blind study was conducted at Alzahra hospital in Guilan, Iran, From January 2019 to November 2020. A total of 508 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K), tramadol (T), ondansetron (O), and placebo (P). The incidence and severity of shivering and patients’ complications were recorded and compared among the groups. Results: The patients were homogenous in terms of demographic variables. Shivering was witnessed in 68 (53.5%), 26 (20.5%), 75 (59.1%), and 82 (64.6%) patients in K, T, O, and P groups, respectively (P = 0.0001). Regarding shivering severity, there was a significant difference among the four groups (P = 0.0001). In addition, a significant difference was seen regarding Apgar scores at the first minute, but not at the fifth minute (P = 0.168). Conclusions: Considering the high incidence of shivering in placebo group, prophylactic intervention in CS under SA seems to be necessary. Among the studied drugs, tramadol was the most effective one, followed by a low dose of ketamine and ondansetron.

scholarly journals A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries

2019 ◽  
pp. 162-167
Author(s):  
Arvind Khare ◽  
Beena Thada ◽  
Devraj Yadav
Keyword(s):  
Spinal Anesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Double Blind Study ◽  
Hemodynamic Parameters ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Voiding Function ◽  
Group A ◽  
Group B

Background: Spinal anesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects.Methodology: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used.Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups.Conclusion: Intrathecal 1% 2-chloroprocaine 30 mg provides spinal anesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg.Citation: Khare A, Thada B, Yadav D, Mathur V, Singh M. A randomized double blind study to compare 1% 2-chloroprocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia for infra-umbilical surgeries. Anaesth. pain & intensive care 2019;23(2):162-167

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