CLONIDINE AS AN ADJUVANT TO HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING INFRAUMBLICAL SURGERIES

2021 ◽  
pp. 72-74
Author(s):  
Purushottam Singhal ◽  
Suresh Pandey ◽  
. S. P. Chittora
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Primary Study ◽  
Control Group ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Small Doses

Background: Use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in patients without affecting the side-effects. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years patients were allocated to three equal groups. Group C received 10 mg hyperbaric bupivacaine without clonidine while Group C and Group C received 15 μg and 30 μg clonidine with 15 30 hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results:Asignicantly higher median block levels were achieved in Group C (P < 0.05) and Group C (P <0.05) than Group C. Highest median 15 30 sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically signicant between Groups C15 and C and between Groups C and C. On comparison of fall in systolic blood pressure trends, there was no signicant difference in the clonidine 30 groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, signicantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

Phenylephrine Added to Prophylactic Ephedrine Infusion during Spinal Anesthesia for Elective Cesarean Section

2001 ◽  
Vol 95 (3) ◽  
pp. 668-674 ◽  
Author(s):  
Frédéric J. Mercier ◽  
Edward T. Riley ◽  
Willard L. Frederickson ◽  
Sandrine Roger-Christoph ◽  
Dan Benhamou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Elective Cesarean ◽  
American Society ◽  
Spinal Hypotension

Background Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy. Methods Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with 6 mg ephedrine bolus doses. Results Hypotension occurred less frequently in the ephedrine-phenylephrine group than in the ephedrine-alone group: 37% versus 75% (P = 0.02). Ephedrine (36+/-16 mg, mean +/- SD) plus 178+/-81 microg phenylephrine was infused in former group, whereas 54+/-18 mg ephedrine was infused in the latter. Median supplemental ephedrine requirements and nausea scores (0-3) were less in the ephedrine-phenylephrine group (0 vs. 12 mg, P = 0.02; and 0 vs. 1.5, P = 0.01, respectively). Umbilical artery pH values were significantly higher in the ephedrine-phenylephrine group than in the group that received ephedrine alone (7.24 vs. 7.19). Apgar scores were similarly good in both groups. Conclusion Phenylephrine added to an infusion of ephedrine halved the incidence of hypotension and increased umbilical cord pH.

scholarly journals Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tarek M. Ashoor ◽  
Noha S. Hussien ◽  
Sherif G. Anis ◽  
Ibrahim M. Esmat
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Volume Overload ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Link Type

Abstract Background Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension. Methods One hundred ten patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 h preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%. Results Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn’t show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group. Conclusion Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control. Registration number ClinicalTrials.gov Identifier: NCT 03664037, Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov

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 Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

2021 ◽  
Author(s):  
Tarek Ashoor ◽  
Noha S. Hussien ◽  
Sherif G. Anis ◽  
Ibrahim M. Esmat
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Volume Overload ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind

Abstract Background: Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension.Methods: 110 patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 hours preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%.Results: Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn’t show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group. Conclusion: Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control.

scholarly journals Comparison of two doses of Dexmedetomidine on hemodynamic parameters of patients undergoing spinal anesthesia

2019 ◽  
Vol 6 (4) ◽  
pp. 1176
Author(s):  
B. Srinivasulu Reddy ◽  
K. Surya
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Respiratory System ◽  
Motor Block ◽  
Sensory Block ◽  
Hemodynamic Parameters ◽  
Follow Up Study

Background: Dexmedetomidine is considered as safe adjuvant as it does not cause depression of the respiratory system. Whether it can be used in the dose of 5 mcg or 10 mcg needs evaluation. Objective of the study was to compare two doses of dexmedetomidine on hemodynamic parameters of patients undergoing spinal anesthesia.Methods: Present study was hospital based follow up study. 80 patients were studied who were of age 18-60 years. These patients were operated using spinal anesthesia. History in detail was taken. They were examined thoroughly and investigated. Informed written consent is taken. Two groups were made. One group with 30 patients received dexmedetomidine 5 mcg. Second group with 50 patients received 10 mcg dexmedetomidine.Results: All baseline parameters were similar in two group patients. Heart rate at various intervals was also similar in two groups patients. Systolic blood pressure at various intervals was also similar in two groups patients. Diastolic blood pressure at various intervals was also similar in two groups patients. Highest level of sensory block was also similar in two groups patients. Patients in 5 mcg group had both the sensory and motor block more compared to patients in 10 mcg group. All other parameters were similar in two group of patients.Conclusions: Dexmedetomidine in doses of 5 mcg and 10 mcg has been found to have similar effect on hemodynamic parameters of the patients. So, it can be used in any of these two doses without affecting the hemodynamic parameters.

A study of intrathecal low dose bupivacaine and fentanyl versus conventional dose of bupivacaine alone for elective caesarean section

2021 ◽  
Vol 19 (3) ◽  
pp. 86-90
Author(s):  
Rama Rao V M ◽  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Rapid Onset ◽  
P Value ◽  
Sensory Level ◽  
Lipid Solubility ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade

Background: Spinal anesthesia is the most common method of the regional block in cesarean section, because it is easy to perform, economical produces rapid onset of anesthesia, and good muscle relaxation, and most importantly, it gives immense pleasure to the conscious mother. To improve the quality of subarachnoid block, intrathecal opioids are used as adjuvants to Bupivacaine. Fentanyl has a rapid onset of action as a lipophilic opioid following intrathecal administration. Because of high lipid solubility, it undergoes rapid uptake by the spinal cord, and hence the chances of delayed respiratory depression are less. Methods: We randomly selected 60 patients belonging to the American Society of Anesthesiologists (ASA) class I and II, who are scheduled for elective LSCS. These patients were divided randomly into two groups of 30 each. Group B received 10mg of 0.5% hyperbaric bupivacaine (2ml). Group BF received 7.5mg of 0.5% hyperbaric bupivacaine (1.5ml) with 25mcg of Fentanyl (0.5ml). Lumbar puncture was performed at the level of L3-L4 with 23 Guage Quincke Babcock's needle with the patient in the right lateral position. The sensory block was assessed with the loss of pin prick sensation, and the motor block was set using the Bromage scale technique. We also recorded the hemodynamic parameters like pulse rate, blood pressure, oxygen saturation. Results: No significant statistical difference was found in demographic data between the two groups. Group BF showed early onset of the sensory block with a P value of 0.001. Time taken to attain peak sensory level was early in the BF group with a P value of 0.001. The total duration of sensory block and duration of effective analgesia was longer in the BF group with a P value of 0.001. The onset of motor blockade was early in the bupivacaine only group with a P value of 0.02. Conclusion: The intrathecal fentanyl 25mcg reduces the dose of 7.5 mg of 0.5% hyperbaric Bupivacaine for spinal anesthesia in cesarean section, thus reducing the incidence of side effects associated with it. By its synergistic effect with 0.5% hyperbaric bupivacaine, it provides better excellent sensory blockade and postoperative analgesia, good hemodynamic stability, less incidence of complications like Nausea, vomiting, and shivering without compromising the safety of mother and fetus in comparison to intrathecal 10mg of 0.5% hyperbaric Bupivacaine alone.

scholarly journals Intravenous Palonosetron for Attenuation of Hypotensive Response and Bradycardia during Spinal Anaesthesia

2021 ◽  
Vol 6 (02) ◽  
pp. 109-113
Author(s):  
Suvidha Sood, M.D. ◽  
Yogesh Roy, MBBS ◽  
Anupriya Saxena, MBBS
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Normal Saline ◽  
Sensory Block ◽  
Sensory Level ◽  
Anesthesia Group ◽  
Significant Difference ◽  
Spinal Anesthesia Group ◽  
Hypotensive Response

Aim: This study was conducted to evaluate the role of intravenous (IV) palonosetron during spinal anesthesia. Method: A total of 100 patients undergoing elective lower limb and lower abdominal surgeries were randomly divided into two groups. Group P was given 0.25mg palonosetron diluted in 10 ml normal saline slowly before spinal anesthesia. Group S was given 10 ml of normal saline slowly before spinal anesthesia. Heart rate (HR) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , mean arterial pressure (MAP), oxygen saturation (SpO2) were monitored at an interval of 2 minutes for the initial 20 minutes, then at an interval of every 5 minutes till the end of the surgery. Time to reach the maximum sensory level and its regression two levels below and then till S1 was noted. The incidence of nausea, vomiting, shivering, use of intravenous mephenteramine, level of motor block and its regression were also recorded. Results: Decreases in HR were more observed in Group S and the differences were statistically significant at 25 min [p=0.048] and 30 min [p=0.047]. The decrease in MAP were observed more in Group S and statistically significant difference noted at 20 min [ p = 0.026], 25 min [ p = 0.046] and at 30 min [ p = 0.047]. The use of intravenous mephentermine [p = 0.009] and development of nausea [p = 0.049] were significantly more common in Group S, Sensory block regression was faster in group P. [p=0.054]. Conclusion: Premedication with 0.25mg IV palonosetron before spinal anesthesia reduces hypotension, bradycardia.

EFEKTIVITAS PEMBERIAN HYDROTHERAPI RENDAM KAKI PADA PENDERITA HIPERTENSI DI BANJAR SRI MANDALA, KELURAHAN DAUHWARU KABUPATEN JEMBRANA

2019 ◽  
Vol 10 (01) ◽  
pp. 33-44
Author(s):  
N.L.G. Sudaryati ◽  
I P. Sudiartawan ◽  
Dwi Mertha Adnyana
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Reduce Blood Pressure ◽  
Second Grade ◽  
Control Group ◽  
Hypertensive Patients ◽  
First Category

The aim of the study was to determine the effectiveness of giving hydrotherapi foot soak in hypertensive patients. The study was conducted with one group pretestposttest design without a control group by measuring blood pressure (pretest) before being given an intervention in the form of foot soak hydrotherm against 15 people with hypertension in Banjar Sri Mandala, Dauhwaru Village, Jembrana Subregency. Then do the blood pressure measurement again (posttest) after finishing the intervention. After the study was completed, the results showed that before the hydrotherapi foot bath intervention, there were 0% of patients classified as normal, 13.32% in prehypertension category, 60.08% in hypertension category I and 26.60% in hypertension category II. After the intervention was given, there were 13.32% of the patients classified as normal, 66.68% in the prehypertension category, 20.00% in the first category of hypertension and no patients belonging to the second grade hypertension category. There is a decrease of 20-30 mmHg for systolic blood pressure and 0-10 mmHg for diastolic blood pressure after intervention. Based on the results of the study it can be concluded that the hydrotherapi foot bath is effectively used to reduce blood pressure in hypertensive patients in the Banjar Sri Mandala, Dauhwaru Village, Jembrana District.

scholarly journals Effects of Acupuncture on Lowering Blood Pressure in Postmenopausal Women with Prehypertension or Stage 1 Hypertension: A Propensity Score-Matched Analysis

2021 ◽  
Vol 10 (7) ◽  
pp. 1426
Author(s):  
Bok-Nam Seo ◽  
Ojin Kwon ◽  
Siwoo Lee ◽  
Ho-Seok Kim ◽  
Kyung-Won Kang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Propensity Score ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Postmenopausal Women ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Matched Design ◽  
Stage 1

Postmenopausal women have a higher prevalence of hypertension compared to premenopausal women. Hypertension is a risk factor for cardiovascular diseases, the prevalence of which is ever increasing. This study investigated the effects of long-term acupuncture on lowering the blood pressure of postmenopausal women with prehypertension and stage 1 hypertension. Participants were 122 postmenopausal women aged less than 65 years, diagnosed with prehypertension or stage 1 hypertension (systolic blood pressure 120–159 mmHg or diastolic blood pressure 80–99 mmHg). We used a propensity score-matched design. The experimental group (n = 61) received acupuncture for four weeks every six months over a period of two years. The control group (n = 61) received no intervention. An Analysis of covariance (ANCOVA) was performed for the primary efficacy analysis. Relative risk ratios were used to compare group differences in treatment effects. Acupuncture significantly reduced the participants’ diastolic blood pressure (−9.92 mmHg; p < 0.001) and systolic blood pressure (−10.34 mmHg; p < 0.001) from baseline to follow-up. The results indicate that acupuncture alleviates hypertension in postmenopausal women, reducing their risk of developing cardiovascular diseases and improving their health and quality of life.

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