scholarly journals Clinical Comparative Study of Effect of Two Different Doses of Phenylephrine on Spinal Induced Hypotension during Cesarean Section

2021 ◽  
pp. 482-489
Author(s):  
S. Hiruthick ◽  
K. V. L. Sanjana
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Prospective Observational Study ◽  
Bolus Dose ◽  
Systolic Pressure ◽  
Induced Hypotension ◽  
Group A ◽  
Group B ◽  
Different Doses

Background and Aims: During Cesarean section, hypotension occurs in the most of parturients, following spinal anesthesia. This prospective observational study was undertaken to determine the efficacy of two different Bolus Doses of Phenylephrine for Prevention of Spinal-Induced Hypotension during Cesarean Section. Materials and Methods: A total of 120 parturients undergoing cesarean section were divided into two groups of group A and group B with sixty in each group. Group A received phenylephrine 75 mcg IV bolus, while Group B received phenylephrine 100 mcg IV bolus, immediately after giving spinal anesthesia. For the next 20 minutes, systolic blood pressure (SBP), diastolic blood pressure (DSP), mean arterial pressure (MAP), and heart rate (HR) were recorded every 2 minutes, and APGAR scores at 1 and 5 minutes were recorded. Results: There was no difference between the two groups in terms of preventing hypotension, with 16.6% in Group A and 16.6% in Group B. In the first 2–6 minutes, however, the rise in systolic pressure in Group B was higher than in Group A. Group B (46.66 %) had a higher rate of bradycardia than Group A (25 %). Conclusion: Both phenylephrine dosages were equally effective in preventing hypotension following spinal anesthesia. However, Prophylactic bolus dose of phenylephrine 75 mcg was found to be effective for the management of spinal-induced hypotension and should be preferred over 100 mcg which causes significant bradycardia and reactive hypertension.

Minidose Bupivacaine–Fentanyl Spinal Anesthesia for Surgical Repair of Hip Fracture in the Aged

2000 ◽  
Vol 92 (1) ◽  
pp. 6-6 ◽  
Author(s):  
Bruce Ben-David ◽  
Roman Frankel ◽  
Tatianna Arzumonov ◽  
Yuri Marchevsky ◽  
Gershon Volpin
Keyword(s):  
Blood Pressure ◽  
Hip Fracture ◽  
Spinal Anesthesia ◽  
Surgical Repair ◽  
Systolic Pressure ◽  
The Elderly ◽  
Vasopressor Support ◽  
Group A ◽  
Blood Pressures ◽  
Group B

Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods Twenty patients aged > or = 70 yr undergoing surgical repair of hip fracture were randomized into two groups of 10 patients each. Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 microg, and group B received 10 mg bupivacaine. Hypotension was defined as a systolic pressure of < 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5-10 mg up to a maximum 50 mg, and thereafter by phenylephrine boluses of 100-200 microg. Results All patients had satisfactory anesthesia. One of 10 patients in group A required ephedrine, a single dose of 5 mg. Nine of 10 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 35 mg ephedrine, and two patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressures as fractions of the baseline pressures were, respectively, 81%, 84%, and 85% versus 64%, 69%, and 64% for group A versus group B. Conclusions A "minidose" of 4 mg bupivacaine in combination with 20 microg fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly. The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.

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 EFFICACY OF PHENYLEPHRINE OVER EPHEDRINE IN CONTROLLING FALL OF BLOOD PRESSURE: A CROSS SECTIONAL STUDY IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Keshav Saran Agrawal ◽  
Aruna Mahanta
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Cross Sectional Study ◽  
Age Group ◽  
Lower Segment ◽  
Cross Sectional ◽  
Lower Segment Caesarean Section ◽  
Block Level ◽  
Group A ◽  
Group B

Background: most of the lower segment caesarean sections are done under spinal anesthesia and in more that 80% of the cases, maternal fall in blood pressure can be observed intraoperatively. Throughout history many vasopressor drugs have been evaluated for the treatment. Aim: our research was conducted to compare the effect of phenylephrine with ephedrine given for the prophylaxis of prevention of intraoperative fall in blood pressure in females who are undergoing LSCS. Materials and Methods: a total of 100 cases were considered for our study and were randomly distributed in two groups. Group A cases were administered Phenylephrine while ephedrine was given to group B cases just after spinal anesthesia. Results: most of our study subjects were in the age group of 21-25 years who were in the range of 51-55 kgs. Spinal anesthesia was given by using bupivacaine & block level was checked at 2 & 5 mins. Phenylephrine was found to be superior in control of fall in blood pressure as more than 90% of the cases were brought back to their preoperative levels in less than 4 mins after spinal anesthesia. Whereas in group B, ephedrine took much more time of around 10 mins for control of BP. Conclusion: with proper monitoring of heart rate, phenylephrine is superior to ephedrine in controlling the fall in blood pressure. Keywords: Ephedrine, Phenylephrine, Hypotension, Bradycardia.

scholarly journals Comparison of two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block for abdominal hysterectomies. A randomized double blinded study.

2017 ◽  
Vol 8 (2) ◽  
pp. 59-63
Author(s):  
R Krishna Prabhu ◽  
A Radhakrishnan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Relief ◽  
Blood Loss ◽  
Motor Block ◽  
Sensory Block ◽  
Abdominal Hysterectomy ◽  
Group A ◽  
Group B ◽  
Different Doses

Background: Abdominal hysterectomy is often a long duration procedure and warrants intense pain relief in the post-operative period. Dexmedetomidine when added to bupivacaine in subarachnoid block prolongs the duration of surgical anaesthesia, decreases blood loss and prolongs duration of post-operative pain relief. Aims and Objective: To compare two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block in abdominal hysterectomy surgeries. Materials and Methods: 60 patients of age group 30-60 years posted for elective abdominal hysterectomies under American Society of Anaesthesiologists (ASA) physical classification I or II were randomly allocated into 2 groups of 30 each. Group A received 5 micrograms (μg) of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Group B received 10 μg of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Changes in blood pressure, heart rate, respiratory rate, oxygen saturation, ephedrine consumption, blood loss, duration of sensory block, duration of motor block, duration of analgesia were compared between two groups. Results: There was no significant difference in change in heart rate, respiratory rate, oxygen saturation, duration of sensory block, duration of motor block between two groups. Patients in group B had significant decrease in blood pressure, blood loss and significant increase in ephedrine consumption compared to Group A. The duration of analgesia was also prolonged in group B compared to Group A. Conclusion: Dexmedetomidine in dose of 10 μg is a better adjuvant to bupivacaine for abdominal hysterectomy surgeries.Asian Journal of Medical Sciences Vol.8(2) 2017 59-63

Arterial stiffness and subclinical aortic damage of reclassified subjects as stage 1 hypertension according to the new 2017 ACC/AHA blood pressure guidelines

VASA ◽  
2019 ◽  
Vol 48 (3) ◽  
pp. 236-243 ◽  
Author(s):  
Theodore G. Papaioannou ◽  
Evangelos Oikonomou ◽  
George Lazaros ◽  
Evangelia Christoforatou ◽  
Georgia Vogiatzi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Stiffness ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Group A ◽  
New Guidelines ◽  
Group B ◽  
Stage 1

Abstract. Background: The 2017 ACC/AHA blood pressure (BP) guidelines generated controversies due to the new proposed BP cut-off values defining hypertension. We aimed to assess aortic stiffness of subjects who are reclassified as stage 1 hypertensive according to the new guidelines and compare them with the subjects of “elevated BP” category. Patients and methods. Data from the “Corinthia” study, an observational, cross-sectional survey of 2,043 participants were analyzed. Subjects were classified into 4 groups: group A: systolic pressure (SBP) 120–129 and diastolic pressure (DBP) < 80 mmHg, group B: SBP 130–139 or DBP 80–89 mmHg, group B1: SBP 130–139 and DBP < 80 mmHg and group B2: SBP 130–139 and DBP 80–89 mmHg. Aortic stiffness was assessed by carotid-to-femoral pulse wave velocity (PWV). A value of PWV > 10m/s was consider indicative of asymptomatic organ damage while values of PWV exceeded the 90 % percentile for each age group were consider as abnormal. Results: Groups B, B1 and B2 have significantly increased PWV compared to group A, independently from age and other risk factors (PWV: 9.2 ± 2.8 vs 9.4 ± 2.7 vs 8.6 ± 2.5 vs 8.1 ± 2.3 m/s, p < 0.01, respectively). The prevalence of PWV > 10 m/s and abnormal PWV values in group A was significantly lower than the corresponding prevalence in randomly selected, age-matched subjects from group B (13.5 % vs 24.4 %, p = 0.027 and 5.6 % vs 14.2 %, p = 0.022, respectively). Conclusions: The reclassified subjects as stage 1 hypertensive by the new guidelines have a significantly increased aortic stiffness and greater prevalence in asymptomatic aortic damage compared to subjects with elevated BP. This finding may indirectly explain the increased cardiovascular risk of this group.

scholarly journals A Comparison of the Effect of Fractionated and Bolus Dose Injection on Spinal Anesthesia for Lower Limb Surgery: A Randomized Clinical Trial

2020 ◽  
Vol 10 (5) ◽  
Author(s):  
Pooya Derakhshan ◽  
Seyed Hamid Reza Faiz ◽  
Poupak Rahimzadeh ◽  
Reza Salehi ◽  
Ghazaleh Khaef
Keyword(s):  
Clinical Trial ◽  
Spinal Anesthesia ◽  
Lower Limb ◽  
Bolus Dose ◽  
Hemodynamic Changes ◽  
Anesthesia Group ◽  
Group A ◽  
Spinal Anesthesia Group ◽  
Group B ◽  
Dose Injection

Background: In previous clinical trials and a small number of studies, the fractional injection of anesthetics led to reduced physiological complications and hemodynamic stability and increased duration of anesthesia. Objectives: The present study intended to compare the effect of fractionated and bolus dose injection of bupivacaine and fentanyl on spinal anesthesia for lower limb fracture surgeries. Methods: In this randomized, double-blind clinical trial, 70 patients with lower limb fractures were divided into groups of bolus spinal anesthesia (Group A) and fractional spinal anesthesia (Group B). Group A received a bolus dose of 25 μg fentanyl plus 15 mg bupivacaine 0.5% intrathecally at a rate of 0.2 mL/sec and were laid down in supine position after 45 seconds. In Group B, a half dose of the mixture, i.e., 25 μg fentanyl plus 15 mg bupivacaine 0.5% mixture, was injected intrathecally, and then, the other half was injected after 45 seconds while the needle was still in place. Afterward, the patients were immediately laid down in the supine position. Hemodynamic changes in the sensory and motor blockage parameters were recorded in both groups. Results: The motor blockage onset time was shorter in Group B compared to Group A (P = 0.026). Moreover, the sensory blockage duration was longer (P = 0.035), and the highest level of sensory blockage was lower (P = 0.008) in Group B compared to Group A. Conclusions: Fractional spinal anesthesia led to a longer duration and more favorable levels of sensory blockage compared to the bolus method. In addition, hemodynamic changes and complications occurred less frequently following this procedure.

Effects of Delayed Supine Positioning after Induction of Subarachnoid Block on Post-spinal Hemodynamic Changes Compared to Traditional Subarachnoid Block: prospective observational randomized controlled dose response clinical study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Karim saad Abd Elhalim Moustafa ◽  
Hala Gomaa Salama ◽  
Sherif George Anis ◽  
Rehab Abd Elfattah Abd Elrazik
Keyword(s):  
Blood Pressure ◽  
Supine Position ◽  
Local Anaesthetic ◽  
Prospective Observational Study ◽  
Sensory Level ◽  
Invasive Blood Pressure ◽  
Subarachnoid Block ◽  
Non Invasive ◽  
Group A ◽  
Group B

Abstract Background This is a prospective observational study to examine if the delayed supine positioning after induction of subarachnoid block will be of value in minimizing hemodynamic derangement following subarachnoidblock for knee Arthroscopein the teaching hospital of Misr University for science and technology Methods Fifty healthy patients are undergoing knee Arthroscope under spinal Anesthesia were randomized into 2 groups Group A(immediate supine position after Subarachnoid block) and Group B (delayed supine position after Subarachnoid block by 2.5 minutes) each group includes 25 patients. After the injection of local anaesthetic, Heart rate (HR), non-invasive blood pressure (Systolic Blood pressure (SBP), diastolic Blood pressure (DBP) and mean blood pressure(MBP)) were measured at 3 min intervals for the first 15 min following administration of local anaesthetic, and then every 5 min until completion of the surgical intervention. Results Hemodynamic readings (SBP, DBP, MBP, HR) showed more stability in Group(B) than Group(A), group(A) showed higher anesthetic sensory level but adequate anesthetic sensory level to perform Knee Arthroscope surgery was achieved in group (B) Conclusion Under the conditions of this study delayed supine positioning after induction of SAB for 2.5 minutes is of great value in gaining an adequate level of anesthesia with more hemodynamic stability and less vasopressor need as a management of hypotension compared to the conventional SAB in Knee Arthroscope surgery.

scholarly journals Clinical Study on the Effects of Different Positions on Supine Hypotensive Syndrome in Cesarean Section after Lumbar Anesthesia

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Chunyan Zhao ◽  
Yi Tang ◽  
Cibo Chen ◽  
Bingchun Xia
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Supine Position ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Significant Difference ◽  
Group A ◽  
Hypotensive Syndrome ◽  
Group B

Aim: To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia. Methods: 600 full-term parturient were randomly divided into 4 groups. The patented positioning pads (patent number: ZL 2017 2 0618886.5) in our department was used in the left-leaning position. The parturient lied in a supine position for anesthesia in, and then the group of positioning pads was placed after turning into the lateral position. The parturient were divided into group A (supine position), group B (left-leaning to 10 °), group C (left-leaning to 20 °), and group D (30 °). Observation index: Main index: Comparison of maternal blood pressure changes and neonatal blood gas analysis in the supine position without using a position pad and with the use of patent positioning pads in different tilt angles (10°, 20°, 30°). Minor index: 1) the use and frequency of vasoactive drugs, whether a left-leaning operating bed or uterine displacement is required; 2) the consciousness of the parturient; 3) newborn’s Apgar scores of 1 minute, 5 minutes, and 10 minutes after birth; 4) whether the obstetrician can perform the operation smoothly in the corresponding left leaning position. Results: The blood pressure at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered in group A and group B were significantly different from those in group C (P<0.05). There were significant differences at different timings in group A and group B, and the decline was more significant at the supine position after anesthesia, the beginning of surgery and the time when the newborn was delivered (P<0.05). The pH value of blood gas analysis of newborns in group A, group B and group C was between 7.25 and 7.37, and there was no significant difference between the three groups (P?0.05). Conclusion: The use of positioning pads can prevent the adverse effects of supine hypotensive syndrome on parturient and newborns to a certain extent.

scholarly journals Dose Comparison of Dexmedetomidine Sedation following Spinal Anesthesia: Parturient versus Nonpregnant Women—A Randomized Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming Xiong ◽  
Biyun Chen ◽  
Zurong Hu ◽  
Somdatta Gupta ◽  
Zhitao Li ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Bolus Dose ◽  
Probit Analysis ◽  
Gynecologic Surgery ◽  
Sequential Method ◽  
Dose Comparison ◽  
Group A ◽  
Adequate Sedation ◽  
Effective Doses

Background. This study was designed to investigate and compare the effective doses of dexmedetomidine for sedation in parturient patients who underwent Cesarean section (CS) and nonpregnant women who underwent elective gynecologic surgery. Methods. The study comprised 60 females aged between 25 and 35. They were divided into two groups. The parturient group received a bolus dose of dexmedetomidine over 15 min after the delivery of the fetus and placenta. In the nonpregnant women group, a bolus of dexmedetomidine was administered intravenously upon the completion of spinal anesthesia. The subsequent dose required by patients in each group was then determined through a modified two-stage Dixon up-and-down sequential method. Probit analysis was used to calculate the ED50 and the ED95 of dexmedetomidine for adequate sedation. Results. The ED50 of dexmedetomidine for adequate sedation in parturient patients was 1.58 μg/kg (1.51–1.66 μg/kg); in nonpregnant women, it was 0.96 μg/kg (0.91–1.01 μg/kg) (95% CI). The ED95 of dexmedetomidine in parturients was 1.80 μg/kg (1.70–2.16) μg/kg and that of nonpregnant women was 1.10 μg/kg (1.04–1.30 μg/kg) (95% CI). The ED50 in parturients was significantly higher than that in nonpregnant women (P<0.05). Conclusion. The ED50 of dexmedetomidine for target sedation in parturients who received spinal anesthesia for CS is greater than 1.5 times that in nonpregnant women who received spinal anesthesia for lower abdominal gynecologic surgery. This study postulates that the dose of dexmedetomidine required to achieve optimal sedation following spinal anesthesia is much higher in parturients than in nonpregnant women undergoing gynecologic surgeries. This trial is registered with NCT02111421.

A Comparison of Incidence of Post Dural Puncture Headache Using 25G Quincke and 25G Whitacre Needle in Obstetric Patients Undergoing Caesarean Section under Spinal Anesthesia

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 28-31
Author(s):  
Chetan Bohara ◽  
Rajesh Maharjan ◽  
Subi Regmi ◽  
Gunjan Regmi ◽  
Rajendra Kunwar ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Dural Puncture ◽  
P Value ◽  
Sitting Position ◽  
Post Dural Puncture Headache ◽  
Subarachnoid Block ◽  
Group A ◽  
Group B

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip.  The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles. Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block. Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache. Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

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