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 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.

Pulse-oximetry Derived Perfusion Index as a Predictor of the Efficacy of Rescue Analgesia After Major Abdominal Surgeries

2020 ◽  
Vol 14 (1) ◽  
pp. 101-107
Author(s):  
Ashraf Nabil Saleh ◽  
Raham Hasan Mostafa ◽  
Ahmad Nabil Hamdy ◽  
Amr Fouad Hafez
Keyword(s):  
Intensive Care ◽  
Pain Scale ◽  
Perfusion Index ◽  
Surgical Intensive Care Unit ◽  
P Value ◽  
Surgical Intensive Care ◽  
Rescue Analgesia ◽  
Clinical Indicators ◽  
Study Objective ◽  
Behavioural Pain Scale

Study Objective: The use of an easy to apply reliable tool is essential to assess pain in patients in intensive care units. This study aimed primarily to evaluate perfusion index usefulness as an objective indicator of pain. Methods and Measurements: Data were collected from 40 non-intubated adult patients admitted to the surgical intensive care unit postoperatively. The Masimo pulse co-oximetry perfusion index (PI) probe was attached to the patient. At the time of the first request for analgesia (T1), the Behavioural pain scale non-intubated scoring system (BPS-NI) was recorded with the PI and patients' haemodynamics following which rescue analgesia was given. Thirty minutes thereafter (T2), second measurements for the mentioned parameters were taken. Main Results: There was a statistically significant reduction in the BPS-NI score, blood pressure and heart rate after analgesic administration (P-values, <0.001, 0.039 and 0.001, respectively), together with a significant increase in the PI (P-value, 0.004). This means that the PI increases with adequate relief from pain, as indicated by a decrease in BPS-NI score and haemodynamics, but the correlation was not statistically significant between their changes. Conclusion: There was no statistically significant correlation between the PI and the pain score or other clinical indicators of pain either before or after the administration of analgesic.

scholarly journals A comparative evaluation of post placental intrauterine contraceptive device (IUCD) insertion between normal delivery and caesarean section

2018 ◽  
Vol 7 (9) ◽  
pp. 3826
Author(s):  
Sharmistha Sarkar ◽  
Dhruba Prasad Paul ◽  
Jayanta Ray
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Comparative Evaluation ◽  
P Value ◽  
Contraceptive Device ◽  
Government Medical College ◽  
Expulsion Rate ◽  
Medical College ◽  
Significant Difference ◽  
Post Placental

Background: Adverse maternal and perinatal outcomes are related to pregnancies spaced too closely together. Objective of present study was to compare the expulsion rate and complications between post placental IUCD insertion between caesarean section and vaginal delivery.Methods: This study was a prospective comparative study conducted in the department of Obstetrics and Gynecology, at Agartala Government Medical College over 1.5 Years (January 2016-June2017) All cases at term pregnancy delivering by caesarean section and vaginal delivery were divided into two different groups. Sample size of 105 in each group. Subjects recruited from-obstetrics OPD and casualty of Agartala Government Medical College (AGMC) and GB Pant Hospital expulsion rate and complications. Comparative evaluation of Expulsion rate and complications following post placental IUCD insertion between caesarean section and vaginal delivery at the end of six months, one year and one and half year.Results: There was no significant difference in either complications between the two groups (P value-.913) or outcomes (p value-.035). Expulsion rate 18.2% following vaginal delivery compared to those with intracaesarean insertion i.e 3.8%.Conclusions: The complications associated with postplacental Intrauterine device insertion is insignificant, still the awareness, acceptance and continuation are very low. Therefore Information, education Communication activity by the field workers must be enhanced to overcome this knowledge gap.

scholarly journals TO DETERMINE EFFICACY OF GRANISETRON VERSUS PLACEBO FOR REDUCING SHIVERING IN PATIENTS UNDERGOING LOWER SEGMENT CAESAREAN SECTION UNDER SPINAL ANAESTHESIA

2021 ◽  
Vol 71 (2) ◽  
pp. 530-34
Author(s):  
Sana Abbas ◽  
Bilal Yasin ◽  
Basit Mehmood Khan ◽  
Umer Hayat ◽  
Beenish Abbas ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Elective Caesarean Section ◽  
Patient Comfort ◽  
Military Hospital ◽  
P Value ◽  
Intravenous Bolus ◽  
Lower Segment ◽  
Group A ◽  
Group B

Objective: To determine the efficacy of granisetron versus placebo (saline) for reducing shivering in patients undergoing lower segment caeserian section under spinal anaesthesia. Study Design: Comparative cross - sectional study. Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital Rawalpindi, from Apr to Sep 2019. Methodology: Total 178 patients undergoing lower segment ceaserian section under spinal anaesthesia with age ranges from 18-40 years of American Society of Anaesthesiologists status I & II with full term pregnancy scheduled for elective caesarean section under spinal anaesthesia. Group A (n=92) received an intravenous bolus of 1 mg granisetron in a 10ml syringe and Group B (n=86) received intravenous bolus of normal saline in a 10ml syringe, drugs were administered immediately before spinal anaesthesia by anaesthetist as coded syringes. Heart rate, blood pressure, core body temperature and shivering scores were measured at 0 minutes, 30 minutes and 60 minutes, average surgery time recorded to be 60 minutes. Results: None of the patients in group A (drug group) exhibited appreciable post spinal shivering whereas 25 (29%) in group B (placebo) had clinically significant shivering necessitated administration of other established pharmacological agents to abort shivering in order to ensure patient comfort and satisfaction with statistically significant p-value of <0.05. Conclusion: Prophylactic injection granisetron was efficacious against post spinal shivering, moreover provides worth while relief of nausea and vomiting which is dilemma with most of the drugs employed for control of post spinal shivering.

scholarly journals Postural Changes in Measures of Arterial Stiffness in Hypertensive Subjects on Antihypertensive Drug Therapy: A Prospective, Pilot Study

2016 ◽  
Vol 26 (02) ◽  
pp. 078-082
Author(s):  
Du Jun ◽  
Chin Cheong ◽  
Ashish Sule
Keyword(s):  
Arterial Stiffness ◽  
Supine Position ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drug Therapy ◽  
Rank Test ◽  
P Value ◽  
Sitting Position ◽  
Antihypertensive Medications ◽  
Postural Changes ◽  
Significant Difference

AbstractProspective study with a controlled arm to know if there are variations of measures of arterial stiffness with posture in subjects with hypertension on antihypertensive medications.We studied postural variations of measures of arterial stiffness in 21 subjects with diagnosed hypertension on antihypertensive medications and compared them with 21 normotensive subjects. All subjects underwent pulse-wave analysis on SphygmoCor in the morning between 8 am to 10 am initially in supine and then in sitting position after 3 minutes. Summary measures on demographics, and blood pressure characteristics at sitting and supine positions are obtained. Differences between characteristics at supine and sitting position are compared using nonparametric paired test of Wilcoxon signed-rank test. A value of p < 0.05 was accepted as statistically significant.Antihypertensive medications decreased the supine aortic augmentation pressure (AAP) and augmentation index (AI) but not significantly. When subgroups of patients with antihypertensive treatment were analyzed, it was noted that angiotensin-converting enzyme inhibitor and angiotensin receptor blocker group (12) decreased AAP and AI significantly in supine position compared with patients on other antihypertensive medications (9) (p-value 0.034 and 0.038, respectively). There was no significant difference in other groups of calcium channel blockers, β-blockers, or diuretics. However, in normotensive control arm, there was an increase in AAP and AI in the supine position.In hypertensive subjects, on antihypertensive, there was reduction in AAP and AI in supine position compared with those of normotensives. The significance of the decrease in AAP and AI in supine position on antihypertensive needs to be studied further.

Comparison of Various Parameters after Induction of Spinal Anaesthesia for Caesarean Section in Sitting and Lateral Position

2017 ◽  
Vol 4 (1) ◽  
pp. 85-88
Author(s):  
Pradeep R. ◽  
◽  
Pradeep Hosagoudar ◽  
K.V. Srinivasan ◽  
Veeresh . ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Lateral Position

scholarly journals Prediction of Foetal Well-being with Non-stress Test

2016 ◽  
Vol 33 (2) ◽  
pp. 65-69
Author(s):  
Jahanara Rahman ◽  
Hosne Ara Begum
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Apgar Score ◽  
Stress Test ◽  
The Other ◽  
P Value ◽  
Mild Depression ◽  
Other Hand ◽  
Significant Difference

Introduction: Non-stress test (NST) is the most common antenatal test performed to assess the foetus at risk of intrauterine hypoxia. On the other hand non-reactivity detected by NST increases the interferences of pregnancy by Caesarean section.Methodology: A cross sectional descriptive study was carried out in the department of Obstetrics and Gynaecology at Dhaka National Medical College between July2007 and June 2008.Objectives: The objectives of the study were (1) To observe the mode of delivery in cases of non-reactive non stress test (NST) and (2) To evaluate perinatal outcome of non-reactive NST.Results: A total 137 high risk pregnant women were included in the study. Age of the women ranges from 16 to 32 years. The mean age of the women was 23.74 ± 3.71 year. Among them 44.53% were primaegravida and 55.47% were multigravida. Gestational age was between 35 and 42 weeks and mean gestational age was 38.34±1.42 weeks. Regarding foetal reactivity 61.3% (n=84) were reactive and 38.7 % (n=53) were non-reactive. Among the babies of non reactive NST 98.11% and 1.89% were delivered by caesarean section and vaginal delivery respectively. Whereas, 48.81% and 51.19% babies of reactive NST were delivered by caesarean section and vaginal delivery respectively. The percentage of caesarean section was much higher in non-reactive NST cases in comparison to that of reactive NST which was statistically highly significant (p value 0.0000). One minute after birth APGAR scoring revealed that 56.6% and 43.4% newborn of non-reactive NST had no depression( APGAR score 7-10) and mild depression ( APGAR score 4-6) respectively. On the other hand 65.47% and 34.5% newborn of reactive NST had no depression and mild depression respectively at one minute after birth. Therefore, small difference was noticed in the neonatal status between the reactive and non-reactive NST which had no statistical significance (p value 0.507). Evaluation of the neonates with APGAR scoring done 5 minutes after birth revealed mild depression (APGAR score 4-6) in 24.53% and 20.24% of non-reactive and reactive NST cases respectively and no depression (APGAR score 7- 10) was found in 75.47% and 70.76% in reactive and nonreactive NST respectively. So, 5 minutes after birth the neonatal status among reactive and non-reactive NST made no significant difference (p value 0.9266).Conclusion: Neonatal evaluation revealed that all foetuses were not compromised as detected by NST. Relying on NST the rate of Caesarean section has been increased. Reassessment of the foetal conditions was needed with the help of other techniques. Therefore NST alone is insufficiently predictive of neonatal outcome.J Bangladesh Coll Phys Surg 2015; 33(2): 65-69

scholarly journals Diameter and collapse index of inferior vena cava as a clinical indicator of resuscitation for critically ill hypotensive patients

2020 ◽  
Author(s):  
Seongpyo Mun
Keyword(s):  
Inferior Vena Cava ◽  
Critically Ill ◽  
Inferior Vena ◽  
Vena Cava ◽  
Adverse Outcomes ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Clinical Indicator ◽  
Significant Difference ◽  
Collapse Index

Abstract Purpose The role of diameter and collapse index of inferior vena cava (DCIIVC) in reflecting intravascular volume status and fluid responsiveness remains unclear. We aimed to evaluate the effectiveness of DCIIVC as a clinical indicator for fluid resuscitation (FR) in critically ill hypotensive patients.Methods This retrospective study enrolled hypotensive patients admitted to the surgical intensive care unit (SICU) between May 2018 and April 2019. Between May and October 2018, fluid therapy was conducted by a physician’s decision (non-DCIIVC group, 32 patients). Between November 2018 and April 2019, DCIIVC was used as a guide (DCIIVC group, 30 patients). Clinical outcomes of the two periods were compared.Results Total amount of fluid intake (TAFI) of non-DCIIVC and DCIIVC group in 24 h was 4,130 and 3,560, respectively (p < 0.05). TAFI in 48 h was 8,420 and 6,910, respectively (p < 0.01). Lactate levels at admission, 24 and 48 h after admission were 4.1 vs 3.8, 3.2 vs 3.1, and 1.9 vs 2.1 mmol/L, respectively. Mean duration of mechanical ventilation, ICU stay, and hospital stay were 4.1 vs 4.5, 7.2 vs 6.3, and 18.1 vs 17.2, respectively. Overall mortality was 16.7% vs 13.3%. There was no significant difference in any other characteristic except TAFI.Conclusion DCIIVC can be used as a tool for indicating FR in critically ill hypotensive patients. This can help physicians infuse fluid restrictively, without adverse outcomes.

scholarly journals COMPARISON OF HAEMODYNAMIC STABILITY WITH 0.5% AND 0.75% HYPERBARIC BUPIVACAINE DURING SPINAL ANAESTHESIA IN WOMEN UNDERGOING CAESAREAN SECTION

2021 ◽  
Vol 71 (6) ◽  
pp. 2078-81
Author(s):  
Hina Iftikhar ◽  
Aneel Aslam ◽  
Habib Ur Rehman ◽  
Zulfiqar Ali ◽  
Mohammad Ali Abbass ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Caesarean Section ◽  
Systolic Blood Pressure ◽  
Spinal Anaesthesia ◽  
P Value ◽  
Hyperbaric Bupivacaine ◽  
Haemodynamic Stability ◽  
The Mean ◽  
The Difference

Objective: To compare the effect of 0.5% and 0.75% hyperbaric Bupivacaine on haemodynamic stability in terms of mean systolic blood pressure and heart rate recorded at 4 min in patients undergoing caesarian section in spinal anesthesia. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Malir, from Jul to Dec 2018. Methodology: The patients were assigned in two groups (A and B) using lottery method. Group A received 0.5% hyperbaric Bupivacaine solution. Group B received 0.5% hyperbaric Bupivacaine solution. Spinal anaesthesia was given, blood pressure and heart rate were recorded. Data were analyzed in SPSS version 23. Both groups were compared for mean systolic blood pressure and heart rate by using independent sample t-test. Results: The mean age of patients was 29.62 ± 6.21 years in 0.75% Bupivacaine group while 29.31 ± 6.20 years in 0.5% Bupivacaine group. The mean systolic blood pressure of patients was 111.63 ± 5.96 mmHg in 0.75% Bupivacaine group while 117.16 ± 7.12 mmHg in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05). The mean heart rate of patients was 92.27 ± 4.71 beats per min (bpm) in 0.75% Bupivacaine group while 97.68 ± 4.58 bpm in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05). Conclusion: 0.5% hyperbaric Bupivacaine was better than 0.75% hyperbaric Bupivacaine solution in spinal anaesthesia during caesarean section.

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