Anaesthesia For Caesarean Section Research Articles

Comparison of fractionated versus bolus dose of bupivacaine heavy (0.5%) in spinal anesthesia for elective caesarean section—A prospective, randomized, single blind, and clinical trial

Comparison of fractionated versus bolus dose of bupivacaine heavy (0.5%) in spinal anesthesia for elective caesarean section—A prospective, randomized, single blind, and clinical trial

Perfusion index as a predictor of hypotension during spinal anesthesia for lower segment cesarean section: A prospective, observational study

Abstract Background and Aims: Hypotension following subarachnoid block (SAB) for lower segment cesarean section (LSCS) has adverse fetal and maternal implications. Perfusion index (PI) has been used for assessing peripheral perfusion dynamics. This study aimed to determine whether a baseline PI can predict hypotension after spinal anesthesia for LSCS. Materials and Methods: In this prospective, observational study, 152 term parturients were divided into two groups: Group I (PI of ≤ 3.5) and Group II (PI >3.5). SAB was performed using bupivacaine 0.5% (hyperbaric) 10 mg with dexmedetomidine 5 μg. PI, vital parameters, and correlation between baseline PI and hypotension were observed. Receiver operating characteristic (ROC) curve was plotted for PI and the occurrence of hypotension. Statistical analysis was performed using Chi-square test, independent sample t-test, Mann–Whitney U-test, and regression analysis with Spearman’s rank correlation coefficient test. Results: The incidence of hypotension was higher in Group II (57.89%) compared to Group I (18.42%) (P < 0.0001). The correlation between baseline PI >3.5, the number of episodes of hypotension, and the total dose of mephentermine required were also significant. The sensitivity and specificity of baseline PI of 3.5 to predict hypotension were 72.37% and 81.58%, respectively. The area under the ROC curve for PI to predict hypotension was 0.830. Conclusion: Parturients with baseline PI >3.5 are at higher risk of developing hypotension following SAB compared to those with baseline PI ≤3.5; hence, PI is a safe and reliable device for predicting hypotension following SAB.

Ultralow-dose spinal anesthesia in a short stature emergency cesarean section

Anesthesia for parturients with short stature is envoked with unique challenges for the anesthesiologist. Difficulties with airway management, owing to the anatomical and physiological changes in pregnancy, risk of acid aspiration, and difficult regional anesthesia with the possible risk of failure/suboptimal effect, are well-documented. We describe the anesthetic management of a 20-year-old parturient of short stature with a height of 110.5 cm undergoing emergency cesarean section. A single-shot subarachnoid block with 4 mg intrathecal bupivacaine and adjuvant fentanyl 10 μg proved straightforward and reliable with no requirement of vasopressors.

Comparative study between sitting and left lateral position for spinal anesthesia in elective cesarean section

Comparative study between sitting and left lateral position for spinal anesthesia in elective cesarean section

Evaluating patients' choice of general and spinal anesthesia for elective cesarean section and associated factors: a descriptive study.

In this descriptive study, pregnant women who had the ability to undergo both spinal and general anesthesia were referred to public and private hospitals in (Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences). A questionnaire recorded the patient's demographic data, education and occupation, history of anesthesia, choice of anesthetic method, and reason for selection. A total of 384 women were included in the study, of whom 60% selected general anesthesia and 40% selected spinal anesthesia. Among the reasons for not choosing spinal anesthesia, most common were fear of injury to the spinal cord (64.3%) and fear of seeing and hearing during the surgery (53.3%), and among the reasons for not choosing general anesthesia, most common were fear of not waking (54.3%) and a desire to be alert at the time of infant birth (40.7%). Most of the women with a history of spinal anesthesia selected spinal anesthesia (53%), and 62% of those without a history of spinal anesthesia selected general anesthesia. Factors such as age, nonmedical staff advice, and being employed were significantly correlated with the choice of anesthesia (P<0.005). The rate of general anesthesia selection was higher than spinal anesthesia. More attention and efforts are required to educate patients regarding the method of anesthesia prior to the surgery.

Comparative Study Between Transversus Abdominis Plane Block and Intravenous Patient Controlled Analgesia After Spinal Anesthesia in Elective Cesarean Sections

Comparative Study Between Transversus Abdominis Plane Block and Intravenous Patient Controlled Analgesia After Spinal Anesthesia in Elective Cesarean Sections

Comparison of norepinephrine bolus versus infusion for prevention of post-spinal hypotension in parturients with preeclampsia undergoing cesarean section

Background: Currently, spinal anesthesia for cesarean section is the anesthetic technique of choice for women with preeclampsia in the absence of contraindications to neuraxial anesthesia. Recently, norepinephrine has been introduced for prevention and treatment of hypotension associated with spinal anesthesia; however, only a couple of studies have compared norepinephrine infusion and bolus. Aims: This study aims to compare primarily the efficacy and safety of norepinephrine bolus given therapeutically and norepinephrine infusion given prophylactically for management of hypotension and effects on other hemodynamic parameters in parturients with preeclampsia undergoing cesarean section under spinal anesthesia and secondarily to determine the effects of study drugs on neonatal Apgar score and arterial blood gas analysis of neonatal blood. Methods: In this prospective randomized study, 100 singleton full-term pregnant females of ASA grade II, aged 18–35 years, diagnosed with preeclampsia (controlled on single antihypertensive drug with BP ≤140/90), scheduled for elective cesarean section under spinal anesthesia were randomly divided into two groups. Group A: Received therapeutic norepinephrine bolus (4 mg) only when hypotension (fall in SBP to ≤20% of baseline) was detected after spinal anesthesia. Group B: Received prophylactic intravenous norepinephrine infusion (4 mg/min) immediately after induction of spinal anesthesia. Results: Heart rate, systolic, diastolic, and mean blood pressure had statistically significant difference at 3,4,5,6,7,8,9, and 10 mins of surgery. Number of episodes of hypotension and number of norepinephrine boluses used in Group A were higher and statistically significant (p-value < 0.001) than Group B. Apgar score at 1 and 5 minutes as well as umbilical artery parameters in two groups was comparable and statistically insignificant (p-value 0.301 for Apgar at 1 min and P value 0.562 for Apgar at 5 mins). Conclusion: Although both norepinephrine bolus and infusion doses are an effective way to treat spinal anesthesia-related hypotension in patients with preeclampsia undergoing cesarean section with comparable maternal and fetal side effects, infusion dose of norepinephrine is better in maintaining hemodynamics of parturients with insignificant changes in neonatal outcomes.

Comparison of Bolus Ephedrine vs Mephentermine in the Management of Hypotension during Spinal Anaesthesia for Caesarean Section: A Randomised Clinical Trial

Introduction: Ephedrine and mephentermine are synthetic sympathomimetic drugs used as vasopressors. Ephedrine has direct and indirect effects on α, b1, and b2 receptors, and it also releases endogenous norepinephrine from synaptic storage sites. This leads to an elevation in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). On the other hand, mephentermine indirectly stimulates beta-adrenergic receptors and to some extent alpha-adrenergic receptors as well. Its primary effect is cardiac stimulation, which increases peripheral vascular resistance and contributes to an increase in blood pressure. Aim: The aim of this study is to examine the efficacy of ephedrine and mephentermine in the treatment of hypotension during Lower Segment Caesarean Section (LSCS). Materials and Methods: This double-blinded randomised clinical trial was conducted in the Department of Anaesthesiology among 90 pregnant females scheduled for caesarean delivery at Hind Institute of Medical Sciences, Sitapur, India from January 2021 to December 2022. Patients who developed hypotension (SBP &lt;90 mmHg or &lt;20% of the baseline) after receiving spinal anaesthesia were included in the study and divided into two groups. Group A received an intravenous bolus of 6 mg of ephedrine, and group B received an intravenous bolus of 6 mg of mephentermine. The variables studied included age, height, weight, Mean Arterial Pressure (MAP), Heart Rate (HR), SBP, DBP, bolus doses, and any side effects that occurred. HR, SBP, and DBP were recorded at baseline and then monitored every two minutes for a total of 10 minutes, and then every five minutes until the end of surgery. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 21.0 for Windows, and the results were represented as numbers (%) and mean±Standard Deviation (SD). Results: The mean age of patients in group A and group B was 24.35 years and 24.72 years, respectively. All vital parameters were comparable. The need for bolus doses after hypotension was significantly higher in group B (1.68±0.81) than in group A (mean 1.28). The statistically significant complications identified were tachycardia, nausea, and vomiting, which were more prevalent in group B with 13 and 16 patients, respectively. Conclusion: In this study, the authors found that ephedrine was more effective than mephentermine in terms of the requirement for bolus doses and the occurrence of intraoperative side effects. The requirement for bolus doses and occurrence of significant complications were higher in the group that received mephentermine. Therefore, ephedrine bolus immediately following spinal anaesthesia would be a safe and effective technique for preventing hypotension in females scheduled for Lower Segment Caesarean Section (LSCS).

AIRWAY MANAGEMENT GUIDELINES IN OBSTETRICS.

Anatomic and physiologic changes during pregnancy make it more difficult to establish a safe airway in pregnant women in case of the need for surgery under general anesthesia than in the non-obstetric population. The inability to ventilate and oxygenate is one of the most common causes of morbidity and mortality associated with general anesthesia for cesarean section. The aim of this paper is to present and analyze modern guidelines and algorithms for the management of difficult airway in obstetrics as an important segment of anesthesiology practice. Modern difficult airway management guidelines for pregnant women describe the procedure of difficult facemask ventilation, difficult airway management by using supraglottic devices, difficult endotracheal intubation, and emergency cricothyrotomy or tracheotomy in a situation where oxygenation and ventilation are impossible. Algorithms describe the procedures and equipment for each variant of difficult airway and decision-making strategies in situations when neither airway nor adequate oxygenation can be provided. Croatian anesthesiologists in most obstetric departments have appropriate equipment, as well as necessary experience in difficult airway management for pregnant women, and modern algorithms from the most developed countries can be adopted and accommodated to our daily practice, as well as incorporated into the training curricula of residents.

Supreme laryngeal mask airway for cesarean section under general anesthesia: a 10-year retrospective cohort study.

Previous research showed the use of supraglottic airways in obstetric anesthesia. The relevant evidence of laryngeal mask airway (LMA) on maternal and neonatal outcomes is still limited. We aimed to assess the maternal and neonatal outcomes when the LMA Supreme was used for cesarean section under general anesthesia. We included all patients who underwent general anesthesia for cesarean section between January 2010 and December 2019. Propensity score matching was used to reduce potential bias from non-random selection of airway intervention. The primary outcome was adverse maternal and neonatal outcomes defined as maternal regurgitation, aspiration, hypoxemia, and low neonatal Apgar scores. Secondary outcomes included patient admission to the intensive care unit, neonate required tracheal intubation, external cardiac massage, and admission to the neonatal intensive care unit. A total of 723 patients were included in the analysis; of whom, 221 received Supreme laryngeal mask airway (LMA group) and 502 were intubated with an endotracheal tube (ETT group). After propensity score matching, 189 patients remained in each group. No episode of regurgitation and aspiration occurred in both groups. There was no difference in the rates of Apgar score below 7 at 1 min (14.3% LMA group vs. 15.3% ETT group, OR 0.931, 95% CI 0.574 to 1.510, P = 0.772) and 5 min (3.7% vs. 4.2%, OR 0.875, 95% CI 0.324 to 2.365, P = 0.792). No difference was observed in the secondary outcomes between the two groups. The LMA Supreme was not associated with higher adverse maternal and neonatal outcomes when compared to an endotracheal tube for cesarean section under general anesthesia. It might be considered an alternative to tracheal intubation in obstetric practice.

Recent advances in obstetric anaesthesia and critical care.

Newer modalities in labour analgesia and anaesthesia for caesarean section including regional anaesthesia techniques and airway management are emerging constantly. Techniques such as point of care ultrasound, especially of the lungs and stomach and point of care tests of coagulation based on viscoelastometry are about to revolutionise perioperative obstetric care. This has improved the quality of care thereby ensuring good perioperative outcomes in the parturient with comorbidities. Critical care for obstetrics is an emerging field that requires a multidisciplinary approach with obstetricians, maternal-foetal medicine experts, intensivists, neonatologists, and anaesthesiologists working together with enhanced preparedness and uniform protocols. Newer techniques and concepts of understanding have thus been established in the traditional speciality of obstetric anaesthesia over the last decade. These have improved maternal safety and neonatal outcomes. This article touches upon some recent advances that have made a significant impact in the field of obstetric anaesthesia and critical care.

Spinal anesthesia for cesarean delivery: knowledge and barriers among women in Makkah, Saudi Arabia

Background: Nevertheless, regarding risks and benefits for both mother and fetus, regional anesthesia is the recommended procedure. Some patients need clarification about the anesthetic process and risks that affect their choice of received anesthetic technique. In this study, we aim to measure the level of knowledge regarding spinal anesthesia for cesarean section (CS) and to determine spinal anesthesia barriers among women in the Makkah region of Saudi Arabia. Methods: A cross-sectional study was conducted among women in Makkah, Saudi Arabia. A pretested, self-administered questionnaire was distributed to participants through social media platforms. The questionnaire includes questions about socio-demographic data (i.e., age, marital status, educational background, etc.) and knowledge of and perceived barriers toward spinal anesthesia. Results: Three hundred seventy-three women, mostly of Saudi nationality (93.8%), participated. The most common barriers to spinal anesthesia for cesarean delivery were worries about a chronic headache (42.9%) and chronic back pain after delivery (41.8%). Poor knowledge of spinal anesthesia for cesarean delivery was found among 46.4% of women, moderate knowledge among 45.3%, and good knowledge among only 8.3%. Factors associated with increased knowledge were being married, being more educated, having children, previously undergoing CS, having a greater family monthly income, and planning to have spinal anesthesia. Conclusion: There is a lack of knowledge among women regarding spinal anesthesia for cesarean delivery. Educated and high-earning women who are married and have children tend to be more knowledgeable about this type of neuraxial anesthesia than other women. Educating women in an ongoing manner regarding the benefits of spinal anesthesia for cesarean delivery is warranted.

Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study

This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

Real-time ultrasound-guided neuraxial anesthesia for cesarean section in parturients with previous internal fixation surgery for lumbar fracture: a case series

Real-time ultrasound-guided neuraxial anesthesia for cesarean section in parturients with previous internal fixation surgery for lumbar fracture: a case series

Maternal Satisfaction towards Spinal Anesthesia for Cesarean Section

Introduction: Patient satisfaction has become an important parameter to assess an overall quality of health care. We conducted this study to evaluate the level of maternal satisfaction with our anesthetic technique and to identify factors that compromise maternal satisfaction. Methods: A descriptive cross-sectional study was conducted in two hundred patients who underwent cesarean section under spinal anesthesia after receiving ethical approval from the Institutional Review Committee. Preset questionnaires were asked in a face-to-face interview within 6 to 24 hours of cesarean section. Descriptive statistics was used to show frequency distribution and percentage of variables. Results: The overall satisfaction level was 99%, with the lowest satisfaction level reported for pain therapy (88.5%). Subscale-wise, 90.5% of the patients were satisfied with the preoperative assessment and evaluation, 95% of the patients were satisfied with the intraoperative care and attention they received from their anesthetist, 97% of the patients were satisfied with their relationship with the anesthetist. More than 97% of the patients were satisfied with the level of care they received from their anesthetist. Conclusion: In general, the overall maternal satisfaction towards spinal anesthesia was high in our population. To further increase our patient satisfaction we need to extend our services to the postoperative period as well.

A Comparative Study on the Use of Prophylactic Intravenous Ephedrine to Reduce Hypotension During Spinal Anaesthesia for Caesarean Sections

A Comparative Study on the Use of Prophylactic Intravenous Ephedrine to Reduce Hypotension During Spinal Anaesthesia for Caesarean Sections

Fine-tuning anesthesia for cesarean section in an operated case of Tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Pregnancy in patients with congenital cyanotic heart disease (corrected and uncorrected ) presents with challenges to anesthesiologist.We report the anesthetic management for cesarean section in a patient of corrected case of TOF.Patient with Fallot’s tetralogywith significant RVOTO infundibulurvalvular, L-R shunt underwent intracardiac repair withsubannular patch at the age of 3 years.

Management of Elective Cesarean Section Anesthesia in HIV-Positive Patients

Management of Elective Cesarean Section Anesthesia in HIV-Positive Patients

Neurological deterioration after spinal anaesthesia: a rare mode of presentation of spinal tumours

&lt;p class="abstract"&gt;Spinal anaesthesia is a safe and widely performed mode of anaesthesia with low complication rate. It may however be complicated infrequently with neurological deterioration as a result of injury to nerve root and spinal cord or epidural haematoma. Rarely neurological deterioration may occur following spinal anaesthesia in the presence of spinal tumours. We presented a case of neurological deterioration following spinal anaesthesia for caesarean section in a patient with previously undiagnosed thoracic spinal tumour.&lt;/p&gt;

The Usefulness of Perfusion Index Derived from a Pulse Oximeter in Predicting Hypotension following Spinal Anesthesia for Cesarean Section

Hypotension is a frequent complication of spinal anesthesia. Decrease in peripheral vascular tone that occurs during pregnancy is one of the factors causing hypotension in patients undergoing cesarean section under spinal anesthesia. Perfusion index derived from pulse oximeter can be an easy and non-invasive measure of peripheral perfusion. This study was conducted to test the usefulness of pulse oximeter in predicting hypotension following spinal anesthesia for cesarean section. In this study, 247 parturients undergoing elective cesarean section under spinal anesthesia were included. Parturients who had baseline PI&lt;3.5 were kept in Group I and parturients who had baseline PI&gt;3.5 were kept in Group II. All the patients were given 0.5% bupivacaine heavy 2.2 ml for spinal anesthesia. In group I, 30 patients (23.62%) had hypotension whereas in Group II, 119 patients (100%) had hypotension. The episodes of hypotension were significantly lower in Group I as compared to Group II (p&lt;0.001). The dose of mephentermine (p&lt;0.001) used was also significantly lower in Group I as compared to Group II. Therefore, we concluded that a baseline PI&gt;3.5 is a prediction of hypotension following spinal anesthesia in patients undergoing cesarean section.