Anaesthesia For Elective Caesarean Section Research Articles

The duration of spinal anaesthesia in elective caesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial.

One of the common methods of anaesthesia for caesarean sections (CSs) involves the use of spinal anaesthesia in mothers. Various positions are utilized in this method. This study aims to compare the evaluation of two positions, Trendelenburg and reverse Trendelenburg, in candidates for CS to assess the duration of anaesthesia and changes in vital signs in women. This study was a randomized clinical trial in which 60 pregnant mothers who met the inclusion criteria entered the study. These mothers were randomly allocated into two equal groups using block randomization. One group of patients received spinal anaesthesia in the Trendelenburg position, while the other group received it in the Reverse Trendelenburg position. Vital signs (systolic and diastolic blood pressure, heart rate, Apgar score, and SPO2) of participants from both groups were evaluated for 1 h after the induction of anaesthesia. Additionally, sensory level and duration of anaesthesia were measured. Finally, the data from both groups were subjected to statistical analysis using SPSS version 26 software. The mean (SD) age of participating mothers in the Reverse Trendelenburg and Trendelenburg groups was 28.93 (5.82) and 30.97 (4.94), respectively. The two study groups did not significantly differ in baseline characteristics such as age, BMI, which could potentially impact vital sign outcomes or anaesthesia duration, and education (P>0.05). The mean (SD) duration of anaesthesia in the Trendelenburg position was significantly higher than in the Reverse Trendelenburg position [221.57(min) vs. 159.00(min)] (P<0.0001). There was no significant difference between the two positions, Trendelenburg and Reverse Trendelenburg, in terms of sensory level and its extent (P=0.08). The two study groups did not significantly differ in hemodynamic changes measured 13 times, including heart rate, systolic and diastolic blood pressure, and Apgar score (P>0.05). In spinal anaesthesia with the Trendelenburg position compared to the Reverse Trendelenburg position, there is a longer duration of anaesthesia. This is while the two positions did not differ in terms of hemodynamic changes and sensory level.

Efficacy of ShotBlocker device versus vapocoolant spray for spinal needle pain relief during spinal anaesthesia in elective caesarean section - A randomised controlled trial.

Apprehension of pain due to a spinal needle is often a cause of anxiety and refusal. ShotBlocker provides non-painful physical stimulation, inhibiting pain perception. The vapocoolant spray contains ethyl chloride vapours, rapidly raising the skin temperature and hampering the transmission of noxious stimuli. The present study compared the effectiveness of the ShotBlocker device and the vapocoolant spray in reducing spinal needle-associated pain in primigravida women undergoing elective lower-segment caesarean section (LSCS). We enroled 144 primigravida women undergoing elective LSCS and were randomised to Group SB (the ShotBlocker device was firmly pressed over the skin, and the spinal needle was inserted through its slit), Group V (the vapocoolant spray was applied at the puncture site before spinal needle insertion), and Group C (received local infiltration before spinal anaesthesia (SA)). The groups were compared for needle-associated pain and patient satisfaction using a 10-point visual analogue scale (VAS) and a 3-point Likert scale. The mean (standard deviation) [95% confidence interval (CI)] VAS scores of Group SB 3.85 (0.74) [3.64, 4.07] and Group V 3.04 (0.74) [2.83, 3.26] were significantly lower than that of Group C 5.19 (0.92) [3.28, 3.62]). On the Likert scale, the maximum number of patients in the vapocoolant group (64.6%) responded satisfactorily, while in the control group, the majority (62.5%) of participants responded dissatisfied (P < 0.001). Both the ShotBlocker and vapocoolant spray reduce needle puncture-associated pain before SA in primigravida patients undergoing elective LSCS. However, the vapocoolant spray is more beneficial in reducing spinal needle-associated pain than the ShotBlocker device.

Effectiveness of Prophylactic Ketamine on Shivering in Cesarean Section after Spinal Anesthesia

Background: Regional anesthesia, including spinal or epidural techniques, can disrupt the body's ability to regulate temperature, leading to a heightened risk of shivering. Studies have indicated that shivering occurs in up to 55% of patients undergoing procedures under regional anesthesia. To address this issue, numerous medications have been explored for their potential to prevent post-anesthetic shivering. Objective: To assess the effectiveness of prophylactic ketamine on shivering in cesarean section after spinal anesthesia. Study Design: Prospective, randomized, double blind, clinical trial. Settings: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital Karachi Pakistan. Duration: Six months from August 2019 to January 2020. Methods: A total of 60 patients undergoing spinal anesthesia for elective cesarean section were included in this study. Two groups A and B were formed and patients were equally divided into these groups by lottery method. Group A were treated with ketamine 0.5 mg/kg I/V and group B treated with normal saline 0.05ml/kg/I/V. Grade 0-1 shivering was labeled as effective and shivering grade 2, 3 or 4 at 15 minutes after administration of the drug, was considered ineffective. Results: The average age of the patients was 28.33 ± 5.67 Years. Rate of shivering was significantly high in patients who were treated with normal saline than ketamine in which shivering was not observed (53.3 vs. 0% respectively; P value of 0.0005). This implies that effectiveness was significantly high in groups A than group B (100% vs. 46.7%). Conclusion: Ketamine observed to be the effective drug for the treatment of postanesthetic shivering. It should be considered prophylactically in any patient undergoing spinal anesthesia.

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added.&#x0D; Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score.&#x0D; Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P &lt; 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less.&#x0D; Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids.&#x0D; Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia&#x0D; Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section.&#x0D; Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923&#x0D; Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

Role of Minimal Dose of Norepinephrine in Prevention of Hypotension Induced by Subarachnoid Anesthesia in Elective Cesarean Section

Abstract Background Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Spinal anesthesia techniques produce hypotension through blockade of sympathetic nerve fibers which control vascular smooth muscle tone. For elective cesarean section, regional anesthesia is preferred as a technique to general anesthesia because of maternal and fetal show a risk to morbidity and mortality. Spinal anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration, and avoids neonatal drug depression from general anesthetics. Aim of the Work The aim of this study to assess the effectiveness of minimal dose of norepinephrine in preventing the episodes of hypotension that follow subarachnoid anesthesia in elective cesarean section. Patients and Methods The study was conducted on 60 randomly chosen patients full filling the inclusion criteria at Ain-Shams university hospitals after approval of medical committee. They were allocated in two groups of 30 patients each: Group (A) received the minimal dose of norepinephrine (25 nanogram/kg/h). Group (B) didn’t receive an infusion with vasopressor. Results The patients in the study group (A) had less events of hypotension 10% compared to 76% in group (B) and less Tachycardia in group (A) with only 3.3% compared to group (B) which were 70%. Although no statistical difference in all other parameters measured in this study. Conclusion Our study suggests that the use of norepinephrine as a vasopressor in the treatment of subarachnoid induced hypotension is safe and effective.

P151 Factors associated with general anaesthesia in elective caesarean section

P151 Factors associated with general anaesthesia in elective caesarean section

Comparison of the Effects of General Anesthesia &amp; Spinal Anesthesia for Elective Cesarean Section in Diabetic Pregnant Women

Introduction: Caesarean section (CS) is now one of the most commonly performed major operations in pregnant women throughout the world. While regional or general anaesthesia (GA) are both acceptable for caesarean delivery, use of GA has decreased dramatically in the past few decades due to a higher risk of anaesthesia-related maternal mortality. As a consequence, spinal anaesthesia (SA) is now the technique of choice for CS. It has become the preferred anesthetic technique when providing anesthesia for patients undergoing elective cesarean section as the risk of maternal and fetal complications associated with spinal anesthesia is less than with general anesthesia. Aim of the study: The aim of this study was to compare the effects of general &amp; spinal anesthesia for elective cesarean section in diabetic pregnant women. Methods: This was a comparative observational study and was conducted in the Department of Anaesthesiology of Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh during the period from January,2022 to December,2020.In our study we included 120 pregnant women with diabetes who were given spinal and general anesthesia during C-section surgery. Our patients were equally divided into two groups – i) Group A (Patients were given general anesthesia) &amp; ii) Group B (Patients were given spinal anesthesia). Result: In total 120 patients from both the groups completed the study. In our study we found the mean age and BMI was 34.48± 11.79 years &amp; 38.48± 14.89 kg/m2 respectively. Among all patients 16%, 58% &amp; 27 % patients had Type 1, Type 2 &amp; gestational diabetes respectively. The mean blood glucose level was significantly lower in SA (80.9 ±17.7) compared to GA (121.1± 17.4) after one hour of surgery. The mean of mother’s perioperative difference was significantly lower in SA (4.0 ± 0.19) compared to GA (9.4 ± 0.21). Conclusion: In our study, we found that general anaesthetic had a substantially higher influence on blood glucose concentrations ..

Postdural puncture headache incidence with 25G and 27G Quincke needles after spinal anesthesia for elective cesarean section

Background: Post dural puncture headache(PDPH) is a bilateral occipito-frontal headache occurs in 0.1 to 36% of cases receiving spinal anesthesia. We evaluated the incidence of PDPH after spinal anesthesia using two commonly used needles, 25G and 27G Quincke needles among females undergoing elective cesarean section. Aims and Objectives: The aim of the study was to compare the post-dural puncture headache with 25G And 27G Quincke Needle – in terms of Incidence, severity in patients after spinal anesthesia for elective caesarean section and to find out number of attempts for successful block and any associated complications. Materials and Methods: Six hundred females of ASA grade I or II posted for elective cesarean section under spinal anesthesia were enrolled into two equal groups to assess incidence of PDPH in the post-operative period. They were assessed by a blinded observer for the onset of headache, characteristics, duration, severity, and any associated symptoms for 5 days. PDPH was defined as postural headache that was aggravated by sitting or standing position and relieved by lying supine. Results: The incidence of PDPH was 11% in 25G needle group and 6.33% in the 27G needle group [Risk Ratio of 0.58 (95% CI: 0.34, 0.99)]. In none of the groups, intensity of headache was severe while all were mild in the 27G group. Nausea and vomiting were the only associated symptomatology, 7.33% in the 25G group and 5.67% in the 27G group. Conclusion: The results support 27G Quincke needle to administer spinal anesthesia in females undergoing elective cesarean section.

Depth of sleep measured during anaesthesia in elective caesarean section following induction with propofol or thiopental

Depth of sleep measured during anaesthesia in elective caesarean section following induction with propofol or thiopental

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

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.

Management of Elective Cesarean Section Anesthesia in HIV-Positive Patients

Management of Elective Cesarean Section Anesthesia in HIV-Positive Patients

α-2 agonists vs. fentanyl as adjuvants for spinal anesthesia in elective cesarean section: a meta-analysis.

Elective cesarean section (CS) is usually performed using spinal anesthesia (SA), which requires the use of local anesthetic (LA) agents, commonly combined with adjuvant drugs. We performed a systematic review and meta-analysis aimed at studying the advantages of α-2 agonists as compared to fentanyl during SA for CS. We screened PubMed and EMBASE for randomized controlled trials (RCTs). We calculated the mean difference (MD) for continuous outcomes, and the relative risk for dichotomous outcomes, using a random-effect model with 95% confidence interval (CI). We performed a Trial Sequential Analysis (TSA) assuming an alpha risk of 5%. The primary outcome was the time to first rescue analgesia. Eight RCTs were included. Time to first rescue analgesia was significantly longer when the α-2 agonists were used (MD 85.9 min [95% CI: 23.8, 147.9]; P=0.007). Duration of sensory block was also longer in the α-2 group (MD 40.5 [95% CI: 20.21,60.7]; P<0.0001), while no differences were found for onset of sensory block and onset and duration of motor block. Rates of shivering and nausea or vomiting were significantly lower in the α-2 agonist group, while risk of hypotension or respiratory depression were not different. The TSA on the primary outcome suggests the need of further research before drawing conclusions. α2-agonists seem to increase the time to first rescue analgesia and to prolong the duration of sensory block when used as adjuvants to LA in CS patients compared to fentanyl. Also, α2-agonists may reduce the incidence of shivering and nausea or vomiting.

Effect of Cardamom Inhalation Therapy on Intra-and Postoperative Nausea and Vomiting of Mothers Undergoing Spinal Anesthesia for Elective Cesarean Section

This study aimed to determine the effect of cardamom inhalation on intra and postoperative nausea and vomiting (IONV/PONV) of mothers undergoing spinal anesthesia for elective cesarean section. A single-blind, randomized, placebo-controlled clinical trial study. Seventy eligible participates were equally randomized to the intervention or placebo group. The demographic and clinical characteristics questionnaire, a 100 mm Visual Analogue Scale (VAS) to measure the severity of nausea; and the mothers' emetic episodes checklist were used. Upon the first episode of nausea, participants inhaled through a plastic bag containing distilled gauze pads in normal saline with or without Cardamom essential oil. Following the intervention, nausea severity in placebo (25.28 ± 32.38) and cardamom (13.14 ± 19.96) groups declined (P < .001), however after controlling the initial severity of nausea, the declining extent was more noticeable in the intervention group than in the placebo group. The episodes of nausea (37.1% vs 65.7%, P=.006), and retching (20% vs 45.7%, P=.028) were significantly lower in the intervention group than in the placebo group. Administration of antiemetic medications was lower in the intervention than the placebo group (37.1% vs 65.7%, P=.009). Cardamom aromatherapy was effective in alleviating mothers' experience of nausea and retching across the cesarean surgical continuum. As such, it can be considered as a palliative treatment for IONV/PONV in Cesarean section surgeries.

P.105 General anaesthesia for elective caesarean section in a tertiary centre: a two-year survey

P.105 General anaesthesia for elective caesarean section in a tertiary centre: a two-year survey

P.103 Intrathecal dexamethasone for arterial hypotension management during spinal anaesthesia for elective caesarean section

P.103 Intrathecal dexamethasone for arterial hypotension management during spinal anaesthesia for elective caesarean section

Ondansetron as Prophylactic against Hypotension and Bradycardia Following Spinal Anaesthesia in Elective Caesarean Section: a Case Control Study

Introduction: Hypotension and bradycardia following the administration of spinal anesthesia for cesarean section are very common and bear profound detrimental effects both on mother and baby. In our country, a significant proportion of patients undergo cesarean section delivery. Considering the workload and the socio-economic condition it is often a bad headache for our anesthesiologists to combat post-spinal hypotension. Vasopressor drugs have been widely used to prevent and treat maternal hypotension during cesarean section under spinal anesthesia. A combination of preloading and using vasopressor has maximum efficacy in preventing spinal-induced hypotension but with compromising with some detrimental adverse effects of vasopressor. Amongst vasopressors, ephedrine is widely used but studies found that a higher bolus dose is often required to prevent hypotension and bradycardia. Aim of the study: To find out the efficacy of ondansetron to prevent haemodynamic derrangement in cesarean section under spinal anaesthesia. Methods: This Prospective Randomized Double-Blind Comparative study was conducted at the Department of Anesthesiology and ICU, Dhaka Medical College Hospital, Dhaka, Bangladesh. The study duration was ten months, from March 2015 to January 2016. A total of 120 participants were randomly included in this study.Each participant was included either into “Group A (n=60)” or “Group B (n=60)” by using fixed number card sampling as mentioned earlier. Group B had been considered as control group in the study, Participants of group A received intravenous ondansetron (0.1 mg/kg body weight) and group B received ephedrine (0.5 mg/kg body weight). Result: The majority of the participants (58.33%) from both groups were from the age group of 26-30 years. Parity distribution revealed that 59.17% (n=71) patients were multigravida while 40.33% (n=49) were primi. In total, 80.33% of the participants had ASA I physical status, and 19.17% had ASA II. All patients .......

Appropriate Method of Administering Vasopressors for Maternal Hypotension Associated with Combined Spinal Epidural Anesthesia in Elective Cesarean Section: Impact on Postnatal Respiratory Support for Newborns.

Background and Objectives: Vasopressors are used for treating maternal hypotension. However, the appropriate administration method and effects on newborns have not been reported. We evaluated maternal blood pressure fluctuation and neonatal findings in patients who received continuous vasopressor administration during elective cesarean sections and those who received bolus vasopressor administration upon onset of hypotension. Materials and Methods: We retrospectively analyzed the data of 220 patients scheduled for elective cesarean delivery under spinal anesthesia at Mie University Hospital between April 2017 and March 2021. The patients were classified according to the method of vasopressor administration. Maternal information, intraoperative maternal blood pressure fluctuation, and neonatal findings were examined. A multiple regression analysis was performed for the administration of postpartum neonatal respiratory support using maternal background information and other variables related to blood pressure changes as independent variables. Results: The Continuous group and the Bolus group were composed of 98 and 122 patients, respectively. No difference was observed in maternal background information between the groups. Significant changes were noted in several blood pressure parameters between both groups. As for neonatal parameters, newborns of Bolus group patients had lower pO2, 1 min and 5 min Apgar scores, and required more respiratory support than those of Continuous group patients. In the multiple regression analysis, the groups and maternal post-anesthesia diastolic blood pressure variability were considered explanatory variables. Conclusions: Maternal hypotension and the need for neonatal respiratory support associated with anesthesia administration in elective cesarean section may be improved by continuous vasopressor administration upon induction of combined spinal–epidural anesthesia.

Effect of maternal body mass index on the prophylactic dose of phenylephrine for preventing hypotension in parturients after spinal anaesthesia

BackgroundTo compare the median effective dose (ED50) of phenylephrine for prophylactic continuous infusion in parturients with different body mass indices (BMIs) during combined spinal-epidural anaesthesia for caesarean section and to investigate the impact of maternal BMI on the prophylactic dose of phenylephrine. MethodsParturients receiving combined spinal-epidural anaesthesia for elective caesarean section were divided into a standard group (Group S, BMI < 30 kg/m2) and an obesity group (Group O, BMI > 30 kg/m2), each with 30 patients. A sequential allocation design was used to administer the prophylactic infusion of phenylephrine after the completion of a spinal anaesthetic injection to prevent hypotension (defined as a reduction of systolic blood pressure ≥ 20% of the baseline value or systolic blood pressure < 90 mmHg), with an initial infusion rate of 50 μg/min for the first parturient subsequent adjusted up or down by 10 μg/min depending on whether the previous parturient developed hypotension or not during the study period. The Dixon and Massey method and the isotonic regression method were used to calculate and compare the ED50 and 95% confidence interval (CI) of phenylephrine between the two groups. ResultsThe results were 21.92 μg/min (95% CI, 14.90–28.94 μg/min) for Group S and 42.14 μg/min (95% CI, 24.58–59.70 μg/min) for Group O. The ratio of relative potency of Group O to Group S is 1.92 (95% CI 1.09–3.14), P = 0.034. ConclusionsThe dose of phenylephrine for the prevention of hypotension after spinal anaesthesia for caesarean section is dependent on maternal BMI. Therefore, a weight-based phenylephrine dose is reasonable.