Anesthesia For Elective Cesarean Delivery Research Articles

High Neuraxial Block in Obstetrics: A 2.5-Year Nationwide Surveillance Approach in the Netherlands.

High neuraxial block is a rare but serious adverse event in obstetric anesthesia that can ultimately lead to respiratory insufficiency and cardiac arrest. Previous reports on its incidence are limited to populations in the United Kingdom and the United States. Little is known about the incidence and clinical features of high neuraxial block in the Netherlands, where the presence of anesthesiologists in the labor and delivery unit is comparatively lower. We aimed to assess the incidence and clinical features of high neuraxial block in obstetrics and to formulate ways to improve obstetric anesthesia on a national level. This nationwide, prospective, population-based cohort study was designed to identify cases of high neuraxial block requiring ventilatory support (with supraglottic airway device or tracheal intubation) or cardiopulmonary resuscitation between November 2019 and May 2022. Cases were prospectively collected using the Netherlands Obstetric Surveillance System (NethOSS) in all hospitals with a maternity unit. Complete case file copies were obtained to determine risk factors and clinical course. During the study period, 5 cases of high neuraxial block requiring tracheal intubation were identified. The estimated incidence of high neuraxial block requiring tracheal intubation was 1 in 29,770 neuraxial procedures in labor (95% confidence interval, 1:12,758-1:91,659). Three of 5 identified cases occurred in the operating room after single-shot spinal anesthesia for Cesarean delivery after epidural analgesia in labor. One case developed in the labor ward due to an inadvertent intrathecal or subdural catheter placed for labor analgesia. The fifth case followed single-shot spinal anesthesia for elective Cesarean delivery. All 5 patients were successfully extubated in the operating room after Cesarean delivery, without the need for intensive care admission. There were no cardiac arrests and no neonatal deaths. High neuraxial block requiring tracheal intubation is a rare but impactful complication in obstetric anesthesia, potentially affecting both mother and fetus. Spinal anesthesia after epidural analgesia in labor is a common cause of high neuraxial block. Meticulous follow-up of epidurals in labor facilitates conversion to surgical anesthesia and may therefore reduce the need for spinal anesthesia after epidural analgesia. Large-scale surveillance systems in obstetric anesthesia are needed to identify those at risk, as well as to formulate further strategies to mitigate this burden.

Anesthetic Management of Patients With Class 3 Obesity Undergoing Elective Cesarean Delivery: A Single-Center Historical Cohort Study

(Can J Anesth/J Can Anesth. 2023; 70:202–210) Rising obesity rates have reached a high of one third or one fourth of adults in the United States and Canada, respectively. This leads to many individuals with this condition requiring medical care including anesthesia for labor and delivery. Obesity is known to be associated with complications in the administration and effectiveness of anesthesia as well as after cesarean delivery. Prior research has not focused on the nuances of specific categories of body mass index (BMI) and their association with outcomes, specifically for anesthesia during cesarean delivery. This study aimed to describe different techniques and outcomes for anesthesia in elective cesarean delivery in patients with class 3 obesity (BMI ≥40), specifically in groups with BMI 40.0 to 49.9, 50.0 to 59.9, and >60.0.

Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean Delivery

Dural-puncture epidural (DPE) and standard epidural are common modes of neuraxial labor analgesia. Little is known about conversion of DPE-initiated labor analgesia to surgical anesthesia for cesarean delivery. To determine whether DPE provides a faster onset and better-quality block compared with the standard epidural technique for cesarean delivery. This double-blind, randomized clinical trial was conducted between April 2019 and October 2022 at a tertiary care university hospital (University of Arkansas for Medical Sciences). Participants included women aged 18 years and older undergoing scheduled cesarean delivery with a singleton pregnancy. Participants were randomized to receive DPE or standard epidural in the labor and delivery room. A T10 sensory block was achieved and maintained using a low concentration of bupivacaine with fentanyl through the epidural catheter until the time of surgery. Epidural extension anesthesia was initiated in the operating room. The primary outcome was the time taken from chloroprocaine administration to surgical anesthesia (T6 sensory block). The secondary outcome was the quality of epidural anesthesia, as defined by a composite of the following factors: (1) failure to achieve a T10 bilateral block preoperatively in the delivery room, (2) failure to achieve a surgical block at T6 within 15 minutes of chloroprocaine administration, (3) requirement for intraoperative analgesia, (4) repeat neuraxial procedure, and (5) conversion to general anesthesia. Among 140 women (mean [SD] age, 30.1 [5.2] years), 70 were randomized to the DPE group, and 70 were randomized to the standard epidural group. The DPE group had a faster onset time to surgical anesthesia compared with the standard epidural group (median [IQR], 422 [290-546] seconds vs 655 [437-926] seconds; median [IQR] difference, 233 [104-369] seconds). The composite rates of lower quality anesthesia were 15.7% (11 of 70 women) in the DPE group and 36.3% (24 of 66 women) in the standard epidural group (odds ratio, 0.33; 95% CI, 0.14-0.74; P = .007). Anesthesia initiated following a DPE technique resulted in faster onset and improved block quality during epidural extension compared with initiation with a standard epidural technique. Further studies are needed to confirm these findings in the setting of intrapartum cesarean delivery. ClinicalTrials.gov Identifier: NCT03915574.

Case Studies.

British Journal of NursingVol. 32, No. Sup7 Case StudiesCase StudiesGema Munoz-Mozas, Colin Fairhurst, Simon ClareGema Munoz-MozasVascular Access Advanced Nurse Practitioner and Lead Vascular Access Nurse, Royal Marsden NHS Foundation TrustSearch for more papers by this author, Colin FairhurstVascular Access Advanced Clinical Practitioner, University Hospitals Plymouth NHS TrustSearch for more papers by this author, Simon ClareResearch and Practice Development Director, the Association for Safe Aseptic PracticeSearch for more papers by this authorGema Munoz-Mozas; Colin Fairhurst; Simon ClarePublished Online:10 Apr 2023https://doi.org/10.12968/bjon.2023.32.Sup7.S11AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Akhtar N, Lee L. Utilization and complications of central venous access devices in oncology patients. 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A Comparison of the Injection Rate of Local Anesthetic during Spinal Anesthesia on the Onset of Sensory Block and Incidence of Hypotension in Caesarean Section

Objective: The injection rate of the local anesthetic may affect the level and the time of onset of sensory block. The aim of this prospective study was to investigate the effects of two different injection rates of local anesthetic solution (0.5% heavy bupivacaine) on the onset of sensory block, and the incidence and the onset of hypotension in pregnant women undergoing spinal anesthesia for elective Cesarean delivery. Methods: A total of 67 patients were randomized into two groups: 120-second injection time (Group Slow; n = 33) and 15-second injection time (Group Fast; n = 34). Maximum level of sensory and motor block, time to sensory block at the level of T6, hemodynamic parameters, use of ephedrine and incidence of side effects were recorded at measurement time points. Results: Maximum level of the sensory block was similar in both groups. The time to achieve adequate and maximum sensory block level was shorter in Group Slow(S) (p = 0.004 and 0.037, respectively). Incidence of hypotension was similar, but hypotension occurred earlier in Group Fast(F) (p = 0.011). Requirement for ephedrine and incidence of nausea and vomiting was similar. Conclusions: This study reveals that 120-second injection duration during spinal anesthesia is associated with shorter time to achieve the maximum sensory block level and slower onset of hypotension. It means that prolonging the duration of local anesthetic injection to 120-seconds is advantageous compared with 15-seconds in caesarean section.

Effect of Different Positions During Surgical Preparation With Combined Spinal-Epidural Anesthesia for Elective Cesarean Delivery: A Randomized Controlled Trial

(Anesth Analg. 2021;133:1235–1243) A lateral tilt of the uterus is used to reduce pressure on the inferior vena cava in pregnant patients undergoing cesarean delivery. This may improve the fetal blood and oxygen supply. This position has been thought to improve the fetal acid-base status, though this has been recently called into question. This study aimed to evaluate whether moving the patient into a 30 degrees left lateral tilt position before elective cesarean delivery with combined spinal-epidural anesthesia could better improve the fetal acid-base status compared with a 15 degrees left lateral tilt or supine position.

Effects of phenylephrine and ephedrine in prevention and treatment of hypotension during spinal anaesthesia for elective cesarean section

Introduction: Hypotension and bradycardia are common side effects of spinal anaesthesia. It can have a potentially deleterious maternal and fetal impact. Phenylephrine is preferred vasopressor in prevention and treatment of post spinal hypotension (PSH) and Ephedrine investigated as an alternative to phenylephrine with promising results. Aim: To compare the efficacy and safety of Ephedrine with Phenylephrine for the prevention and treatment of hypotension under spinal anesthesia for cesarean delivery. Methods: This prospective, randomized study was done at tertiary care centre. Total 80patients of ASA I/II posted for elective Cesarean Section were randomly divided into 2 equal groups, Group P (Phenylephrine) received 100ug of Inj. Phenylephrine i.v. and Group E (Ephedrine) received 10mg of Inj. Ephedrine i.v. Result: Incidence of bradycardia was higher in phenylephrine group after induction. SBP, DBP and mean blood pressure measured during pre-operative, per-operative and post-operative periods in both groups showed low incidence of hypotension in Group P as compared to Group E. Conclusion: Phenylephrine is more efficient in managing hypotension during spinal anaesthesia for elective caesarean delivery. Neonatal outcome remains equally good in both the groups.

Effect of Preoperative Oral Carbohydrate Loading on Body Temperature During Combined Spinal-epidural Anesthesia for Elective Cesarean Delivery

(Anesth Analg. 2021;133:731–738. doi: 10.1213/ANE.0000000000005447) Hypothermia is common after neuraxial blockade during cesarean delivery (36% to 85%). Preoperative oral carbohydrate loading has been shown to mitigate this complication. This objective of this study was to assess the impact of preoperative oral carbohydrate loading on body temperature during elective cesarean delivery under combined spinal-epidural anesthesia (CSEA).

Comparison of clinical effects of meperidine and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean delivery: a randomized controlled trial.

The objective of this study was to compare the effect of adding meperidine or sufentanil to hyperbaric bupivacaine in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. The primary outcome was the first analgesic request time, and secondary outcomes included an analgesic requirement in the first 24h and intraoperative and postoperative side effects. This was a randomized, double-blind clinical trial in which patients were allocated into two groups. One group received preservative-free meperidine 12.5mg (1mL) in addition to 0.5% 10mg (2mL) of hyperbaric bupivacaine for spinal anesthesia. The other group received sufentanil 5μg (1mL) added to 0.5% 10mg (2mL) of hyperbaric bupivacaine. A total of 60 parturients were included in the study, 30 patients in each group. Time to first analgesic request was significantly longer in the meperidine group (400.0 ± 142.1min) compared to (274.0 ± 104.1min) in the sufentanil group (P < 0.0001). Around 73% of the parturients in the sufentanil group required analgesics at 4h compared to 13% in the meperidine group (P < 0.0001). There were no significant differences in postoperative pruritus, nausea and vomiting, in addition to shivering. As for surgeon satisfaction, 56.7% reported excellent abdominal muscle relaxation during the surgery in the meperidine group compared to 10% in the sufentanil group (P < 0.0001). Meperidine was superior to sufentanil in terms of improved analgesia, intraoperative postoperative pruritus, and shivering, as well as increased surgeon satisfaction in women undergoing spinal anesthesia for elective cesarean delivery. ClinicalTrials.gov (NCT04446715).

Intrathecal morphine does not prevent chronic postsurgical pain after elective Caesarean delivery: a randomised controlled trial

BackgroundMorphine is frequently added to spinal anaesthesia for Caesarean delivery. We aimed to determine whether intrathecal morphine for spinal anaesthesia decreases the risk of chronic postsurgical pain (CPSP). MethodsIn this randomised, double-blind, placebo-controlled trial, 290 healthy parturients undergoing elective Caesarean delivery were randomly assigned in a 1:1 ratio to receive either intrathecal morphine 100 μg (n=145) or normal saline (control; n=145) as a part of spinal anaesthesia. Anaesthetic care and postoperative pain management were standardised in all patients. The primary outcome was the incidence of CPSP at 3 months. Secondary outcomes included CPSP at 6 months, pain severity, and pain interference, measured by the Brief Pain Inventory questionnaire using an 11-point numeric rating scale, at 3 and 6 months after the surgery. ResultsTwo hundred and seventy-six patients completed the 3-month follow-up, 139 in the morphine group and 137 in the placebo group. The incidences of CPSP at 3 months were 19% (27 of 139) in the morphine group and 18% (25 of 137) in the placebo group (odds ratio, 1.08; 95% confidence interval, 0.59–1.97; P=0.803). At 6 months, CPSP was present in 23 of 139 (16%) morphine group patients compared with 19 of 137 (14%) in the placebo group (odds ratio, 1.23; 95% confidence interval, 0.63–2.38; P=0.536). Brief Pain Inventory questionnaire scores for pain severity and pain interference at 3 and 6 months were similar between groups. ConclusionsAdministration of morphine 100 μg as a component of spinal anaesthesia for elective Caesarean delivery failed to reduce the incidence of chronic pain at 3 and 6 months after surgery. Clinical trial registrationNCT03451695.

Performance of non-invasive stroke volume variation during passive leg raising as a predictor of hypotension following induction of spinal anesthesia for elective cesarean delivery: a single cohort study

BackgroundSpinal anesthesia for cesarean delivery is accompanied by hypotension in up to 70% of cases. To date, there is no gold standard for predicting hypotension after spinal anesthesia for cesarean delivery. The Clearsight™ device is a non-invasive system that uses a digital cuff to calculate stroke volume. We hypothesized that stroke volume variation induced with passive leg raising before spinal anesthesia for elective cesarean delivery could predict the occurrence of hypotension. MethodsWe conducted a prospective observational study, including third trimester parturients undergoing elective cesarean delivery with spinal anesthesia. We analyzed the stroke volume variation performance for predicting hypotension. Stroke volume was collected in the semi-recumbent position (baseline) and during passive leg raising before spinal anesthesia. Systolic arterial blood pressure measurement was followed for 15 min after spinal anesthesia. Hypotension was defined as a ≥20% decrease from the baseline measurement. All parturients received appropriate hypotension prophylaxis. ResultsData from 42 parturients were analyzed. Hypotension occurred in 45%. The area-under-the curve for predicting hypotension using the stroke volume variation was 0.83 (95% CI 0.68 to 0.98; P=0.001). The best cut-off value for predicting hypotension was 7%, having a sensitivity of 87% (95% CI 0.70 to 0.99) and a specificity of 83% (95% CI 0.69 to 0.97). ConclusionIn our study of third trimester parturients undergoing cesarean delivery and receiving appropriate hypotension prophylaxis, a digital non-invasive monitoring device of stroke volume variation analysis was useful for predicting the occurrence of hypotension after spinal anesthesia.

A randomized trial to investigate needle redirections/re-insertions using a handheld ultrasound device versus traditional palpation for spinal anesthesia in obese women undergoing cesarean delivery

BackgroundUltrasound may be useful to identify the spinal anesthesia insertion point, particularly when landmarks are not palpable. We tested the hypothesis that the number of needle redirections/re-insertions is lower when using a handheld ultrasound device compared with palpation in obese women undergoing spinal anesthesia for cesarean delivery. MethodsStudy recruits were obese (body mass index (BMI) >30 kg/m2) women with impalpable bony landmarks who were undergoing spinal anesthesia for elective cesarean delivery. Women were randomized to ultrasound or palpation. The primary study outcome was a composite between-group comparison of total number of needle redirections (any withdrawal and re-advancement of the needle and/or introducer within the intervertebral space) or re-insertions (any new skin puncture in the same or different intervertebral space) per patient. Secondary outcomes included insertion site identification time and patient verbal numerical pain score (0–10) for comfort during surgical skin incision. ResultsForty women completed the study. The mean BMI (standard deviation) for the ultrasound group was 39.8 (5.5) kg/m2 and for the palpation group 37.3 (5.2) kg/m2. There was no difference in the composite primary outcome (median (interquartile range) [range]) between the ultrasound group (4 (2–13) [2–22]) and the palpation group (6 (4–10) [1–17]) (P=0.22), with the 95% confidence interval of the difference 2 (−1.7 to 5.7). There were no differences in the secondary outcomes. ConclusionsHandheld ultrasound did not demonstrate any advantages over traditional palpation techniques for spinal anesthesia in an obese population undergoing cesarean delivery, although the study was underpowered to show a difference.

Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception.

BackgroundIntraoperative pain is a possible complication of neuraxial anaesthesia for caesarean delivery. There is little information available about its incidence, risk factors and physician perception.MethodsParturients undergoing spinal anaesthesia for elective caesarean delivery were enrolled. Before surgery, parturients were asked about preoperative anxiety on a verbal numerical scale (VNS), anticipated analgesic requirement, postoperative pain levels, Spielberger STATE‐TRAIT inventory index, Pain Catastrophizing Scale. After surgery, parturients were asked to answer questions (intraoperative VNS pain). The anaesthesiologist and obstetrician were asked to fill out a questionnaire asking about perceived intraoperative pain. Influence of preoperative anxiety on intraoperative pain (yes/no) was assessed using logistic regression. Mc Fadden's R2 was calculated. The agreement in physician perception of intraoperative pain with reported pain by the parturient was examined by calculating Cohen's kappa and 95% Confidence Intervals (CI).ResultsWe included 193 parturients in our analysis. Incidence of intraoperative pain was 11.9%. Median intraoperative VNS pain of parturients with pain was 4.0 (1st quartile 4.0; 3rd quartile 9.0). Preoperative anxiety was not a good predictor of intraoperative pain (p‐value of β‐coefficient = 0.43, Mc Fadden's R2 = 0.01). Including further preoperative variables did not result in a good prediction model. Cohen's kappa between reported pain by parturient and by the obstetrician was 0.21 (95% CI: 0.01, 0.41) and by the anaesthesiologist was 0.3 (95% CI: 0.12, 0.48).ConclusionsWe found a substantial incidence (11.9%) of intraoperative pain during caesarean delivery. Preoperative anxiety did not predict intraoperative pain. Physicians did not accurately identify parturients’ intraoperative pain.SignificanceIntraoperative pain occurred in 11.9% and severe intraoperative pain occurred in 1.11% of parturients undergoing elective caesarean delivery under spinal anaesthesia. We did not find any preoperative variables that could reliably predict intraoperative pain. Obstetricians and anaesthesiologists underestimated the incidence of intraoperative pain in our cohort and thus, more attention must be put to parturients’ pain.

Fluid Loading Therapy to Prevent Spinal Hypotension in Women Undergoing Elective Cesarean Section: Network Meta-analysis, Trial Sequential Analysis and Meta-regression

(Eur J Anaesthesiol. 2020;37:1126–1142) Up to 80% of women experience hypotension after spinal anesthesia without prophylaxis for cesarean delivery (CD). The recommended approach to prevent hypotension is a phenylephrine infusion at the time of spinal anesthesia. Fluid-loading strategies can also play a part in maintaining hemodynamic stability. While some meta-analyses exist on the use of fluid therapy to prevent hypotension due to spinal anesthesia, it is unclear whether these studies had sufficient power to draw conclusions. The aim of this study was to employ network meta-analysis with trial sequence analysis and meta-regression to determine the optimal fluid-loading strategy to prevent hypotension due to spinal anesthesia in elective CDs.

A Study of Phenylephrine Administration for the Prevention and Treatment of Hypotension in Cesarean Section during Spinal Anaesthesia

Background: Hypotension remains the most common complication following spinal anesthesia in cesarean sections. Despite using various preventive measures, hypotension occurs in most cases; vasopressors are often required. The current study evaluated the safety and efficacy of prophylactic phenylephrine infusion in preventing spinal anesthesia-induced hypotension in the Cesarean Section. Materials and Methods: A total of 50 parturients aged 20-35 years with American Society of Anesthesiologists (ASA) grade II, scheduled for elective cesarean sections were randomly allocated into one of the two groups. Group A (n=25) received intravenous prophylactic phenylephrine infusion at 100μg/min for 3min after spinal anesthesia using a syringe pump. Each minute, systolic arterial pressure (SAP) was measured, and infusion stopped if SAP > baseline and continued if less than or equal to baseline systolic arterial pressure. Intravenous phenylephrine bolus 100μg was given when SAP decreased to <80% of baseline. Group B (n=25) received only intravenous phenylephrine bolus 100μg when SAP decreased to <80% of baseline. After 1 minute of spinal anesthesia, Heart Rate (HR), SAP, and diastolic blood pressure (DBP) were recorded every minute until the baby's extraction. After the delivery of the baby, APGAR scores at 1 minute and 5 minutes were noted. Umbilical artery blood was sent for analysis of the pH. The total volumes of study solutions given up to the time of delivery of the baby were recorded. Results: Phenylephrine infusion decreased the incidence and frequency of hypotension compared with control and the phenylephrine dose was much higher in the infusion group than in the control group (p=0.0001). None of the patients had any incidence of nausea or vomiting. There was no significant difference in umbilical artery blood pH and no reduction in the APGAR scores. HR was significantly slower in the infusion group compared with the control group. Conclusion: A prophylactic infusion of phenylephrine100 μg/min in patients receiving spinal anesthesia for elective cesarean delivery decreased the incidence of hypotension and without any deleterious neonatal outcome.

Effect of Preoperative Oral Carbohydrate Loading on Body Temperature During Combined Spinal-Epidural Anesthesia for Elective Cesarean Delivery.

Intraoperative hypothermia is a common complication after neuraxial block in cesarean delivery. At least 1 animal study has found that carbohydrate loading can maintain the body temperature of rats during general anesthesia, but it is unclear whether carbohydrate loading is beneficial for body temperature maintenance in parturient women during combined spinal-epidural anesthesia (CSEA) for elective cesarean delivery. Women undergoing elective cesarean delivery were randomized into a control group (group C), an oral carbohydrate group (group OC), or an oral placebo group (group OP), with 40 women in each group. Core body temperature (Tc) and body surface temperature (Ts) before and after cesarean delivery, changes in Tc (ΔTc) and Ts (ΔTs), and the incidence of side effects (eg, intraoperative shivering) were compared among the groups. The postoperative Tc (core body temperature after cesarean delivery [Tc2]) of group OC (36.48 [0.48]°C) was higher than those of group C (35.95 [0.55]°C; P < .001), and group OP (36.03 [0.49]°C; P = .001). The ΔTc (0.30 [0.39]°C) in group OC was significantly smaller than those in group C (0.73 [0.40]°C; P = .001) and group OP (0.63 [0.46]°C; P = .0048). Oral carbohydrate loading 2 hours before surgery facilitated body temperature maintenance during CSEA for elective cesarean delivery.

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

Background: Cesarean section is a worldwide common surgery that requires anesthetic techniques. Many local anesthetics are being now used, but are associated with, dose- dependent and at different level, some side effects including toxicity. Hypotension was described as the first and threat side effect associated to neuraxial techniques. Despite many preventive strategies, it continues to challenge anesthesia providers around the world. Lidocaine was found to be less toxic compared with others commonly used and has been recommended for anesthesia procedures requiring large dose of local anesthetic including epidural anesthesia. The main purpose of this research was to determine the incidence of hypotension and identify the possible risk factors associated with it and thus, assess the efficacy and safety when lidocaine is applied together with epinephrine, in epidural anesthesia for elective cesarean delivery. Materials and methods: This retrospective observational institutional-based study, recruited 612 parturients who underwent elective cesarean section under epidural anesthesia with 2% lidocaine and 1/200000 epinephrine, at 1st affiliated hospital of Chongqing Medical University in 2019. Exclusion criteria included any contraindication to elective cesarean section delivery, general anesthesia, baseline systolic blood pressure &lt; 100mmh and &gt; 140 mm hg, gestational age &lt; 37 weeks and &gt; 42 weeks etc. SPSS 26.0 version and different appropriated tests were used for statistical analysis. P value &lt; 0.05 was accepted as statistically significant. Results: The hypotension incidence was 13.2%, and identified factors associated with it were Baseline Systolic Blood Pressure &lt; 120mmhg, gestational age &lt; 40 weeks, maternal body weight ≤ 60 kg and duration of cesarean delivery (surgery) &gt; 45 minutes. Conclusion: The variables in correlation with increased hypotension rate are baseline systolic blood pressure, gestational age, maternal weight, and surgery duration. 2%Lidocaine with epinephrine as adjuvant presented best outcomes towards both mother and neonates, was therefore efficacy and safe under the anesthetic conditions of our study.

Prevention of Hypotension After Spinal Anaesthesia for Cesarean Section: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

(Anaesthesia. 2020;75:109–121) The potential for maternal hypotension is one key risk of spinal anesthesia for elective cesarean delivery (CD). A variety of methods to prevent postspinal hypotension during CD are recommended in the literature. While an international consensus statement published in 2018 recommended prophylactic vasopressors for all CDs it did not take into account the risks associated with these agents. Also, a recent meta-analysis comparing different methods to prevent hypotension was inadequate to determine treatment efficacy. The aim of this study was to determine the relative efficacy of interventions, including vasopressors, to prevent hypotension associated with spinal anesthesia during elective CD.

Association of renin-angiotensin-aldosterone system genetic polymorphisms with maternal hypotension during spinal anaesthesia for caesarean delivery: a retrospective cohort study

BackgroundUnless prevented, hypotension occurs in up to 80% of normotensive women undergoing spinal anaesthesia for caesarean delivery. Renin-angiotensin-aldosterone system genetic polymorphisms have been associated with hypertensive disease, but few studies investigated effects on blood pressure regulation under spinal anaesthesia. We postulated that these polymorphisms increased vasodilation and maternal hypotension during spinal anaesthesia. MethodsA retrospective secondary analysis of data from four prospective trials with similar inclusion/exclusion criteria evaluating phenylephrine/ephedrine delivery systems during spinal anaesthesia for elective caesarean delivery. Angiotensin type-1 receptor (AT1R) (A1166C), angiotensin-converting enzyme (ACE) (I/D), and aldosterone synthase CYP11B2 (C344T) polymorphisms were identified from stored specimens. The associations between the polymorphisms and hypotension (systolic blood pressure <80% of baseline), and vasopressor use, were determined by univariable and multivariable regression. ResultsOf 556 patients, 378 (68.0%) had hypotension. The AC/CC genotypes of AT1R (A1166C) were associated with hypotension by univariable analysis (OR 2.70, 95% CI 1.38 to 5.28, P=0.004]) and multivariable analysis (OR 3.65, [95% CI 1.68 to 7.94, P=0.004]) after adjustment for age, race, intravenous fluid volume, and block height. No difference in vasopressor use or adverse maternal or fetal outcomes were noted. Baseline characteristics were similar, with the exception of higher baseline blood pressure, block height, and intravenous fluid volume in the hypotensive group. There was no significant association between ACE and CYP11B2 polymorphisms and hypotension. ConclusionAC/CC genotypes of AT1R (A1166C) polymorphism were associated with maternal hypotension under spinal anaesthesia for caesarean delivery. An association with cardiovascular indices and high-risk parturients should be examined.

The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement during Spinal Anesthesia for Elective Cesarean Delivery

Abstract Background Physiological changes associated with pregnancy are significant enough to have serious anesthetic implications. When these are compounded by obesity, the anesthesiologists may have to deal with a patient with seriously limited physiological reserve. Obese patients often had co-morbidities and pathological changes in different organ systems. Aim The objective of this study is to determine if obesity have a clinical important effect on the vasopressor requirements or the block height following a standard fixed dose of spinal anesthesia during elective cesarean delivery. Methodology In this prospective randomized comparative clinical study, two groups of 33 patients were recruited with widely differing body mass indices to examine the influence of body mass index (BMI) on the responses to a specific dose of spinal bupivacaine. One group includes women with BMI &amp;lt; 32 kg/m2 (group N) and the other group has a BMI of &amp;gt; 40 kg/m2 (group O). Results This study showed that Body Mass Index doesn’t have much influence on sensorimotor block level and vasopressor requirement during spinal anesthesia for elective cesarean delivery &amp;so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients. Conclusion The result of the present study showed that Body Mass Index up to 50 doesn’t have much influence on sensorimotor block level or vasopressor requirement during spinal anesthesia for elective cesarean delivery &amp;so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients.