Anesthesia In Parturients Research Articles

Impact of anesthesiologist experience on neuraxial anesthesia outcomes in cesarean sections.

Despite the requirement for meticulous management of cesarean anesthesia, no study has explored the impact of novice trainee anesthesiologists in this field. This study assessed challenges in neuraxial anesthesia for cesarean sections and compared outcomes between novice and senior anesthesiologists. We retrospectively analyzed 446 cesarean sections with neuraxial anesthesia. The primary objective was to evaluate the impact of anesthesiologists' experience on the time required to administer neuraxial anesthesia and whether maternal body mass index (BMI) influenced this relationship. Secondary objectives included examining maternal hemodynamic variability, operative details, and newborn outcomes relative to the anesthesiologist's experience. Novice anesthesiologists required a significantly longer time to perform neuraxial anesthesia (24.9 [7.1] min vs. 18.2 [7.0] min, P<0.001) than their senior counterparts. A significant interaction was observed between anesthesiologist experience and maternal BMI on the time to administer neuraxial anesthesia (P=0.017), with a moderate correlation between BMI and administration time for novices (r=0.50, P<0.001) and only a slight correlation for seniors (r=0.17, P=0.001). Experience level did not significantly affect intraoperative hemodynamics, Apgar scores, or umbilical cord blood gas analyses. The effect of maternal BMI on the difficulty of performing neuraxial anesthesia in parturients can be more pronounced for novice anesthesiologists than for experienced ones. Despite requiring more time to perform neuraxial anesthesia, novice anesthesiologists do not significantly affect maternal hemodynamics or newborn distress during obstetric anesthesia, provided that they are under the supervision of experienced anesthesiologists.

Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections. Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections. Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16. Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI &gt; 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI &gt; 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes. Conclusion: The study concludes that a Perfusion Index &gt; 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI &gt; 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.

Role of Granisetron in Reducing Spinal Anesthesia Induced Hypotension during Cesarean Section

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Although it has been considered as a safe technique, spinal anesthesia has many side effects, including hypotension, bradycardia, nausea, and vomiting. Factors influencing the level and the intensity of block include the injected drug, the level of injection, the needle type, the patient position, and patient characteristics, such as age, height, weight, pregnancy, and spinal anatomy. Objective To evaluate the efficacy of different doses of granisetron, a 5-HT3 receptor inhibitors, on reducing the incidence of hypotension after subarachnoid block for cesarean section. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent this study was conducted in the operating theatres of Ain Shams University Hospitals. Results In our study we compared the effect of different doses of granisetron in reducing the hypotension occurring as a result of spinal anesthesia in parturients undergoing elective LSCS. The result of the study showed that compared to placebo group, there was a reduction in the degree of hypotension in group who was pre-medicated with IV grainsetron, and this reduction was more with increasing the dose of granisetron. Conclusion IV granisetron can be used as a pre-medication to reduce spinal anesthesia induced hypotension in parturients undergoing elective lower section cesarean section.

Efficacy of Combination Therapy Using Crystalloid, Colloid and Ephedrine in Prevention of Post Spinal Hypotension at Cesarean Delivery

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Objective To determine the most effective strategy to decrease the incidence and severity of post spinal hypotension by comparing three different combination therapies using crystalloid, colloid and ephedrine at cesarean delivery. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent from all parturients this study was conducted in the operating theatres of Ain Shams Obstetric and Gynecology University Hospitals. Results In our study we found that a combination of an ephedrine infusion at 1.25 mg, minute with a crystalloid co-load was more effective in the prevention of hypotension. Conclusion Employing all mentioned combination treatments reduced the rate of hypotension occurrence following spinal anesthesia in parturients undergoing cesarean delivery. The most effective method was administration of crystalloid coloading plus ephedrine infusion.

Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section

Objective: To compare the incidence of post-dural puncture headache (PDPH) following spinal anesthesia in parturients undergoing elective cesarean section between the sitting and left lateral decubitus positions. Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, Pakistan, from May 2022 to October 2022. A total of 120 parturients undergoing elective cesarean section under spinal anesthesia were randomly assigned to either the sitting or left lateral decubitus position group. The primary outcome was the occurrence of PDPH within 5 days postoperatively. Secondary outcomes included adverse effects such as hypotension, nausea/vomiting, and bradycardia. Data were analyzed using SPSS version 25.0. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, with a significance level set at p &lt; 0.05. Results: The incidence of PDPH post-procedure was significantly higher in the sitting group compared to the left lateral decubitus group (33.3% vs. 6.7%). In the sitting position group, 63.3% of women experienced hypotension, 26.7% had bradycardia, and 30.0% reported nausea/vomiting, whereas in the left lateral decubitus group, these figures were 58.3%, 21.7%, and 23.3%, respectively. Conclusion: This study concludes that the left lateral decubitus position during spinal anesthesia for cesarean section is associated with a lower incidence of PDPH compared to the sitting position.

Comparison of Low-Frequency or High-Frequency Electrical Acupoint Stimulation on Hypotension After Spinal Anesthesia in Parturients: A Prospective Randomized Controlled Clinical Trial.

Objective: To investigate whether transcutaneous electrical acupoint stimulation (TEAS) at PC6 could reduce hypotension after spinal anesthesia (SA) in parturients and to compare the effect of TEAS at different frequencies. Methods: From February 20, 2023, to August 29, 2023, 90 parturients scheduled for c-section under SA were randomly assigned to receive no treatment (Control), TEAS at high frequency (TEAS-HF), or TEAS at low frequency (TEAS-LF). Treatments started immediately after SA and lasted for 30 min. The primary endpoint was incidence of hypotension by 30 min after SA. Secondary endpoints included lowest systolic blood pressure (SBP) during 30 min after SA, dose of ephedrine, dose of atropine, Apgar score at 1 min, and adverse events, including nausea, vomiting, dizziness, dyspnea, and chest congestion. Results: In the TEAS-HF group, the incidence of hypotension by 30 min after SA was lower (13.3%) than in the Control (53.3%, p = 0.001; OR 1.9, 95% confidence interval [CI]: 1.2-2.8) and TEAS-LF group (40.0%, p = 0.02, OR 1.4, 95% CI: 1.0-2.0). The lowest SBP during 30 min after SA was higher in the TEAS-HF group (100.0 ± 9.4 mm Hg) than in the Control group (91.5 ± 16.5 mm Hg) and TEAS-LF group (93.9 ± 16.6 mm Hg). Patients who received TEAS showed a lower score of nausea and vomiting (both p = 0.02). Patients in the group TEAS-HF showed a lower incidence of dizziness, dyspnea, and of chest congestion than those in the other two groups. There was no difference with respect to atropine consumption and neonatal Apgar score. Conclusions: TEAS-HF at PC6 reduced hypotension after SA in parturients, while TEAS-LF did not. Trial registration: ClinicalTrials.gov (NCT05724095).

Optimal patient positioning for spinal anesthesia using a visual aid in cesarean section patients: A randomized control trial.

Spinal anesthesia is the safest technique of anesthesia in parturients for cesarean section. Usually, patients are instructed verbally to acquire the ideal position for spinal anesthesia, but there can be difficulty in attaining the best position if patients fail to understand the verbal command, which will lead to detainment in accomplishing the technique and increased possibility of patient's dissatisfaction. Hence, in our study, we hypothesized that using photographs with verbal commands would reduce the time taken for spinal needle placement, reduce the total number of skin pricks, and improve the success at the first attempt. One hundred and eleven pregnant women undergoing elective cesarean section were divided into Group C (only verbal instructions were given) and Group V (visual aid and verbal instructions were given). Time taken for successful spinal needle placement was noted in seconds and summarized in terms of median and interquartile range. Number of skin punctures, intervertebral spaces attempted, and first-pass success were determined in terms of percentage. Pearson's Chi-square test was used to compare the above parameters between the two groups. There was significant reduction in the time taken for spinal needle placement in Group V compared to the control group. There was significant improvement in first-pass success rate and reduction in the number of skin pricks and intervertebral spaces attempted in Group V. Use of visual aid with verbal commands helps in better understanding of positioning, thus improving the first-pass success significantly. It also reduces the duration for successful spinal needle placement, number of skin pricks, and intervertebral spaces attempted.

To Evaluate the Maternal and Foetal Outcome in Parturients Undergoing Caesarean Section for Pre-Eclampsia Under Spinal and General Anaesthesia: A Randomised Prospective Study

Background: Pre-eclampsia has always been a challenge to the anaesthesiologist, in terms of choosing which type of anaesthesia to prefer. This present study was done to evaluate the maternal and foetal outcome in patients of caesarean section for pre-eclampsia under spinal and general anaesthesia.&#x0D; Methods: This prospective study was conducted in 60 parturients, ASA 1 and 2 who underwent caesarean section for pre-eclampsia. These parturients were randomly and divided into two groups, Group S receiving spinal anesthesia and Group G receiving general anesthesia. For maternal outcome, the parturients were monitored for Blood Pressure, Heart Rate, Oxygen Saturation. Post-operative ICU admissions, convulsions, and pulmonary edema chances were seen. For fetal outcome, APGAR score was noted at 1 minute and 5 minutes after birth of child.&#x0D; Results: The systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were comparable in both the groups in the pre-operative period and at induction. However, intraoperatively, these parameters were significantly lower in the spinal anaesthesia group as compared to general anesthesia group (p&lt;0.05). The Apgar Score was also found to be significantly higher in the newborns in spinal anaesthesia group as compared to general anaesthesia group. Post-operatively, more number of ICU admissions were seen in general anaesthesia group as compared to spinal anaesthesia group (p&lt;0.05).&#x0D; Conclusion: Spinal Anaesthesia can be considered as a first choice of anaesthesia in parturients undergoing caesarean section for preeclampsia with better hemodynamic control in intra-operative period and lesser chances of post-operative morbidity and mortality.

Predictive Efficacy of the Perfusion Index for Hypotension following Spinal Anesthesia in Parturient Undergoing Elective Cesarean Section: A Systematic Review and Meta-Analysis.

This meta-analysis assessed the predictive efficacy of perfusion index for hypotension following spinal anesthesia (SA) in parturients undergoing elective cesarean section (CS). Electronic databases, including Google Scholar, EMBASE, Cochrane Library, and MEDLINE, were searched from inception to June 2023. The primary outcome was the diagnostic accuracy of the perfusion index in predicting the probability of perioperative hypotension following SA. The review included 12 studies involving 2009 patients, published between 2017 and 2023. The pooled sensitivity and specificity were 0.81 (95% confidence interval (CI) = 0.72-0.87) and 0.75 (95% CI = 0.67-0.82), respectively. Additionally, the pooled area under the curve (AUC) was calculated as 0.84 (95% CI = 0.81-0.87), suggesting a moderate to good accuracy of the diagnostic test. Using Fagan's nomogram plot, the positive likelihood ratio (LR) and negative LR were found to be 3 and 0.26, respectively. The results demonstrated that the perfusion index exhibited an acceptable level of accuracy in predicting perioperative hypotension after spinal anesthesia in parturients undergoing elective CS. These findings highlight the potential value of incorporating a perfusion index as a useful tool for clinicians to integrate into routine clinical practice, which necessitates further large-scale studies for verification.

Efficacy of intravenous ketamine as premedicant for prevention of intraoperative hypotension after spinal anesthesia in parturients posted for elective cesarean section

Background: Hypotension following spinal anesthesia (SA) in lower segment cesarean section can be deleterious to the parturient and to fetus. Ketamine acts by stimulating the cardiovascular system leading to high blood pressure and increase in heart rate (HR) and cardiac output. Aims and Objectives: This study aimed to assess the efficacy of 15 mg of prophylactic intravenous ketamine in elective cesarean section for prevention of hypotension after SA. Materials and Methods: This double-blinded randomized controlled study was conducted on 98 participating parturients who were American Society of Anesthesiologists term pregnant women. The parturients were randomly divided into two groups (n=49 in each). All the parturients received SA. Ketamine group - Group K received 15 mg of ketamine IV bolus in 3 mL saline and control group - Group C received the same volume of normal saline IV bolus. HR and systolic blood pressure (SBP) were recorded at baseline at 5, 10, 15, and 20 min after the injection and then every 15 min till the end of the operation. Incidences of hypotension were recorded. The total number dose of ephedrine used, APGAR score, and Visual Analog Scale scores were recorded. The Ramsay Sedation Score was also recorded at baseline, then 5, 10, 15, 30, and 45 min after injection, and then at the end of the operation. Results: This study showed a statistically significant increase in the incidence of hypotension and higher use of intravenous ephedrine 6 mg boluses in the control group when compared to the ketamine group. Forty-two parturients in the control group developed hypotension compared to 23 parturients in the ketamine group with P&lt;0.001. The total ephedrine dose was significantly lower among the ketamine group. Sedation was observed for the first 15 min intraoperatively in the ketamine group with P=0.001. There was no statistically significant difference in APGAR score between the two groups. Conclusion: There was significantly higher hemodynamic stability in the ketamine group with regard to SBP, diastolic blood pressure, and HR. Hence, low-dose ketamine, when used as a premedicant, is an effective agent that can be used in preventing post-spinal intraoperative hypotension in parturients undergoing cesarean section delivery.

Postdural Puncture Headache after Spinal Anaesthesia in Parturients Undergoing Cesarean Section in the Department of Anesthesia in a Tertiary Care Center: A Descriptive Cross-sectional Study

The post-dural puncture headache is one of the common complications of spinal anaesthesia. It is one of the most frequent claims for malpractice involving obstetrics anaesthesia. Though self-limiting it is troublesome to the patient. The aim of this study was to find out the prevalence of post-dural puncture headache after spinal anaesthesia in parturients undergoing cesarean section in the Department of Anesthesia in a tertiary care centre. A descriptive cross-sectional study was done among parturients who underwent cesarean section under spinal anaesthesia from 27 June 2022 to 19 January 2023 after receiving ethical approval from the Institutional Review Committee (Reference number: MEMG/480/IRC). The pregnant patients aged 18-45 years of the American Society of Anesthesiologists Physical Status II/IIE who underwent elective or emergency cesarean section under spinal anaesthesia were included. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 385 parturients, the prevalence of post-dural puncture headache was 27 (7.01%) (4.53-9.67, 95% Confidence Interval). A total of 12 (44.44%) cases experienced post-dural puncture headache in the first 24 hours followed by 9 (33.33%) and 6 (22.22%) cases in 48 and 72 hours respectively. Moderate pain was complained of by 3 (11.11%) and 2 (7.41%) cases at 48 and 72 hours post-cesarean section respectively. The prevalence of post-dural puncture headache after spinal anaesthesia in parturients undergoing cesarean section was similar to studies done in similar settings. cesarean section; headache; prevalence.

Evaluation of the Effect of Intravenous Dexamethasone on the Duration of Spinal Anaesthesia in Parturients Undergoing Lower Segment Caesarean Section.

Introduction Dexamethasone is shown to prolong the duration of nerve blocks when administered perineurally as well as intravenously. The effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia is lesser known. We conducted a randomized control trial to determine the effect of intravenous dexamethasone on the duration of spinal anesthesia in parturients undergoing lower-segment cesarean section (LSCS). Methods Eighty parturients planned for LSCS under spinal anesthesia were randomly allocated to two groups. Patients in group A were administered dexamethasone intravenously, and group B received normal saline intravenously before spinal anesthesia. The primary objective was to determine the effect of intravenous dexamethasone on the duration of sensory and motor block after spinal anesthesia. The secondary objective was to determine the duration of analgesia and complications in both groups. Result The total duration of the sensory and motor blocks in group A was 118.38 ± 19.88 minutes and 95.63 ± 19.91 minutes, respectively. The entire sensory and motor blockade duration in group B was 116.88 ± 13.48 minutes and 97.63 ± 15.15 minutes, respectively. The difference between the groups was found to be statistically insignificant. Conclusion Intravenous 8 mg dexamethasone in patients planned for LSCS under hyperbaric spinal anesthesia does not prolong the sensory or motor block duration compared to placebo.

Effect of Hip/Shoulder Width Ratio on the Spread of Spinal Anaesthesia in Term Parturients: A Cross-sectional Study

Introduction: There is increased cephalad spread of spinal anaesthesia with similar dose of hyperbaric bupivacaine in parturients with greater hip width and shorter shoulder width. Aim: To determine the effect of Hip and Shoulder width Ratio (HSR) on the spread of spinal anaesthesia in term parturients. Materials and Methods: The present study was a prospective cross-sectional study conducted in the Department of Anaesthesiology, Regional Institute of Medical Sciences, a tertiary care centre, at Imphal, Manipur, India, from October 2019 to September 2021. A total of 92 parturients aged 18-40 years of age, American Society of Anaesthesiologists (ASA) I and II, undergoing elective caesarean section under subarachnoid block were enrolled. With the parturient in lateral position, a 25G spinal needle was inserted in the L4-L5 interspace. A 2 mL of 0.5% hyperbaric bupivacaine was injected intrathecal in 10 seconds. Age, height, weight, Body Mass Index (BMI), HSR and Vertebral Column Length (VCL) were recorded. Spinal anaesthesia spread was assessed at 0,5,10,15,20,25,30 minutes after the procedure with pin prick test starting from the anaesthetised area and continued cephalad till the sensation changed from the dullness to sharp pain in both the mid-clavicular lines. Results: The mean age, weight, height and BMI were 28.82±6.2 years, 62.36±5.8 kilograms, 158.63±4 centimetre, and 24.77±2 Kg/m2 , respectively. HSR and shoulder width had a significant correlation with the cephalad spread of spinal anaesthesia with r=-0.672 and p-value &lt;0.001 and r=0.369 and p-value &lt;0.001, respectively. Conclusion: HSR and shoulder width has a significant correlation with spread of spinal anaesthesia with a given dose of 0.5% hyperbaric bupivacaine in parturients. The study should expect more cephalad spread of anaesthesia in parturient population when the HSR&gt;1.

Non - Invasive hemodynamic parameters as predictors for hypotension following spinal anesthesia in parturients undergoing lower segment cesarean section: A prospective observational study

Non - Invasive hemodynamic parameters as predictors for hypotension following spinal anesthesia in parturients undergoing lower segment cesarean section: A prospective observational study

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.

Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study

BackgroundCoronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design. MethodsWe searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery. ResultsWe identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of daysbetween the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation −0.55, 95% CI −0.81 to −0.09). ConclusionsPatients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.

Post-Dural Puncture Headache: A Tertiary Care Hospital an Observational Study on Causes, Effects and Management

Background: The current study was carried out to evaluate the association of socio-clinical variables with Post Dural Puncture Headache (PDPH) in the obstetrics and obstetrics patients. Post-dural puncture headache are well- known complications of neuraxial anesthesia in parturients. Objectives: The aim of this study is to assess the Causes, Effects and Management of post dural puncture headache among obstetric patients in a tertiary care hospital an observational study. Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of anesthesiology, Rangpur Medical College Hospital, Bangladesh. In Bangladesh for the duration of the period from January 2020 to December 2021. Results: This study shows that the according to age of 120 Patients aged 18 to 45 years where, 30(25.0%) were 18-25 years, 65(54.17%) were 26-35 years and 25(20.83%) were 36-45 years. And according to gender 21% were Male, 79% were Female. And according to BMI (n=120). According to BMI distribution the &lt;18.5 (underweight range), 18.5 to &lt;24.9 (Normal), 25-29.9 (Overweight) and ≥30.0 (Obese) were 15(12.5%), 55(45.83%), 35(29.16%) and 15(12.5%) respectfully. Conclusions: We concluded that in the present study about obstetric populace had better prevalence of PDPH in contrast to obstetric population. PDPH was once related with enhanced quantity of efforts; sorts of method used, and begin of ambulation.

Comparison of Weight-Adjusted Dose versus Fixed Dose Ondansetron in Preventing Shivering Following Spinal Anaesthesia for Caesarean Deliveries

BACKGROUND&#x0D; Spinal anaesthesia is the preferred method of anaesthesia in parturients undergoing both elective and emergency lower-segment caesarean section. A common complication of spinal anaesthesia is shivering. Shivering increases perioperative heart rate and oxygen consumption by 5 times and also increases the metabolic demand by 100 times, thereby increasing chances of myocardial ischemia, hypoxia, hypoxemia and later lactic acidosis. In this study, we wanted to compare the incidence of shivering following spinal anaesthesia when a weight-adjusted dose versus a fixed dose of ondansetron is used during caesarean delivery.&#x0D; METHODS&#x0D; This was a hospital-based randomized double-blinded (patient and observer blinded) single hospital-based study conducted among 190 pregnant patients who underwent elective caesarean delivery under spinal anaesthesia in the Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati from 1st August 2021 to 31st July 2022 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. The patients were divided into two groups: group 1 (patients who received a weight-adjusted dose of ondansetron at 0.1mg/kg) and group 2 (patients who received fixed-dose ondansetron).&#x0D; RESULTS&#x0D; Shivering occurred in 11 patients (11.6 %) in group 1 and 21 patients (22.1 %) in group 2, but there was no statistical difference between the two groups (p-value 0.053) (using the chi-square test). 10 patients (10.5 %) developed grade I shivering and 1 patient (1.1 %) developed grade II shivering in group 1. In group 2, 10 patients (10.5 %) developed grade I shivering and 11 patients (11.6 %) developed grade II shivering (P-value - 0.0163) which was statistically significant (using chi-square test). Nausea occurred in 2 patients (2.1 %) in group 2 while no incidence of nausea was seen in group 1. Incidence of headache was seen in both groups; 1 patient (1.1 %). There was no statistical difference between the adverse effects of the groups.&#x0D; CONCLUSIONS&#x0D; The severity of shivering was lower in the weight-adjusted dose at 0.1 mg/kg ondansetron group in patients undergoing spinal anaesthesia for caesarean delivery. The incidence of shivering was comparable in both the weight-adjusted dose and fixed-dose ondansetron groups. The incidence of nausea, vomiting, headache and pruritus did not differ significantly among the groups.

Does Spinal Anesthesia Affect Huff Cough Strength in Parturient Under Elective Cesarean Section?

Background: Spinal anesthesia in parturients that undergo cesarean section is a method of choice, but some patients complain about shortness of breath after surgery. This might be due to spinal block may have effect on huff cough strength resulting in the difficulty to expel the mucus from the lungs. The Mini-Wright Peak Flow Meter, the surrogate device of huff cough strength, is a bedside equipment used to assess exhalation force by its peak expiratory flow rate (PEFR). As a result, the investigators would like to know if the spinal block affected the parturient huff cough strength. Objective: To evaluate the spinal anesthesia during cesarean section effect on the parturient huff cough strength and to find the factors that influence the difference of PEFR beside the spinal block. Materials and Methods: The PEFR was recorded three times in 161 healthy term pregnant women at 38 to 42 weeks of gestational age that were scheduled for elective cesarean section, at preoperative, immediate after spinal block, and before discharge from the recovery room. The measurement was performed in all parturients with 15 degree left lateral tilt position and the highest PEFR achieved in three successive attempts. The spinal anesthesia with 10.75 to 11 mg of 0.5% hyperbaric bupivacaine and 0.15 to 0.2 mg morphine was performed under the standard anesthetic care. Results: One hundred sixty-one patients successfully completed the present study. The PEFR appeared to decrease significantly after spinal block from 285.53±55.21 L/minute to 238.70±49.69 L/minute (p&lt;0.001) and seemed to sustain till the time of discharge from the recovery room at 235.40±47.29 L/minute (p=0.493). These implied that though the patients fulfilled the discharge from recovery criteria, the level of sensory blockade was not yet improved. Interestingly, these values were comparable and showed no correlation with age, BMI, and solid sensory blockade. Conclusion: Spinal anesthesia might affect huff cough strength in parturients that underwent elective cesarean section as evidenced by the decrease of PEFR even at the time of discharge from the recovery room. Keywords: Bupivacaine; Cesarean section; Huff cough strength; Parturient; Peak expiratory flow rate; Spinal anesthesia

Management of shivering after spinal anesthesia in parturient

Aim: This study aimed to evaluate and compare the effectiveness and safety of different methods of shivering control in patients with spinal anesthesia during cesarean delivery in Al-Abbas, Obstetrics and Gynecology (Imam Al-Hujjah), and Al Kafeel hospitals in Karbala. Methods: This cross-sectional study was conducted on pregnant women who have delivered from 2016 to 2022 in Karbala city. More than 90% of cesarean delivery in Karbala were conducted in 3 hospitals including Imam Al-Hujjah hospital, Al-Abbas, and Al Kafeel. Patients were selected by a simple random method and the sample size for each hospital was defined with the proportion to size method. The researcher-made checklist was used to collect the data and data were extracted from medical documents of patients. In case of huge missing data in medical documents, the patient was excluded from the study, and another patient was selected by the same method. Result: In this study, 755 patients were included to the study. The mean age of participants was 24.48 ± 4.56 years. The incidence of shivering was 21.59% in participants, which were 31.34% in participants who received no intervention, warmed cover, and fluid therapy; and 18.05% in participants who received tramadol, and pethidine, or clonidine.