Anesthesia For Cesarean Delivery Research Articles

Lower-body warming and postoperative temperature in cesarean delivery under spinal anesthesia: a randomized controlled trial

Study objective: Intraoperative warming techniques after spinal anesthesia in cesarean delivery have conflicting results. Lower body warming has not been investigated, and may be beneficial to counteract heat loss from vasodilation. We investigated a combination of intraoperative lower body forced-air warming and warmed intravenous (IV) fluids versus only warmed IV fluids alone for the primary outcome of maternal temperature in the post-anesthesia care unit (PACU) after elective cesarean delivery.Design: A single-center, single-blinded, randomized, superiority trial.Setting: Obstetric operating room and post-anesthesia care unit in a university hospital.Patients: Sixty-six healthy women undergoing elective cesarean delivery under spinal anesthesia.Interventions: After written informed consent, recruited women received intravenous (IV) co-loading of 1000 mL lactated Ringer’s solution warmed to 42°C during performance of spinal anesthesia. They were then randomized to receive intra-operative lower-body forced-air warming (warming group) or no forced-air warming (control group).Measurements: The primary outcome was maternal oral temperature upon arrival at PACU. Secondary outcome measures included the incidence of hypothermia (<36.0°C), shivering and thermal comfort scores, and the incidence of meperidine administration. In addition, umbilical cord blood gases, Apgar scores, and newborns' rectal temperature were measured after delivery. ResultsIn total, 66 women were recruited. After exclusion of 3 participants (1 missing crucial data, 2 converted to general anesthesia), 63 women remained available for analysis. The mean (Standard deviation) core temperature on arrival to PACU was 36.6°C (0.4°C) in the warming group and 36.5°C (0.3°C) in the control group (P = 0.67). There were no significant differences in shivering intensity between the groups at any time; thermal comfort scores were significantly higher for the air-warming group 30 minutes after arrival to PACU (P = 0.03), but not at any other time. There were no differences in meperidine administration or neonatal outcomes. ConclusionIn healthy women having cesarean delivery under spinal anesthesia, addition of lower body forced air warming conveyed no additional benefit beyond standard management with warmed IV fluids.

Effect of phenylephrine rescue injection on hypotension after spinal anaesthesia for caesarean delivery when guided by both heart rate and SBP during an early warning window: A randomised controlled trial.

Spinal anaesthesia is now the most common technique for caesarean delivery. However, because of the intermittent nature of noninvasive blood pressure (NIBP) measurements, maternal blood pressure may become hypotensive between the measurements. There is thus an inbuilt delay before the anaesthesiologist can intervene to counteract the hypotension. Based on the principle that changes in blood pressure can induce compensatory changes in the heart rate (HR), combining the NIBP with real-time HR, we designed two warning windows to predict hypotension and hypertension. To evaluate whether phenylephrine administration guided by these warning windows would help maintain haemodynamic stability. A teaching hospital. A randomised controlled trial. One hundred and ten pregnant women scheduled for elective caesarean delivery were enrolled, from which, after exclusions, 86 were eligible for the study. All eligible patients received a continuous intravenous infusion of phenylephrine as soon as spinal anaesthesia was initiated. Thereafter, patients were randomly assigned to two groups. In the test group (Win-Group): rescue phenylephrine administration was triggered by an early warning window of HR above 100 beats per minute (bpm) and SBP 90 to 110 mmHg; pausing the infusion phenylephrine was triggered by a HR lower than 60 bpm and SBP greater than 90 mmHg. In the control group, phenylephrine was guided by BP only when it appeared on the monitor: SBP less than 90 mmHg was the trigger for administering rescue phenylephrine; SBP greater than 110 mmHg was the trigger for pausing the phenylephrine infusion. The primary outcome was incidence of hypotension. Secondary outcomes were the incidence of hypertension and other adverse haemodynamic events. The incidence of hypotension was significantly lower in the Win-Group than in the BP-Group (27.8 vs. 66.7%, P = 0.001). The minimum SBP was significantly higher in Win-Group than in BP-Group (93.9 ± 9.49 vs. 86.7 ± 11.16 mmHg, P  = 0.004). There was no significant difference in the incidence of hypertension between groups. After spinal anaesthesia for caesarean delivery, when phenylephrine infusion is guided by HR along with BP from a warning window it effectively reduces the incidence of hypotension without any significant effect on incidence of hypertension. Chictr.org.cn; Identifier: ChiCTR 2100041812.

A Retrospective Multicenter Analysis of Patient and Hospital-Level Factors Predicting the Use of General Anesthesia for Cesarean Deliveries

(Int J Obstet Anesth. 2023:54:103638) A recent study reported that as parturient comorbidity increased, there was an increasing likelihood of receiving general anesthesia (GA) compared with neuraxial anesthesia (NA) for cesarean delivery (CD). This study expands on that research, and the authors theorize that in addition to patient factors, there may be hospital-level factors that increase the likelihood of GA for CD in certain patients.

The Use of Processed Electroencephalography (pEEG) in Obstetric Anesthesia: A Narrative Review

(Int J Obstet Anesth. 2023:54:103650) Accidental awareness while one is under general anesthesia is a large concern that can lead to long-term psychological side effects. One in 670 patients undergoing general anesthesia for cesarean delivery will experience accidental awareness. This is related to inaccurate anesthesia dosages due to pregnancy-related factors. Neuraxial analgesia during cesarean delivery is often considered the best way to avoid accidental awareness; however, this is not always possible. This review aimed to assess and analyze the use of processed electroencephalography (pEEG) during cesarean delivery.

Failed spinal anesthesia for cesarean delivery: prevention, identification and management.

There is an increasing awareness of the significance of intraoperative pain during cesarean delivery. Failure of spinal anesthesia for cesarean delivery can occur preoperatively or intraoperatively. Testing of the neuraxial block can identify preoperative failure. Recognition of the risk of high neuraxial block in repeat spinal in case of preoperative failure is important. Knowledge of risk factors for block failure facilitates prevention by selecting the most appropriate neuraxial procedure, adequate intrathecal doses and choice of technique. Intraoperative pain is not uncommon, and neither obstetricians nor anesthesiologists can adequately identify intraoperative pain. Early intraoperative pain should be treated differently from pain towards the end of surgery. Block testing is crucial to identify preoperative failure of spinal anesthesia. Repeat neuraxial is possible but care must be taken with dosing. In this situation, switching to a combined spinal epidural or an epidural technique can be useful. Intraoperative pain must be acknowledged and adequately treated, including offering general anesthesia. Preoperative informed consent should include block failure and its management.

Impact of Ondancentron In Intra-Anesthesia During Caesarean Section: A Meta-Analysis of Randomized Trials

Background: The medulla distinguishes nausea and vomiting. Intra-operative nausea and vomiting (IONV) can occur up to 80% of the time following spinal anesthesia for caesarean delivery. Patients are uncomfortable and surgery is halted. Aims: This meta-analysis examines the effects of ondancentron on IONV, hypertension, and pruritus. Methods: The databases examined were CINAHL, PubMed, ScienceDirect, Wiley, and Scopus, with coverage from September 2014 to July 2024. Article text must be complete with Uji Coba Terkendali Acak design and published in English. They used R-Studio 4.3.1 m, Comperhesivif Meta-Analysis 3.3.070, and Review Manager Cochrane 5.4.1 for lunak and risk analysis. Results: The heterogeneity analysis of on- and centron residuals on IONV indicated I-squared (I2) of 99%, hypotension I2=98%, and pruritus I2=97% for 1103 people in thirteen studies. The Random Effect Model revealed a significant positive effect on Standard Mean Difference (SMD) analysis (IONV = 5.77, 95% CI: 0.58, 10.95; p=&lt;0.01), decreased hypotension (SMD = -2.14, 95% CI: -4.80, 0.52= p=&lt;0.01), and pruritus incidence (SMD = 0.67, 95%). CI = -1.48 to 2.83; p &lt; 0.01. The meta regression subgroup revealed a significant decrease in IONV in the first 5 minutes with an Odds Ratio of 0.38 (95%-CI 0.04 to 3.62; p=&lt;0.01) for the 4mg dose. Conclusions: While useful in controlling perioperative and hypotension, ondansentron may exacerbate pruritus. Ondansentron dose and pruritus effects need additional study.

Modelling the incidence and severity of hypothermia during spinal anaesthesia for caesarean delivery: a prospective observational study in a resource-limited setting

Modelling the incidence and severity of hypothermia during spinal anaesthesia for caesarean delivery: a prospective observational study in a resource-limited setting

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.

The effect of addition of ultra-low dose of naloxone to fentanyl–bupivacaine mixture on the incidence of pruritis after spinal anesthesia for cesarean delivery: Randomized clinical study

Abstract Background and Aims: The use of intrathecal opioids is associated with high risk of pruritis and this may be decreased by adding a low dose of naloxone. This study evaluated the effect of the addition of 20 μg of naloxone to fentanyl–bupivacaine mixture on the incidence of pruritis in pregnant females scheduled for cesarean section (CS). Material and Methods: Eighty pregnant patients scheduled for CS under spinal anesthesia were randomized to receive either 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl (group F) or 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl and 20 μg naloxone (group FN). The incidence, onset, duration, site, and severity of pruritis were measured. Furthermore, the postoperative numerical rating scale (NRS) score, the total tramadol rescue analgesia, and the time for the first request of rescue analgesia were recorded. Results: Compared to the F group, the FN group showed a significant decrease in the incidence of pruritis (P = 0.022), prolongation of the onset of pruritis (P = 0.006), shortening of the duration of pruritis (P = 0.029), and decrease in the severity of pruritis (P = 0.039). Furthermore, the postoperative pain score, the rescue analgesic consumption, and the time for the first request of rescue analgesia were comparable between the two groups (P &gt; 0.05). Conclusions: The addition of an ultra-low dose of naloxone (20 μg) to fentanyl–bupivacaine mixture in spinal anesthesia for pregnant females scheduled for CS significantly reduced the incidence of pruritis without having a significant effect on the postoperative analgesia.

Incidence and clinical impact of aspiration during cesarean delivery: A multi-center retrospective study

BackgroundThe risk of aspiration during general anesthesia for cesarean delivery has long been thought to be increased due to factors such as increased intra-abdominal pressures and delayed gastric emptying in pregnant patients. However, recent studies have reported normal gastric emptying in pregnant patients, suggesting that the risk of aspiration may not be as high as previously believed. MethodsWe conducted a retrospective study of 48,609 cesarean deliveries, of which 22,690 (46.7%) were performed under general anesthesia at two large tertiary medical centers in Israel. The study aimed to examine the incidence of potentially severe aspiration during cesarean delivery, both under general and neuraxial anesthesia. ResultsAmong the patients included in the study, three were admitted to the intensive care unit due to suspected pulmonary aspiration. Two of these cases occurred during induction of general anesthesia for emergency cesarean delivery associated with difficult intubation and one under deep sedation during spinal anesthesia. The incidence of aspiration during cesarean delivery during general anesthesia in our study was 1 in 11,345 patients, and the incidence of aspiration during neuraxial anesthesia was 1 in 25,929 patients. No deaths due to aspiration were reported during the study period. ConclusionsOur findings provide another contemporary analysis of aspiration rates in obstetric patients, highlighting increased risks during the management of difficult airways during general anesthesia and deep sedation associated with neuraxial anesthesia.

Prophylactic infusion of norepinephrine does not affect the rostral spread of spinal anesthesia in pregnancy: a prospective, randomized, double-blinded study.

Background: The infusion of phenylephrine to prevent spinal-induced hypotension (SIH) in cesarean delivery may decrease the rostral spread of a spinal local anesthetic. We hypothesized that infusion of norepinephrine may decrease the rostral spread of spinal anesthesia, similar to that caused by phenylephrine. The aim of this study was to compare the block height of spinal anesthesia in the presence or absence of norepinephrine infusion administered to prevent SIH during cesarean delivery. Methods: Eighty patients were enrolled and allocated into groups receiving a norepinephrine infusion (group N) or saline infusion (group C). After intrathecal injection of hyperbaric bupivacaine 10mg, the block height for cold and pinprick sensation was checked 10 and 20min after the injection. The demographic characteristics, spinal anesthesia, side effects, and neonatal outcomes were also recorded. Results: The block height for cold and pinprick sensation was similar between the two groups, although the incidence of hypotension was significantly lower (p < 0.00) in group N than in group C. Systolic blood pressure was also more stable in group N than in group C, with the incidence of interventions being significantly lower in group N. There was no significant difference in patient satisfaction between the two groups. Conclusion: Evidence from this study suggested that prophylactic norepinephrine infusion does not reduce the rostral spread of spinal anesthesia in pregnancy. We suggest that it is not necessary to increase the dose of an intrathecal local anesthetic for cesarean delivery when prophylactic norepinephrine is administered. Clinical Trial Registration: https://www.chictr.org.cn/bin/project/edit?pid=152899, identifier [ChiCTR2200057439].

Racial and Ethnic Disparities in Receipt of General Anesthesia for Cesarean Delivery

General anesthesia for cesarean delivery is associated with increased maternal morbidity, and Black and Hispanic pregnant patients have higher rates of general anesthesia use compared with their non-Hispanic White counterparts. It is unknown whether risk factors and indications for general anesthesia differ among patients of differing race and ethnicity. To evaluate differences in general anesthesia use for cesarean delivery and the indication for the general anesthetic by race and ethnicity. In this retrospective, cross-sectional, single-center study, electronic medical records for all 35 117 patients who underwent cesarean delivery at Northwestern Medicine's Prentice Women's Hospital from January 1, 2007, to March 2, 2018, were queried for maternal demographics, clinical characteristics, obstetric and anesthetic data, the indication for cesarean delivery, and the indication for general anesthesia when used. Data analysis occurred in August 2023. Cesarean delivery. The rate of general anesthesia for cesarean delivery by race and ethnicity. Of the 35 117 patients (median age, 33 years [IQR, 30-36 years]) who underwent cesarean delivery, 1147 (3.3%) received general anesthesia; the rates of general anesthesia were 2.5% for Asian patients (61 of 2422), 5.0% for Black patients (194 of 3895), 3.7% for Hispanic patients (197 of 5305), 2.8% for non-Hispanic White patients (542 of 19 479), and 3.8% (153 of 4016) for all other groups (including those who declined to provide race and ethnicity information) (P < .001). A total of 19 933 pregnant patients (56.8%) were in labor at the time of their cesarean delivery. Of those, 16 363 (82.1%) had neuraxial labor analgesia in situ. Among those who had an epidural catheter in situ, there were no racial or ethnic differences in the rates of general anesthesia use vs neuraxial analgesia use (Asian patients, 34 of 503 [6.8%] vs 1289 of 15 860 [8.1%]; Black patients, 78 of 503 [15.5%] vs 1925 of 15 860 [12.1%]; Hispanic patients, 80 of 503 [15.9%] vs 2415 of 15 860 [15.2%]; non-Hispanic White patients, 255 of 503 [50.7%] vs 8285 of 15 860 [52.2%]; and patients of other race or ethnicity, 56 of 503 [11.1%] vs 1946 of 15 860 [12.3%]; P = .16). Indications for cesarean delivery and for general anesthesia were not different when stratified by race and ethnicity. Racial disparities in rates of general anesthesia continue to exist; however, this study suggests that, for laboring patients who had labor epidural catheters in situ, no disparity by race or ethnicity existed. Future studies should address whether disparities in care that occur prior to neuraxial catheter placement are associated with higher rates of general anesthesia among patients from ethnic and racial minority groups.

Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study.

The African Surgical Outcomes Study (ASOS) found that maternal mortality following cesarean delivery in Africa is 50 times higher than in high-income countries, and associated with obstetric hemorrhage and anesthesia complications. Mothers who died were more likely to receive general anesthesia (GA). The associations between GA versus spinal anesthesia (SA) and preoperative risk factors, maternal anesthesia complications, and neonatal outcomes following cesarean delivery in Africa are unknown. This is a secondary explanatory analysis of 3792 patients undergoing cesarean delivery in ASOS, a prospective observational cohort study, across 22 African countries. The primary aim was to estimate the association between preoperative risk factors and the outcome of the method of anesthesia delivered. Secondary aims were to estimate the association between the method of anesthesia and the outcomes (1) maternal intraoperative hypotension, (2) severe maternal anesthesia complications, and (3) neonatal mortality. Generalized linear mixed models adjusting for obstetric gravidity and gestation, American Society of Anesthesiologists (ASA) category, urgency of surgery, maternal comorbidities, fetal distress, and level of anesthesia provider were used. Of 3709 patients, SA was performed in 2968 (80%) and GA in 741 (20%). Preoperative factors independently associated with GA for cesarean delivery were gestational age (adjusted odds ratio [aOR], 1.093; 95% confidence interval [CI], 1.052-1.135), ASA categories III (aOR, 11.84; 95% CI, 2.93-46.31) and IV (aOR, 11.48; 95% CI, 2.93-44.93), eclampsia (aOR, 3.92; 95% CI, 2.18-7.06), placental abruption (aOR, 6.23; 95% CI, 3.36-11.54), and ruptured uterus (aOR, 3.61; 95% CI, 1.36-9.63). SA was administered to 48 of 94 (51.1%) patients with eclampsia, 12 of 28 (42.9%) with cardiac disease, 14 of 19 (73.7%) with preoperative sepsis, 48 of 76 (63.2%) with antepartum hemorrhage, 30 of 55 (54.5%) with placenta previa, 33 of 78 (42.3%) with placental abruption, and 12 of 29 (41.4%) with a ruptured uterus. The composite maternal outcome "all anesthesia complications" was more frequent in GA than SA (9/741 [1.2%] vs 3/2968 [0.1%], P < .001). The unadjusted neonatal mortality was higher with GA than SA (65/662 [9.8%] vs 73/2669 [2.7%], P < .001). The adjusted analyses demonstrated no association between method of anesthesia and (1) intraoperative maternal hypotension and (2) neonatal mortality. Analysis of patients undergoing anesthesia for cesarean delivery in Africa indicated patients more likely to receive GA. Anesthesia complications and neonatal mortality were more frequent following GA. SA was often administered to high-risk patients, including those with eclampsia or obstetric hemorrhage. Training in the principles of selection of method of anesthesia, and the skills of safe GA and neonatal resuscitation, is recommended.

Validating Parallel-Forms Tests for Assessing Anesthesia Resident Knowledge.

We created a serious game to teach first year anesthesiology (CA-1) residents to perform general anesthesia for cesarean delivery. We aimed to investigate resident knowledge gains after playing the game and having received one of 2 modalities of debriefing. We report on the development and validation of scores from parallel test forms for criterion-referenced interpretations of resident knowledge. The test forms were intended for use as pre- and posttests for the experiment. Validation of instruments measuring the study's primary outcome was considered essential for adding rigor to the planned experiment, to be able to trust the study's results. Parallel, multiple-choice test forms development steps included: (1) assessment purpose and population specification; (2) content domain specification and writing/selection of items; (3) content validation by experts of paired items by topic and cognitive level; and (4) empirical validation of scores from the parallel test forms using Classical Test Theory (CTT) techniques. Field testing involved online administration of 52 shuffled items from both test forms to 24 CA-1's, 21 second-year anesthesiology (CA-2) residents, 2 fellows, 1 attending anesthesiologist, and 1 of unknown rank at 3 US institutions. Items from each form yielded near-normal score distributions, with similar medians, ranges, and standard deviations. Evaluations of CTT item difficulty (item p values) and discrimination (D) indices indicated that most items met assumptions of criterion-referenced test design, separating experienced from novice residents. Experienced residents performed better on overall domain scores than novices (P < .05). Kuder-Richardson Formula 20 (KR-20) reliability estimates of both test forms were above the acceptability cut of .70, and parallel forms reliability estimate was high at .86, indicating results were consistent with theoretical expectations. Total scores of parallel test forms demonstrated item-level validity, strong internal consistency and parallel forms reliability, suggesting sufficient robustness for knowledge outcomes assessments of CA-1 residents.

A retrospective cohort study of the anesthetic management of postpartum tubal ligation

BackgroundNeuraxial anesthesia with reactivation of a labor epidural catheter is commonly utilized for postpartum tubal ligations (PPTL), although the optimal anesthetic approach is unknown. We assessed institutional anesthesia practices for PPTL, and evaluated the failure rates of reactivation of labor epidural catheters, de novo spinal anesthesia, and spinal anesthesia after failed blocks. MethodsWe conducted a single-center retrospective cohort analysis of 300 consecutive patients who underwent a PPTL and 100 having spinal anesthesia for cesarean delivery. Anesthetic management data (existing labor epidural catheter reactivation, de novo spinal anesthesia or general anesthesia) were collected from electronic medical records. Anesthetic block failure rates were determined for each anesthetic technique. ResultsThe failure rate was 15% for de novo spinal anesthesia and 23% after failed reactivation of a labor epidural catheter or spinal anesthesia. The epidural catheter reactivation failure rate was 35%. The failure rate of spinal anesthesia for cesarean delivery was 4%. Drug dosage, epidural catheter use in labor, time since epidural catheter placement or delivery, labor neuraxial technique (combined spinal-epidural, epidural), supplemental top-up doses during labor, and anesthesiologist experience did not predict neuraxial anesthesia failures. ConclusionsOur analysis revealed an unexpectedly high neuraxial anesthesia failure rate even when de novo spinal anesthesia was used for PPTL. The results are consistent with other institutions' recent findings, and are higher than spinal anesthesia failure rates associated with cesarean delivery. Further studies are required to determine optimal anesthesia dosing strategies, and to understand the mechanisms behind high neuraxial anesthesia failures for PPTL.

A Prospective Randomized Double Blind Comparative Study to Determine the Efficacy of Norepinephrine and Ephedrine to Maintain Arterial Blood Pressure During Spinal Anesthesia for Cesarean Delivery

Background: Spinal Anesthesia Induced Hypotension(SAIH) continues to be the troublesome complication for obstetric patients undergoing cesarean section under subarachnoid block. Vasopressors are emerging as the cornerstone of treating SAIH in cesarean section patients with the evolving evidence of arterial vasodilatation as the primary cause of hypotension. This study was hypothesized to compare the efficacy of norepinephrine and ephedrine boluses to maintain hemodynamics in cesarean section.&#x0D; Methods: After approval from institutional ethics committee and registration in Clinical Trials Registry India(CTRI ) and informed consent, study was conducted in 110 healthy parturients aged 18-40 years, belonging to ASA  physical status I and II, posted for elective cesarean section under spinal anesthesia, were randomly allocated into group N(n=55) and group E(n=55),who received intravenous boluses of norepinephrine  6 g and ephedrine 10mg respectively as prophylaxis(one dose soon after induction) and in treatment of SAIH. The number of vasopressor boluses were recorded as primary objective and hemodynamics, APGAR scores, adverse events were noted.&#x0D; Results: The number of boluses of vasopressor used was 1.9±1.2 for Ephedrine and 4.72±2.9 for Norepinephrine. At 30,40,50 and 60 minutes after anesthesia, there was significant fall in mean arterial pressure in the norepinephrine group compared to ephedrine group. The incidence of tachycardia was more in ephedrine group and incidence of bradycardia was more in norepinephrine group.&#x0D; Conclusion: Both the study drugs, ephedrine and norepinephrine are  comparably effective in preventing SAIH after prophylactic bolus and effective in maintaining blood pressure intraoperatively, more number of boluses of norepinephrine was required compared to ephedrine.

Anesthesiologists' Attitudes Toward Randomization to General versus Neuraxial Anesthesia for Cesarean Delivery.

Anesthesiologists' Attitudes Toward Randomization to General versus Neuraxial Anesthesia for Cesarean Delivery.

Is crystalloid co-loading necessary to prevent spinal hypotension during elective cesarean delivery? A randomized double-blind trial

BackgroundHypotension is common during spinal anesthesia for cesarean delivery. Preventive strategies include fluid loading and phenylephrine. We hypothesized that if prophylactic phenylephrine infusion is used, omission of fluid loading would be non-inferior to fluid co-loading in maintaining cardiac output. We assumed that if there was a difference, the increase in cardiac output would be greater in the no-loading than in the co-loading group. MethodsTerm pregnant women scheduled for elective cesarean delivery were randomized to receive 1 L crystalloid co-loading or maintenance fluids only. Phenylephrine was titrated to maintain blood pressure. Changes in cardiac output following spinal anesthesia were the primary outcome. The study was powered as a non-inferiority trial, allowing the no-loading arm to have a 50% greater change in cardiac output. Heart rate, dose of phenylephrine, occurrence of nausea and vomiting, Apgar scores and neonatal acid base status were secondary outcomes. ResultsData from 63 women were analyzed. In contrast to our hypothesis, there was 33% less increase in cardiac output with no loading (ratio 0.67, 95% CI 0.15 to 1.36), and 60% greater reduction of cardiac output with no loading (ratio 1.6, 95% CI 1.0 to 2.7). Total dose of phenylephrine was higher in the no-loading group. There may be a less favorable neonatal acid base status without volume loading. ConclusionOmission of crystalloid co-loading leads to a decrease in cardiac output which has a potentially unfavorable impact on neonatal acid base status. We conclude that crystalloid co-loading may be useful in the presence of phenylephrine infusion.

Fear of anesthesia for cesarean section among pregnant women: a multicenter cross-sectional study

BackgroundFear of anesthesia for cesarean section delivery is an important health issue that should be addressed by anesthesiologists, obstetricians, and other providers of antenatal and perioperative healthcare. This multicenter study was conducted to assess the fear of anesthesia for cesarean section among Palestinian pregnant women and to identify the predictors of high fear.MethodsThe study was conducted in a cross-sectional design among Palestinian pregnant women in different antenatal healthcare clinics. The study participants were recruited using a convenience sampling procedure. The pregnant women were asked to respond to items in a questionnaire.ResultsIn this study, a total of 394 pregnant women completed the questionnaires. Of the pregnant women, 280 (71.1%) have had cesarean delivery under anesthesia, and 104 (26.4%) elected cesarean delivery. Multiple linear regression showed that higher fear scores were predicted by having a university degree (p-value < 0.001), living in rural areas (p-value = 0.007), dissatisfaction with social life (p-value = 0.004), satisfaction with religious commitment (p-value = 0.001), having had cesarean delivery under anesthesia (p-value = 0.005), and preference of cesarean delivery (p-value < 0.001).ConclusionFear of anesthesia was prevalent among pregnant women in Palestine. Higher fear could be predicted by education level, place of residence, satisfaction with social life, satisfaction with religious commitment, having had cesarean delivery under anesthesia, and preference for normal delivery. Anesthesiologists, gynecologists and obstetricians, nurses, midwives, and other providers of antenatal and perioperative healthcare services should consider these factors while counseling pregnant women and addressing their fear of anesthesia.

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 &gt;60.0.