Cesarean Section In Parturient Research Articles

The effect of type of anesthesia (general versus spinal) on postoperative levels of brain natriuretic peptide in parturient women with cardiovascular diseases undergoing cesarean section and related cardiac impacts

ABSTRACT Background Dealing with parturient women with cardiac disease is still a challenge for anesthesiologists due to the presence of physiologic burden of pregnancy in addition to the already existing compromised cardiovascular system. A variety of cardiac indices have been utilized to forecast the risk of perioperative cardiac complications, yet limitations in their predictive value exist. Perioperative brain natriuretic peptide (BNP) level is used as a prognosticator of cardiac complications following surgery in cardiac and non-cardiac individuals. Aim of study To compare the effect of general and spinal anesthesia during cesarean section in parturient with cardiac disease on BNP levels and on predicting adverse cardiac events. Methods Thirty cardiac parturient with cesarean section were assigned randomly into two groups of equal size. Group A: participants received general anesthesia (GA); Group B: participants received spinal anesthesia. Preoperative and 2 and 24 h postoperative BNP levels were measured. Intraoperative and 24 h postoperative cardiac complications were observed. Results Preoperative and 2 and 24 h postoperative BNP mean levels were similar in the two groups. In each group, the 2 and 24 h postoperative rise in BNP mean levels was insignificant compared to the preoperative mean levels of BNP. Incidence of complications was comparable in both groups, but it was associated with the already high preoperative levels of BNP. Conclusions The study concludes that safely conducted certain type of anesthesia has no effect on the perioperative BNP levels nor incidence of complications which is associated with the already high preoperative BNP levels.

Spinal anesthesia during caesarean section in parturients with gestational diabetes: prospective controlled non-randomized study

BACKGROUND: Gestational diabetes mellitus (GDM) increases the incidence of cesarean section (CS) to 57.4%. Chronic high blood glucose levels can affect opioid receptors and neurotransmitter metabolism. Pregnant women with GDM require more analgesics and consumed more opioids in the immediate postoperative period after CS than patients without GDM. Thus, in parturients with GDM, the features of the spinal anesthesia (SA) course during CD surgery and the postoperative course remain not fully understood.
 OBJECTIVE: To assess SA during CS in parturients with GDM.
 METHODS AND METHODS: A prospective controlled study was conducted. The study group included patients with compensated GDM, excluding the criteria for manifest diabetes. The control group included patients without carbohydrate metabolism impairment. The inclusion criteria were as follows: SA, full-term and singleton pregnancy, elective CS, age 1525 years, normal venous blood glucose levels in the morning before surgery, parity of pregnancy, and childbirth. The exclusion criteria were as follows: patients with American Society of Anesthesiologists class IV, inadequate SA requiring the administration of drugs for general anesthesia, severe extragenital pathology, preeclampsia and eclampsia, insulin therapy, and use of oral hypoglycemic agents. After SA induction, Bromage motor block and sensory block were assessed.
 RESULTS: Sensory block was achieved in 53% after 3 min, 84% after 4 min, and 100% of the patients in the control group after 5 min. In the GDM group, the threshold of 50% was reached after 7 min, and in all patients, sensory block was noted after 10 min. In the assessment of motor block by Bromage, all patients in the control group achieved motor block after 5 min, whereas in the GDM group, only 77.5% achieved motor block.
 CONCLUSION: Our results suggest that with SA during CS in patients with GDM, compared with parturients without carbohydrate metabolism alteration, the rates of sensory and motor block development decreased. Differences in pain intensity were noted after the early postoperative period, and significant pain sensations in the GDM group are manifested on average 60 min earlier than that in the non-GDM group.

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

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

A retrospective audit of anaesthesia for caesarean section in parturients with eclampsia at a tertiary referral hospital in Cape Town

Background: Anaesthesia for caesarean section (CS) in women with eclampsia is a major clinical challenge, and there are limited data concerning the rationale for the choice of technique, and short-term outcomes. A retrospective audit was performed on practice at a tertiary referral centre in Cape Town. Methods: The primary outcome of the audit was the proportion of patients with eclampsia receiving either spinal anaesthesia (SA) or general anaesthesia (GA) for CS, and an assessment of the rationale for the choice of method. In addition, short-term maternal and neonatal outcomes were recorded. Results: There were 11 exclusions in 100 patient records screened, therefore 89 were analysed. Seven/89 (7.9%) patients received SA and 82/89 (92.1%) GA. Overall, 63/89 (70.8%) patients had a preoperative GCS < 14, and 26/89 (29.2%) ≥ 14. Seven/26 patients with GCS ≥ 14 had SA; the remaining 19/26 received GA. GA was performed because there was no platelet count available in three, pulmonary oedema in two, difficult airway due to a bitten tongue in two, fetal bradycardia in two, HELLP syndrome in one, renal failure in one, and patient refusal in one patient. In seven women, there was no clear reason for GA. Median (IQR) Apgar scores at 1 minute in SA patients (8 [8–9]) were higher than those in GA patients with GCS ≥ 14 (5 [3–6]) and < 14 (4 [2–6]), p = .008 and .001 respectively. At five minutes, neonates of SA patients had median scores of 10 [9–10], compared with 8 [7–8] in those of GA patients with GCS ≥ 14, and 8 [7–9] in those with GCS < 14, p = .007 and .019 respectively. There were two stillbirths and two neonatal deaths in the GA group. Patients with GCS ≥ 14 receiving GA required mechanical ventilation for 0 [0–1] days, and those with GCS < 14 were ventilated for 1 [1–2] days. No patients receiving SA required postoperative ventilation, compared with 5/19 (26.3%) patients with GCS ≥ 14 who received GA. Seven/63 patients with GCS < 14 had cerebral oedema, and two had a cerebral infarct. There were two maternal deaths. Conclusions: The small percentage of women with eclampsia who received SA for CS, experienced good maternal and fetal outcomes, and more patients could have safely received SA. Larger prospective audits in high- and low-resource environments are required to establish factors influencing the context-sensitive choice of method of anaesthesia, and risk versus benefit of GA versus SA for CS in women with eclampsia.

Low dose spinal anaesthesia for caesarean section in parturients having pregnancy induced hypertension: Effect on haemodynamicre sponse and vasopressor requirement: A prospective randomized double blind case control study

Currently, the safety of spinal anaesthetic techniques is well established for caesarean section in pregnancy induced hypertension (PIH) patient. Addition of fentanyl to local anaesthetic allows achievement of adequate anaesthesia with lower dose of local anaesthetic in spinal anaesthesia, thereby reducing the occurence of hypotension and need for vasopressor. A prospective, randomized, double blind, case control study was carried out in 80 parturients having PIH undergoing caesarean section in spinal anaesthesia were randomized into 2 groups depending on intrathecal drug received by them as Group C (Conventional dose group- received hyperbaric bupivacaine 10 mg)and Group L{low dose group, hyperbaric bupivacaine (7.5 mg) with fentanyl (25 mcg)} and compared regarding sensory- motor block characteristics, incidence of hypotension (fall in MAP > 25% from baseline) vasopressor requirement Phenylephrine and Ephedrine. Patient in Group L had significantly less number of hypotension episodes as compared to Group C(20 vs 31, p= 0.011). Hence vasopressor requirement was also significantly less in Group L than in Group C [Phenylephrine (1600 mcg vs 2500 mcg, p=0.044), Ephedrine (66 mg vs 18 mg, p= 0.030)].Low dose spinal anaesthesia using 7.5 mg hyperbaric bupivacaine with 25 mcg fentanyl seems to be superior alternative to conventional dose of 10 mg hyperbaric bupivacaine for caesarean section in parturients having pregnancy induced hypertension, because it was associated with better hemodynamic stability, reduced vasopressor requirement.

A case report of Caesarean section in parturient with kyphoscoliosis under spinal and epidural anaesthesia

A case report of Caesarean section in parturient with kyphoscoliosis under spinal and epidural anaesthesia

Comparison of injection ondansetron with granisetron on maternal haemodynamics and regression of sensory and motor blockade in elective caesarean section: A randomised non inferiority exploratory trial

Introduction: Spinal anesthesia has many advantages for cesarean section in parturients, but hypotension is considered the most frequent complication and can be managed by different interventions. Hypotension may be induced by sympathetic blockade and Bezold-Jarisch reflex (mediated by peripheral serotonin receptor, 5-HT3 type). Besides, early regression of sensory and motor blockade are also necessary to prevent various complication. It has been found that level of serotonin is increased in cerebrospinal fluid after spinal anaesthesia. So use of 5HT 3 anatagonist can have effect on both. Objectives: To compare between two serotonin receptor antagonists on the hemodynamics, sensory, and motor blockade induced by intrathecal bupivacaine in parturients undergoing cesarean section. Materials and Methods: Fourty four patients undergoing elective cesarean section under spinal anesthesia by intrathecal bupivacaine were randomly divided into two groups (22 pregnant females of ASA I–II physical status in each group). Group O received intravenous 8 mg ondansetron diluted in 8 ml normal saline and injected 5 min before spinal anesthesia, group G given intravenous 1 mg granisetron in 8 ml normal saline by the same route. Mean arterial blood pressure, heart rate, vasopressor use, sensory and motor blockade were assessed. Results: use of vasopressors was significantly low in group O (p Conclusion: In parturient females undergoing elective cesarean section, intravenous 8 mg ondansetron significantly reduces the demand of vasopressors and ganisetron 1 mg provides faster recovery from sensory and motor blockade. Keywords: Ondansetron, Granisetron, Haemodynamics, Sensory and motor blockade.

Successful use of extracorporeal membrane oxygenation during cesarean section in parturients with symptomatic severe pulmonary stenosis: a case report

Successful use of extracorporeal membrane oxygenation during cesarean section in parturients with symptomatic severe pulmonary stenosis: a case report

Anesthesia for Cesarean Section in Parturients with Abnormal Placentation: A Retrospective Study.

IntroductionPlacental invasion anomalies are associated with high mortality and may require hysterectomy due to the high risk of massive hemorrhage. The aim of this retrospective study was to evaluate intraoperative anesthetic management, postoperative follow-up, clinical features, and fetal wellbeing in patients undergoing cesarean section due to placental invasion anomalies in a tertiary health center.MethodsThe retrospective study included patients that underwent cesarean section due to placental invasion anomalies at a tertiary health center over the period between 2013 and 2018. Intraoperative anesthetic management, blood and blood products transfusion, and total volume of blood loss, as well as neonatal Apgar score and postoperative intensive care unit (ICU) follow-up, were reviewed for each patient.ResultsThe study evaluated a total of 92 patients that underwent cesarean section due to placental invasion anomalies, including 49 patients with placenta previa, 42 patients with placenta percreta, and one patient with placenta accreta. Of the 92 patients, 59 (64.1%) patients underwent general anesthesia, 31 (33.7%) underwent spinal anesthesia, and two (2.2%) underwent spinal anesthesia followed by general anesthesia. Hysterectomy was performed in four patients, including three patients who underwent general anesthesia and one patient who started with spinal anesthesia and subsequently switched to general anesthesia prior to a hysterectomy. The Apgar scores at min 1 and min 5 after the induction of anesthesia were significantly lower in patients who underwent general anesthesia as compared to those who underwent spinal anesthesia (p=0.002 and p=0.007, respectively). The duration of surgery and intraoperative blood loss were significantly higher in patients with placenta percreta as compared to other patients (p<0.001 for both).ConclusionIn surgical planning for the patients with placental invasion anomalies, care should be taken by anesthesiologists to select the most ideal anesthetic technique, by taking into account the type of anomaly, probable volume of blood loss, and surgical complications, to ensure both maternal and fetal wellbeing. Moreover, the coordination of a team of well-educated and experienced staff is essential.

Effect of anesthesia factor on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension

Objective To compare the effects of general anesthesia and spinal anesthesia on prognosis of cesarean section in parturients with medium and severe pulmonary arterial hypertension (PAH). Methods Parturients with medium and severe PAH, at ≥24 weeks of gestation, aged 20-45 yr, undergoing elective cesarean section under general or epidural anesthesia from November 1, 2011 to December 31, 2017 in our hospital, were divided into general anesthesia group and epidural anesthesia group according to the anesthetic method. General anesthesia was combined intravenous-inhalational anesthesia. The highest temperature within 5 days after surgery, the lowest SpO2 (inhaling oxygen 2-4 L/min via a nasal tube) within 3 days after surgery, duration of intensive care unit stay, time of postoperative use of antibiotics, requirement for targeted drugs for pulmonary hypertension, results of laboratory tests (blood biochemistry, coagulation function), postoperative mechanical ventilation, length of hospital stay, and hospitalization costs were recorded. The Apgar score and weight of the newborn, postoperative complications and death of the newborn and parturients in hospital were recorded. Cox regression analysis was used to identify the risk factors after cesarean section in parturients with medium and severe PAH. Results Fifty-seven parturients were enrolled in this study, with 21 cases in general anesthesia group and 36 cases in epidural anesthesia group. Compared with general anesthesia group, the rate of postoperative mechanical ventilation was significantly decreased, the incidence of adverse events of parturients in hospital and mortality rate were decreased, the postoperative level of albumin was increased, activated partial thromboplastin time was shortened (P 0.05). The results of Cox regression analysis showed that anesthetic method and preoperative SpO2 difference were independent risk factors for cesarean section-related adverse events and death of parturients with medium and severe PAH. The risk of adverse events and death of parturients was significantly higher in general anesthesia group than in epidural anesthesia group (P<0.05). Conclusion Epidural anesthesia produces better prognosis than general anesthesia when used for cesarean section in parturients with moderate and severe PAH. Key words: Hypertension, pulmonary; Anesthesia; Cesarean section; Prognosis

Anesthetic management of cesarean section in parturients with severe mitral stenosis: A case series

Mitral stenosis (MS) is the most common valvular heart disease associated with pregnancy. The increase in cardiac output during pregnancy results in deterioration of the patient's condition with progress to higher New York Heart Association class. Both general and regional anesthesias have been described for cesarean section in these patients. Anesthetic management of these patients depends upon the severity of the disease. General anesthesia has traditionally been preferred for cesarean section in patients with severe MS. Regional anesthesia has become popular as a safe choice in the recent past for cesarean section in all parturients including those with heart disease. We report three parturients with severe MS who underwent cesarean delivery under graded epidural block successfully. The parturients and the neonates were fine after the procedure.

ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine

Background:Studies have reported that the ED50 of intrathecal ropivacaine was increased when using prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. However, ED95 is more meaningful to clinical practice than ED50. Therefore, we conducted this study to determine the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine for cesarean section in parturients receiving prophylactic infusion of phenylephrine to prevent spinal-induced hypotension.Methods:A hundred of healthy parturients undergoing elective cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled in this randomized, double-blinded, dose-ranging study. Patients were randomly assigned to receive 7, 9, 11, 13 or 15 mg intrathecal hyperbaric ropivacaine respectively. The prophylactic phenylephrine infusion (50 μg/min) was initiated immediately at the same time of spinal injection. Successful spinal anesthesia was defined as a T5 sensory level achieved within 10 min after intrathecal drug administration and no epidural supplement was required during the surgery. The ED95 was calculated with Probit analysis.Results:The ED95 of intrathecal ropivacaine with 5 μg sufentanil for successful anesthesia was 15.2 mg (95%CI, 13.5–18.8 mg), when receiving prophylactic infusion of phenylephrine.Conclusion:Under the conditions of the present study, the ED95 of intrathecal hyperbaric ropivacaine for successful spinal anesthesia for cesarean section in healthy parturient receiving prophylactic infusion of phenylephrine was 15.2 mg.

"Anesthetic Managements of Cesarean Section in Parturient Diagnosed with Placenta Previa, Retrospective Analysis of 240 Consecutive Cases in Aswan University Hospital Cross Sectional Study"

"Anesthetic Managements of Cesarean Section in Parturient Diagnosed with Placenta Previa, Retrospective Analysis of 240 Consecutive Cases in Aswan University Hospital Cross Sectional Study"

"Anesthetic Managements of Cesarean Section in Parturient Diagnosed with Placenta Previa, Retrospective Analysis of 240 Consecutive Cases in Aswan University Hospital Cross Sectional Study"

"Anesthetic Managements of Cesarean Section in Parturient Diagnosed with Placenta Previa, Retrospective Analysis of 240 Consecutive Cases in Aswan University Hospital Cross Sectional Study"

A case report of emergency cesarean section in parturient with kyphoscoliosis

Anesthesia for emergency cesarean section for the pregnancy with kyphoscoliosis is associated with potential risks for both mother and fetus due to alterations in maternal physiology and the pathological changes seen in kyphoscoliosis. The anesthetic management must include the well-being of both mother and fetus. The need of anesthesia for delivery in pregnant women with kyphoscoliosis is more than the normal parturient. We report the case of a 23-year-old female, full-term primigravida with kyphoscoliosis who was posted for emergency caesarean section. The anesthetic management of this patient is presented here.

Epidural Anaesthesia a Safe Option for Caesarean Section in Parturient with Severe Pulmonary Hypertension - ACase Report

Epidural Anaesthesia a Safe Option for Caesarean Section in Parturient with Severe Pulmonary Hypertension - ACase Report

Epidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension

Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease.

Emergency mitral valve replacement and cesarean section in parturients: Two case reports

Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR) of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR) after percutaneous transluminal mitral commissurotomy (PTMC) due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR) followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

Abstract Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P &lt; 0.05 was considered significant. Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P &lt; 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate &gt;125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P &lt; 0.001. Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.

Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P 125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe. Keywords: Cesarean delivery, choice of anesthesia, complication, neuraxial anesthesia, placenta previa, spinal anesthesia