Ephedrine Requirements Research Articles

Does Preoperative Coffee Consumption Prevent Intraoperative Hypotension in Cesarean Section Surgeries?

In this study, we evaluated the effects of a cup of coffee given to patients before surgery in a cesarean section by means of intraoperative hypotension, ephedrine requirement, and the incidence of post-dural puncture headache (PDPH). A total of 140 patients undergoing elective cesarean sectionwith spinal anesthesia were included in this study. Participants who drank a single cup of filtered coffee two hours before spinal anesthesia were included in the coffee group, and those who drank water were in the control group. In each group, 70 patients were included. Hemodynamic parameters were recorded every three to five minutes after spinal anesthesia. Intraoperative use of ephedrine was recorded. The PDPH was monitored for three days. The incidence of intraoperative hypotension was 48.6% in the coffee group and 71.4% in the control group (p = 0.006). The rate of ephedrine usage (25.7%) was significantly lower in the coffee group (p = 0.001). The incidence of PDPH in the first 24 hours (2.9%) was significantly lower in the coffee group (11.4%). The visual analog scale (VAS) score was similar between groups (p = 0.048, p > 0.05). Consumption of a single cup of coffee before spinal anesthesia reduced the incidence of intraoperative hypotension and the rate of ephedrine usage in cesarean sections.

Risk factors of more severe hypotension after spinal anesthesia for cesarean section.

The aim of this study was to examine the risk factors associated with the use of vasopressors to prevent hypotension that occurs after spinal anesthesia during cesarean section. Although the prophylactic use of vasopressors is already suggested as routine care in many parts of the world, the occurrence of spinal anesthesia-induced hypotension (SAIH) is still common in parturients. This retrospective study included parturients receiving elective cesarean deliveries under spinal anesthesia from April 2016 to March 2020. Risk factors related to ephedrine dosage were analyzed using a hurdle model, and risk factors related to SAIH were further analyzed with logistic regression. Five risk factors, namely maternal body mass index (BMI, p < 0.001), baseline systolic blood pressure (SBP, p < 0.001), baseline heart rate (HR, p = 0.047), multiparity ( p = 0.003), and large fetal weight ( p = 0.005) were significantly associated with the requirement for ephedrine. Furthermore, a higher ephedrine dosage was significantly associated with maternal BMI ( p < 0.001), baseline SBP ( p < 0.001), baseline HR ( p < 0.001), multiparity ( p = 0.027), large fetal weight ( p = 0.030), maternal age ( p = 0.009), and twin pregnancies ( p < 0.001). Logistic regression analysis also showed that the same five risk factors-maternal BMI ( p = 0.030), baseline SBP ( p < 0.001), baseline HR ( p < 0.001), multiparity ( p < 0.001), and large fetal weight ( p < 0.001)-were significantly associated with SAIH, even in cases where vasopressors were administered. These findings can be useful for clinicians when deciding the dose of prophylactic ephedrine or phenylephrine to prevent SAIH.

Effect of sitting time on the vasopressor requirement in elderly patients after spinal anesthesia: A randomized controlled study

ABSTRACT Background Neuraxial anesthesia appears to be a highly recommended, well-accepted technique for minimizing perioperative adverse effects in elderly patients. This research was designed to compare the impact of sitting for one, three, and 5 min on ephedrine consumption following spinal anesthesia in the elderly. Methods This randomized, controlled, double-blinded trial was conducted on 66 patients above 65 years undergoing surgeries under spinal anesthesia. Patients were randomly assigned to three equal groups. Patients received spinal anesthesia and then sat before they began to lie down for 1 min in the sitting-1 group, 3 min in the sitting-3 group, and 5 min in the sitting-5 group. Results The most reduction of mean arterial blood pressure (MAP) is in the Sitting-1 group, followed by the Sitting-3 group, and finally, the Sitting-5 group (p < 0.05). The most needed ephedrine was in the sitting-1 group (10 patients), followed by the sitting-3 (6 patients) and then the sitting-5 group (one patient) (p < 0.05). The sensory level was significantly higher in the sitting-1 group, followed by the sitting-3 and then sitting-5 group (p < 0.001). Conclusions Sitting for 5 min after spinal anesthesia in elderly patients decreases the ephedrine requirement and maintains adequate sensory block for surgery.

Potential differences in ephedrine requirements between left lateral and right lateral decubitus positions during neuraxial anesthesia for cesarean delivery.

The recent article by Wen et al., published in PLOS ONE, titled "Effects of neuraxial anesthesia in sitting and lateral positions on maternal hemodynamics in cesarean section: A systematic review and meta-analysis," caught my attention. In their study, the authors observed the effects of neuraxial anesthesia in sitting and lateral positions on maternal hemodynamics during cesarean section. Given the anatomical differences between the left and right sides of the body, which could result in differences in maternal hemodynamics and vasopressor requirements during neuraxial anesthesia for cesarean delivery, I was intrigued by the idea of further dividing the lateral position data from Wen et al.'s study into three subgroups: "left lateral position," "right lateral position," and "not mentioned" (where the included original study did not mention the lateral position) for a subgroup analysis. It seems to be more rigorous, the subgroup analysis revealed that the usage rate of ephedrine support was 1.42 times higher for parturients in the right lateral position compared to those in the sitting position. This finding supports our recommendation to distinguish between left and right lateral decubitus positioning in neuraxial anesthesia for cesarean delivery. But in contrast, no significant difference was observed between the sitting and lateral positions in terms of the number of parturients requiring ephedrine in Wen et al.'s. Given the limited research on the right-lateral position and its hemodynamic effects, further studies are needed to explore its clinical applications. Future research should also focus on conducting larger trials with greater sample sizes to evaluate the long-term neonatal outcomes associated with varying maternal positions. Additionally, researchers should conduct subgroup analyses that separate the left- and right-lateral positions to provide clearer guidance for anesthesiologists.

The preventive effect of 5-hydroxytryptamine-3 receptor antagonist on blood pressure reduction and postoperative nausea and vomiting during general anesthesia induction: A double-blinded, randomized controlled trial

Study objectiveAdministering a 5-hydroxytryptamine-3 receptor (5-HT3) at anesthesia induction may aid in achieving hemodynamic stability during general anesthesia induced using opioids. Therefore, we aimed to evaluate the effect of ramosetron, a 5-HT3 antagonist, administered on hypotension at the induction of total intravenous anesthesia (TIVA) with propofol and remifentanil. Additionally, we aimed to compare the impact of ramosetron administration at anesthesia induction versus that at the end of the surgery on postoperative nausea and vomiting (PONV). DesignPatients were randomly allocated to the Induction group (administration of ramosetron [0.3 mg/5 ml] at anesthesia induction and normal saline [5 ml] at the end of the surgery) or End group (administration of normal saline [5 ml] at anesthesia induction and ramosetron [0.3 mg/5 ml] at the end of the surgery). Hemodynamic status, PONV, and postoperative pain were assessed. SettingOperating room, post-anesthetic care unit, and general ward. Patients: In total, 176 non-smoking patients without any past medical history undergoing laparoscopic gynecological surgeries under TIVA were included in the study. MeasurementsBlood pressure (BP), heart rate, PONV, visual analog scale (VAS). Main resultsThe Induction group exhibited significantly higher BP at anesthesia induction and required significantly lower doses of phenylephrine and ephedrine during anesthesia than the End group had. However, PONV and postoperative pain were similar between the two groups. ConclusionsAdministering ramosetron at anesthesia induction resulted in significantly better hemodynamic stability with significantly lesser requirement of phenylephrine and ephedrine than administering at the end of the surgery did. Therefore, we recommend ramosetron administration at anesthesia induction rather than at the end of the surgery to prevent PONV and the decrease in the mean BP during TIVA with propofol and remifentanil.

The effect of intravenous granisetron on prophylactic ephedrine for preventing hypotension after general anaesthesia induction in elderly patients: a randomized controlled trial

Serotonin 3 receptor antagonists, a commonly used drug for preventing postoperative nausea and vomiting, have recently been reported to decrease the incidence of hypotension and the need for vasoactive drugs after spinal anaesthesia in obstetric surgery. However, it remains unknown whether they could also prevent hypotension after induction of general anaesthesia. In the current study, we aimed to investigate the effect of intravenous granisetron on prophylactic ephedrine for preventing hypotension after general anaesthesia induction in elderly patients. Sixty elderly patients were randomly assigned to receive granisetron or saline control 30 min before induction of general anaesthesia. The first patient in each group received a prophylactic dose of ephedrine (0.15 mg kg−1) to prevent hypotension. The prophylactic dose for each patient was increased or decreased by 0.05 mg/kg based on the efficacy results of the previous patient. The up-down sequential allocation analysis and probit regression was used to calculate the effective dose for 50% of patients (ED50) with prophylactic ephedrine. In the up-down sequential allocation analysis, the ED50 of ephedrine was significantly lower in group granisetron (0.08 mg kg−1 [95% CI, 0.06–0.11 mg kg−1]) when compared with group control (0.14 mg kg−1 [95% CI, 0.13–0.16 mg kg−1]) (P < 0.001). The conclusion was further supported by probit regression analysis (0.09 mg kg−1 [95% CI, 0.05–0.12 mg kg−1] in group granisetron and 0.14 mg kg−1 [95% CI, 0.12–0.16 mg kg−1] in group control). Intravenous granisetron reduced the requirement of prophylactic ephedrine in preventing hypotension after general anaesthesia induction in elderly patients.

Influence of maternal position during combined spinal-epidural anesthesia for labor analgesia on technical difficulties and complications.

Generally, combined spinal-epidural anesthesia (CSEA) for labor analgesia is performed in the lateral or sitting position; however, only few studies have investigated the effect of maternal position on labor analgesia induction. We aimed to retrospectively assess the influence of maternal position on induction time and complications. We retrospectively analyzed anesthetic and medical records regarding labor analgesia in 201 parturients treated between January 2019 and November 2019. Patients were classified into 2 groups based on their position (sitting or lateral) during induction. The primary outcome was the time required for CSEA induction. We compared 2 groups on the primary outcome and the occurrences of other complications during CSEA induction using hyperbaric bupivacaine. Moreover, we performed multiple linear regression analysis to identify independent factors associated with induction time. There was no significant between-group difference in the time required for induction. Multiple linear regression analysis revealed an independent association of the distance from the skin to the epidural space with the time required for induction. The lateral group had a significantly higher incidence of paresthesia than the sitting group (P = 0.028). The lateral group had a significantly higher ephedrine requirement (P < 0.001) than the sitting group. Maternal position was not associated with the time required for CSEA induction. However, the sitting group had a lower paresthesia occurrence and ephedrine requirement than the lateral group. Other technical complications were not associated with maternal position during CSEA induction.

The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial

BackgroundThis study aimed to compare three epinephrine doses for the prevention of spinal hypotension during Caesarean delivery. MethodsThis randomized controlled trial included full-term pregnant women undergoing elective Caesarean delivery under spinal anesthesia. The participants received prophylactic epinephrine infusions at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Spinal hypotension (systolic blood pressure <80% of baseline) was managed with a 9-mg ephedrine bolus. The primary outcome was the incidence of spinal hypotension. Secondary outcomes included total ephedrine requirement, the incidence of severe spinal hypotension, excessive tachycardia and hypertension, and neonatal outcomes. ResultsThe final analysis included 271 patients. The incidence of hypotension was lowest in the 0.03 mcg group (11/90 [12%]), followed by the 0.02 mcg (32/91 [35%]) and the 0.01 mcg (55/90 [61%]) groups (p < 0.001). The median ephedrine requirements (quartiles) were also the lowest in the 0.03 mcg group (0 [0−0] mg), followed by the 0.02 mcg (0 [0–9] mg) and the 0.01 mcg (9 [0–18] mg) groups. The incidence of severe hypotension was lower in the 0.03 mcg and 0.02 mcg groups than in the 0.01 mcg group (3/90 [3%], 5/91 [6%], and 15/90 [17%], respectively). The incidences of excessive tachycardia, hypertension, and neonatal outcomes were comparable among the groups. ConclusionThe use of epinephrine to prevent spinal hypotension during Caesarean delivery is feasible and effective. An initial dose of 0.03 mcg/kg/min produced the lowest incidence of hypotension compared to 0.02 mcg/kg/min and 0.01 mcg/kg/min doses. The three doses were comparable in terms of the incidence of tachycardia, hypertension, and neonatal outcomes. Study registrationClinicalTrials.gov Identifier: NCT05279703.

The relationship between abdominal circumference-to-hip ratio and ephedrine requirement in spinal anesthesia for elective cesarean: A prospective observational study Running title: AC-to-hip ratio and ephedrine requirement

Objective: Maternal hypotension caused by extensive sympathetic blockade is a serious complication of spinal anesthesia during cesarean section. This study planned to determine the relationship between weight, height, BMI, abdominal circumference (AC), hip circumference (HC), and AC-to-hip ratio with the ephedrine consumption in patients who underwent cesarean section with subarachnoid block. Materials and Methods: The study population comprised 60 women. Prior to spinal anesthesia; patients' demographic characteristics (age, weight, height), abdominal and hip circumferences, basal hemodynamic parameters, and ASA physical status were recorded. To minimize errors, three consecutive measurements were obtained; results were averaged and the AC-to-hip ratio was calculated by dividing the values of the abdominal (cm) and hip circumference (cm). In all patients, spinal anesthesia was done in the sitting position using 2.4 ml 0.5% hyperbaric bupivacaine (12 mg). Persistent hypotension was treated with intravenous ephedrine (5 mg). The number of patients who used ephedrine and the total amount of ephedrine used during surgery were recorded. Results: Of these 60 participants, 40 (66.6%) patients had hypotension requiring ephedrine administration. There is a positive correlation between ephedrine consumption (mg) and abdominal circumferences (r=0.280, p=0.03). Also, there is a significant positive correlation between ephedrine consumption (mg) and AC-to-hip ratio (r=0.608, p&lt;0.001). The correlation coefficient between the ephedrine dose with the AC-to-hip ratio was 56.805, the p-value was &lt;0.001 and AC was 0.211, with a p-value of 0.030 which means the correlation was statistically significant. Conclusion: Abdominal circumference and AC-to-hip ratio have a significant correlation with ephedrine consumption in patients who underwent cesarean section via subarachnoid block with a given dose of 2.4 ml 0.5% hyperbaric bupivacaine.

Baseline Heart Rate as a Predictor of Post-Spinal Hypotension in Patients Undergoing a Caesarean Section

Background: Although spinal anesthesia is generally well tolerated, hypotension is a common adverse effectof subarachnoid block in some patients. In pregnant women, it was demonstrated that sympathetic activity isincreased as compared with that of not pregnant women.Aim of study: To determine whether preoperative heart rate is a predictor for post spinal hypotension or not inobstetric patients.Methods: A prospective trial study that was conducted in the Obstetrics operating room at Al-Imamain Al-Kadhmain and Baghdad Teaching Hospitals, Baghdad, Iraq for a period of 12 months from Nov. 2019 to Nov.2020. It involved 100 healthy full term pregnant women scheduled for elective C/S under spinal anesthesia.Baseline systolic, diastolic, mean arterial pressure, and heart rate were recorded. Blood pressure was monitoredwith an automated cuff blood pressure monitor at three-minute intervals until 30 minutes then every five minutes.Results: In this study, 55% of study patients complained from hypotension after spinal anesthesia. mean ofbaseline HR was significantly higher in patients who developed post spinal hypotension than that in those whodidn’t. The cut point of baseline HR was 92 beats/mint., so baseline HR &gt; 92 beats/mint. is predictive for postspinal hypotension. Requirement of ephedrine was significantly higher in hypotensive patients who had baselineHR &gt; 92 than that in those who had baseline HR ≤ 92.Conclusion: Preoperative heart is a good predictor for post spinal hypotension in pregnant women underwentcesarean section under spinal c anesthesia.

Efficacy of Variable Doses of Prophylactic Intravenous Ondansetron in Attenuating Spinal Induced Hypotension in Parturients Undergoing Caesarean Delivery: A Randomised Control Trial.

IntroductionSpinal anaesthesia is frequently associated with adverse effects like maternal hypotension and bradycardia. This effect is due to a decrease in systemic vascular resistance, a decrease in central venous pressure or Bezold-Jarisch Reflex (mediated by 5-HT3 receptors). We aimed to measure the effect of three different doses of prophylactic intravenous ondansetron (5-HT3 antagonists) with a placebo on maternal haemodynamics.MethodsA prospective randomised control study was done over 240 parturients, aged 19-35 years. They were randomly allocated into four groups (n=60) Group O4, Group O6, Group O8 and Group S to receive either intravenous ondansetron 4 mg, 6 mg, 8 mg or 0.9% normal saline respectively. Haemodynamic variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], heart rate [HR]) were recorded at 2-minute intervals for the first 20 minutes and at 5-minute intervals for further 30 minutes.ResultsA significant decrease in haemodynamic parameters was observed in group S when compared with ondansetron groups at various time intervals (p<0.05). The difference was most significant in groups O6 and O8. Development of nausea and vomiting was significantly higher in Group S compared to ondansetron groups (p< 0.005). The requirement for ephedrine was more in Group S in comparison to ondansetron groups (p<0.0001).ConclusionAll three groups of ondansetron showed a decrease in the incidence of hypotension and use of vasopressor but Group O6 and O8 were more effective in attenuating spinal-induced hypotension in parturients undergoing caesarean section.

A Comparison of the Injection Rate of Local Anesthetic during Spinal Anesthesia on the Onset of Sensory Block and Incidence of Hypotension in Caesarean Section

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

Efficacy of Clonidine as an Adjuvant to Ropivacaine in Transversus Abdominis Plane Block in Adult Renal Transplant Recipients: A Double-blinded Randomized Controlled Trial.

Transversus abdominis plane (TAP) block has been used to provide analgesia in renal transplant surgery with varying results. This study was designed to assess if the addition of clonidine in TAP block would decrease 24-h postoperative morphine consumption in adult renal transplant recipients. Forty adult patients undergoing renal transplantation under general anesthesia in a tertiary care hospital were randomized into either group RC (TAP block with 20 mL of 0.5% ropivacaine plus 2 μg.kg-1 clonidine) or group R (TAP block with 20 mL 0.5% ropivacaine) after induction of anesthesia. Postoperative analgesia was provided using patient-controlled morphine. The primary outcome was 24-h patient-controlled morphine consumption. The secondary outcomes were a) intraoperative hemodynamics, b) fentanyl and ephedrine requirement, c) postoperative pain using the Visual Analog Scale at 0, 2, 6, 12 and 24 hours, d) time to first postoperative analgesia, e) postoperative hemodynamics, and f) side effects. There was no significant difference in postoperative morphine consumption between the groups (25 mg in group RC vs. 28.5 mg in group R) (median interquartile range) (P = 0.439). Postoperative pain scores were comparable between the groups. Intraoperatively, fewer patients required rescue fentanyl in group RC (7 patients) as compared to group R (17 patients) (P = 0.003). Significantly more patients in group RC required ephedrine boluses as compared to group R (9 patients in group RC vs. 2 in group R, P = 0.014). The addition of 2 μg.kg-1 clonidine to ropivacaine in TAP block did not reduce 24-h postoperative morphine consumption after renal transplantation. It reduced the need for intraoperative analgesics but increased the need for intraoperative ephedrine administration.

Crystalloid preload versus crystalloid co-load for hypotension in parturients undergoing caesarean section under spinal anaesthesia

Abstract Though hypotension is a common complication after spinal anaesthesia, preloading with crystalloids may not be able to prevent it. We aimed to compare the efficacy of crystalloid preload and co-load for the prevention of maternal hypotension in parturients undergoing caesarean section under spinal anaesthesia. Seventy parturients, aged 20 to 40 years of American Society of Anaesthesiologist (ASA) physical status 1/II, scheduled for caesarean section under spinal anaesthesia were divided into two groups. Parturients in group P received 15 ml/kg of ringer's lactate as preload over 20 min before the intrathecal drug administration. Parturients in group C received 15 ml/kg of ringer's lactate over 20 min, just after intrathecal drug administration. Incidence of hypotension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, the requirement of ephedrine, and any complications was recorded. 25 (71%) parturients in group P and 15 (42%) parturients in group C developed statistically significant hypotension. 21 (59%) parturients developed nausea and vomiting in group P as compared to 9 (25%) parturients in group C which were statistically significant. The mean number of doses of ephedrine required in group P was 1.8±0.6 and 0.9±0.7 in group C which was statistically significant. The total dose of ephedrine used in group P was 9.6±3.4mg and 5.9± 2.1mg in group C which was statistically significant. Co-loading with 15 ml/ kg of crystalloid-like ringer's lactate was more effective than preloading in preventing spinal-induced maternal hypotension, thereby reducing ephedrine requirement and avoiding complications. Keywords: Anaesthesia, Co-load, Hypotension, Preload, Spinal, Caesarean section.

THE EFFECT OF ONDANSETRON ADMINISTRATION 20 MINUTES PRIOR TO SPINALANAESTHESIA ON HAEMODYNAMIC STATUS IN PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION: COMPARISON BETWEEN TWO DIFFERENT DOSES

Background: Risks involved in general anaesthesia has made spinal anaesthesia the standard anaesthetic technique for caesarean section. Spinal anaesthesia has its own side effects that may affect the mother and the unborn child's wellbeing. Ondansetron is a 5-HTreceptors antagonist, basically used as an antiemetic drug and is thought to counteract bradycardia and hypotension induced by spinal block. The primary aim of the study was to assess systolic blood pressure (SBP), diastolic blood pressure (DBP), and the mean arterial pressure (MAP) among different ondansetron doses and a control group in different time intervals. Methods:Aprospective, double-blinded, placebo- controlled, randomized clinical trial was conducted during a period of 6 months on a total of 90 patients, scheduled to undergo elective caesarean delivery under spinal anesthesia, in SMGS Hospital, Jammu. All patients with ASAI and II parturient, who were included in the study. Results: Number of patients with hypotension, was not signicantly different between the study groups. Total number of hypotensive episodes showed signicant difference and was lower in Group 2. (p=0.044) Patients of group 1 had increased frequency of administration of mephtermine in response to fall in blood pressure.In Ondansetron group, there was a dose dependant decrease in ephedrine requirement. Conclusion: Administering ondansetron (6 mg) 20 minutes before spinal block can raise the hope of increasing the efcacy of Spinal anesthesia. It may not cause reduction in the incidence of hypotension in caesarean section under spinal block, but can signicantly decrease the consumption of adrenergic agonists.

Effect of prophylactic combination of glycopyrrolate, ondansetron, and ephedrine upon hypotension during obstetric spinal anaesthesia-A randomised controlled trial.

Background and Aims:Various pharmacological and non-pharmacological strategies have been employed to minimise hypotension during obstetric spinal anaesthesia. We compared a prophylactic combination of glycopyrrolate, ondansetron, and ephedrine in terms of total vasopressor consumption, with standard treatment in this randomised controlled trial.Methods:One hundred patients undergoing elective caeserean sections were randomly divided into two groups of 50 each, the study group received prophylactic ondansetron and glycopyrrolate boluses followed by an infusion of ephedrine, while the control group received ephedrine boluses as required. The total ephedrine consumption (primary objective), incidence and degree of hypotension, heart rate variations, and neonatal APGAR scores (secondary objectives) were analysed.Results:The median ephedrine requirement was lesser in the study group compared to the control group [13.2 mg (10--15.75) vs. 27.7 mg (12--24)], with a P value of 0.02. Fewer participants experienced hypotension in the study group before baby delivery compared to the control group (12 vs. 36, P = 0.004). Heart rate was higher in the study group. No significant differences were observed in neonatal APGAR scores and incidence of adverse events.Conclusion:A combination of glycopyrrolate, ondansetron, and ephedrine might offer better haemodynamic stability and reduce vasopressor consumption in obstetric patients undergoing spinal anaesthesia as opposed to standard treatment.

A Comparative Study of Analgesic Efficacy of Intrathecal Bupivacaine with Ketamine Versus Bupivacaine with Magnesium Sulphate in Parturients Undergoing Elective Caesarian Sections.

Background and Aims:Spinal anaesthesia is the most preferred technique of anaesthesia in parturient, undergoing lower segment caesarean sections (LSCS) which provides effective pain relief during intra operative and early postoperative period. However, recent studies demonstrate that about 50%–70% of patients experience moderate to severe pain after LSCS indicating that postoperative pain remains poorly managed. The aim of our study was to compare intrathecal magnesium sulphate (Mgso4) and ketamine as adjuvants to hyperbaric bupivacaine in parturients posted for elective caesarean sections under spinal anaesthesia to determine their effectiveness in extending the duration of analgesiaMaterials and Methods:After institutional ethical committee approval, 82 parturient undergoing elective LSCS were enrolled into the prospective randomized double blinded study. Group BK (n = 41) received intrathecal ketamine (25 mg) as additive to hyperbaric bupivacaine and group BM (n = 41) received magnesium sulphate (75 mg) as additive to hyperbaric bupivacaine. Time of onset of sensory analgesia, motor blockade, duration of analgesia was noted down. Intraoperative hemodynamics and any adverse effects of study drugs were noted.Results:The mean duration of analgesia in group BK was significantly longer (P < 0.05) than in Group BM. The onset of sensory and motor blockade was significantly early in Group BK compared to Group BM. Hemodynamics was better maintained in Group BK with less requirement of ephedrine compared to Group BM. The visual analog scale scores were significantly lower without side effects in both the groups.Conclusion:The present study demonstrated that the duration, quality of analgesia, hemodynamic stability was better with intra thecal ketamine as an adjuvant to bupivacaine compared to intrathecal MgSo4 without any significant side effects on mother and child.

Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial

Study objectiveThis study aimed to compare the effects of high doses of ondansetron and granisetron before spinal anesthesia on hemodynamic parameters in patients undergoing elective cesarean section. DesignA double-blinded randomized placebo-controlled trial. SettingOperating room. PatientsA total of 120 parturients with term pregnancy undergoing elective cesarean section with combined spinal-epidural anesthesia were included. InterventionsThree groups (n = 40 for each group) were formed by randomization. Five minutes before the anesthesia procedure, Group I received 8 mg intravenous (IV) ondansetron diluted in 10 ml normal saline, Group II received IV 3 mg granisetron diluted in 10 ml normal saline, and Group III received IV 10 ml normal saline. MeasurementsFollowing intrathecal drug administration, intraoperative hemodynamic changes were recorded every 2 min for 20 min and then every 5 min until the end of the operation. Main resultsTwenty patients (50%) in Group I, 12 patients (30%) in Group II, and 29 patients (72.5%) in Group III had hypotension requiring treatment with IV ephedrine (P = 0.001). The ephedrine requirement in Group III was significantly higher than in Groups I (P = 0.033) and II (P < 0.001). Also, the ephedrine requirement in Group II was lower than in Group I, but the difference was not statistically significant (P = 0.055). The mean arterial pressure for the three groups differed in the 10th, 18th, and 60th minutes. The number of patients with nausea or vomiting was lower in Groups I and II than in Group III (P < 0.001). At 5 min, the Apgar scores were higher than 8 for all neonates. Postoperative scores for the visual analogue scale were similar for all groups. ConclusionsIt was concluded that prophylactic IV administration of 3 mg of granisetron or 8 mg of ondansetron before spinal anesthesia results in a significantly lower ephedrine requirement compared to placebo.

Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study.

Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR (P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR.

Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy

Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of post-tourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy. Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded. Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion: Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.