Side Effects Of Spinal Anesthesia Research Articles

Towards Good Health and Well-Being; Risk Factors Assessment for Side Effects of Spinal Anesthesia

Towards Good Health and Well-Being; Risk Factors Assessment for Side Effects of Spinal Anesthesia

Effects of neuraxial anesthesia in sitting and lateral positions on maternal hemodynamics in cesarean section: A systematic review and meta-analysis.

During cesarean section, hypotension is a frequent side effect of spinal anesthesia. As a sitting or lateral position is required for spinal anesthesia performance, which of these two positions is more likely to cause intraoperative nausea, vomiting, and hypotension is still unknown. This meta-analysis compared the effects of these two positions on maternal hemodynamics and intraoperative nausea and vomiting. Systematic review and meta-analysis. Operating room. This study included 803 patients from 12 randomized controlled trials (RCTs). Neuraxial anesthesia in sitting position vs. lateral position. We chose RCTs comparing the effects of spinal anesthesia in the sitting and lateral positions on maternal hemodynamics by thoroughly searching PubMed, Embase, the Cochrane Library, and the Web of Science for articles published from database inception until October 31, 2022. The Cochrane Handbook was used to assess the methodological quality of each RCT; the results were analyzed using RevMan 5.4 software; and the Egger test was used to assess publication bias. 12 randomised controlled trials with 803 participants were ultimately included in the final analysis. No significant differences were observed between the two positions in terms of the incidence of hypotension(RR, 0.82; 95% CI, 0.58-1.16; P = 0.26; I2 = 66%), lowest systolic blood pressure(MD, -0.81; 95% CI, -7.38-5.75; P = 0.81; I2 = 86%), the dose of ephedrine(MD, -1.19; 95% CI, -4.91-2.52; P = 0.53; I2 = 83%), and number of parturients requiring ephedrine(RR, 0.97; 95% CI, 0.64-1.46; P = 0.88; I2 = 74%). For the incidence of intraoperative nausea and vomiting, there was no statistical difference between the two positions. Parturients undergoing elective cesarean section under spinal anesthesia in the sitting or lateral position experienced similar incidence of hypotension, and there were no significant differences between these two positions in terms of the amount of ephedrine administered or the number of patients needing ephedrine. In both positions, the frequency of nausea and vomiting was comparable. The ideal position for anesthesia can be chosen based on the preferences and individual circumstances of the parturient and anesthesiologist.

Post-spinal Anesthesia Low Back Pain in Obese Female Patients: Comparison of the Median Versus Paramedian Approach.

A side effect of spinal anesthesia is post-dural puncture backache (PDPB), which is characterized by ongoing discomfort at the location of the spinal puncture without any radicular pain. This study aims to compare the incidence and severity of post-dural puncture back pain following spinal anesthesia by median versus paramedian technique in obese female patients. A prospective randomized comparative study on 120 female patients, aged 20-50 years with a BMI of 30-40 kg/m2 and American Society of Anesthesiologists physical status II, scheduled for elective surgery under spinal anesthesia, was included in the study. Patients were randomly divided into two groups, with 60 patients in each group. Group P uses the paramedian approach for spinal anesthesia, and group M uses the midline approach for spinal anesthesia. Low back pain incidence was lower in group P than in group M at seven days, but at one month and after, its incidence remained the same in both groups. No difference in the severity of pain was observed. The occurrence of back pain in the first seven days of surgery was significantly more frequent with the median approach. The pain severity decreased as the time passed from day seven to three months of follow-up. There is no difference in the severity of pain with either approach at different intervals.

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial

Reducing hypotension is crucial as hypotension is the most common side effect of spinal anesthesia, and in older patients with various comorbidities, it can lead to fatality. We hypothesized that continuous infusion of norepinephrine could effectively prevent hypotension in older patients undergoing hip surgery under spinal anesthesia with propofol sedation. The study randomly assigned patients aged ≥ 70 years to either a control (Group C, n = 35) or a norepinephrine group (Group N, n = 35). After spinal anesthesia, continuous infusion of propofol and normal saline or norepinephrine was initiated. The number of hypotensive episodes, the primary outcome, as well as other intraoperative hemodynamic events and postoperative complications were compared. In total, 67 patients were included in the final analysis. The number of hypotensive episodes was significantly higher in Group C than in Group N (p < 0.001). Furthermore, Group C required a greater amount of fluid to maintain normovolemia (p = 0.008) and showed less urine output (p = 0.019). However, there was no difference in postoperative complications between the two groups. Continuous intravenous infusion of prophylactic norepinephrine prevented hypotensive episodes, reduced the requirement of fluid, and increased the urine output in older patients undergoing unilateral hip surgery under spinal anesthesia with propofol sedation.Clinical trial registration number: KCT0005046 (https://cris.nih.go.kr). IRB number: 2020-0533 (Institutional Review Board of Asan Medical Center, approval date: 13/APR/2020).

Efficacy of inferior vena cava collapsibility index and caval aorta index in predicting the incidence of hypotension after spinal anaesthesia- A prospective, blinded, observational study.

Spinal anaesthesia-induced hypotension (SAIH) is a frequent side effect of spinal anaesthesia. SAIH is usually observed in patients with hypovolemia. Ultrasonography has evolved as a non-invasive tool for volume status assessment. This prospective, blinded, observational study was conducted on 75 adult patients who required spinal anaesthesia after receiving ethical approval and registering the study. Ultrasonographic evaluation of the aorta and the inferior vena cava (IVC) was done preoperatively, and the IVC collapsibility index (IVCCI) and caval aorta index were calculated. The incidence of SAIH was recorded. The strength of the association between different parameters and SAIH was calculated. To find out the value of the optimal cut-off for the prediction of SAIH, receiver operating characteristic (ROC) analysis for various ultrasound parameters was done. The bidirectional stepwise selection was utilised for multivariate analysis to choose the single best predictor. SAIH was observed in 36 patients. Among demographic parameters, age, female gender, and height showed a medium correlation. Among ultrasonographic measurements, minimum IVC internal diameter (IVCmin) and IVCCI showed a strong association with SAIH. The best parameter regarding area under the ROC curve (AUC) and diagnostic accuracy was IVCCI (0.828 and 85%, respectively). On multivariate analysis, age (95% CI [1.01, 1.12], P = 0.024) and IVCCI (95% CI [1.05, 1.18], P < 0.001) were significant independent predictors. At a cut-off point of ≥43.5%, IVCCI accurately predicted SAIH (sensitivity 81% and specificity 90%). Preoperative ultrasonographic assessment of IVC to evaluate its collapsibility index is a convenient, cost-effective, and reproducible tool for predicting SAIH.

The effect of low-frequency electroacupuncture on hemodynamic parameters and nausea in cesarean section patients under spinal anesthesia

BackgroundHemodynamic changes and nausea remain common side effects of spinal anesthesia for parturients. It is suggested that electroacupuncture (EA) at master points of pericardial and heart meridians may have inotropic and vasoconstrictive effects. This study was conducted to evaluate the effects of low-frequency EA at the Neiguan (PC-6) and Shenmen (HE-7) points on the incidence of hypotension, bradycardia, and nausea in patients undergoing cesarean section under spinal anesthesia. MethodsIn a double-blind clinical trial, 90 otherwise healthy candidates for elective cesarean section under spinal anesthesia were enrolled. Patients were allocated to receive stimulation with a frequency of 2 Hz for 20 min at PC-6 and HE-7 points (EA group), stimulation at two non-acupoints of the shoulder, and no treatment (control). Serial measurements of blood pressure, heart rate (HR), and the incidence of nausea and vomiting were compared among the three groups. ResultsMore ephedrine was required to maintain arterial blood pressure in the control and non-acupoint groups compared with the acupoint group (53.3, 30.3, and 21%, respectively; p=0.05). The severity of nausea and occurrence of vomiting in the acupuncture group was significantly lower than in the other two groups (p=0.01). ConclusionLow-frequency EA at the PC-6 and HE-7 points reduces the incidence of hypotension and severity of nausea/vomiting in cesarean section patients under spinal anesthesia.

Comparison of Side Effects of General Anesthesia and Spinal Anesthesia in Postoperative Patients

Introduction: Anesthesia is an action to relieve pain during surgery and various other procedures that cause pain in the body, there are several anesthesia actions including general and spinal anesthesia but the anesthesia action causes some side effects. Objective: This study aims to determine the comparison of side effects of spinal anesthesia and general anesthesia in postoperative patients. Method: The research design used in this study is a comparative study with the type of descriptive research. Population The population in this study was patients under spinal anesthesia and general anesthesia. Result and Discussion: Based on the results of statistical analysis of the Chi-square test, it shows that there is a significant comparison in both types of anesthesia used for surgery, namely general narcose anesthesia and spinal anesthesia on postoperative side effects with a value of (p-value = 0.026). Conclusion: The conclusion of two different types of anesthesia shows significant differences due to differences in the way of administration of anesthetic drugs and the doses given so that they get different side effects. Advice in using the type of anesthesia must be considered the type of surgery to be performed as little as possible must reduce the side effects obtained by the patient.

Evaluation of the preventive effects of neostigmine plus atropine on post-dural puncture headache

Background: Post-dural puncture headache (PDPH) is one of the most common side effects of spinal anesthesia. Several strategies and drugs have been suggested for the treatment and/or prevention of this headache. The aim of this study is evaluating the effects of intravenous prescription of neostigmine plus atropine 15 minutes after dural puncture on incidence and severity of PDPH during 5 days of follow-up in the setting of lower limb orthopedic surgeries.Materials and Methods: In a randomized, controlled, double-blind clinical trial, 99 patients of lower limb orthopedic surgeries were randomized into study (49 patients) and control groups (50 patients). Fifteen minutes after dural puncture, participants in the two groups intravenously took neostigmine (40 μg/kg) plus atropine (20 μg/kg) and placebo (normal saline), respectively. Side effects of the studied drugs and incidence, severity, and duration of PDPH were evaluated 5 days after surgery.Results: A total of 20 patients in the study group and 31 in the control group showed a headache-with-PDPH profile during 5 days of follow-up (P-value = 0.035). The mean duration of PDPH was 1.15 ± 0.48 and 1.32 ± 0.54 days in the study and control groups, respectively (P-value = 0.254).Conclusion: Preventive administration of 40 μg/kg neostigmine plus 20 μg/kg of atropine may be effective in reducing the incidence and severity of PDPH after spinal anesthesia in lower limb orthopedic surgeries.

Comparison between Intrathecal Dexmedetomidine &amp; Bupivacaine Vs Bupivacaine Alone for Prevention of Shivering in C-Section

Background: Shivering is one of the very common side effects of spinal anesthesia. It can be extremely discomforting for parturient undergoing caesarean section. Aim: To compare intrathecal dexmedetomidine and bupivacaine with bupivacaine alone to see whether intrathecal dexmedetomidine can be helpful in preventing shivering in cases undergoing C-section Methodology: This was a prospective randomized controlled trial carried out at Department of Anaesthesiology, Sheikh Zayed Hospital, Rahim Yar Khan. In this study all pregnant females undergoing C section between the age of 18 to 40 years irrespective of their gravida and parity were included. The cases were divided into two equal groups B and D. Group B were offered injection Bupivacaine only and those in group D were offered Bupivacaine along with Dexmedetomidine. Final outcome was seen at 4 hours for shivering after giving spinal anesthesia. Results: In this study there were 120 cases, 60 in each group. The mean age in group B and D was 31.12±4.57 vs 30.67±5.03 years with p value 0.81 and mean BMI was23.19±4.11 vs 23.81±4.23 kg/m2 with P value 0.95 respectively. There were 80% cases in group B and 66.67% in group D belonging to rural population with p value 0.88. Shivering was observed in 24 (40%) cases in group B and 6(10%) in group D with p value 0.01. Conclusion: Combination of intrathecal Bupivacaine and Dexmedetomedine is significantly better than intra thecal Bupivacaine alone in prevention of shivering in patients undergoing C section. Keywords: Bupivacaine, Dexmedetomidine, Shivering, Intrathecal

Comparison of phenylephrine and norepinephrine for prevention of hypotension in patients undergoing cesarean section under spinal anesthesia – A randomized prospective study

Background: Hypotension is a common side effect of spinal anesthesia for cesarean section with incidence of upto 71%. Various vasopressors are available for counteracting spinal hypotension each with different pharmacological profile. Norepinephrine is currently one of the feasible options for prophylaxis of spinal induced hypotension in patients undergoing cesarean section. Aims: To compare efficacy of phenylephrine and norepinephrine for reducing incidence of hypotension in patients undergoing cesarean section under spinal anesthesia and their effect on neonatal outcome. The primary outcome compared was incidence of hypotension (defined as fall in systolic blood pressure of >20% from the baseline value or a value <90 mmHg). The secondary outcomes noted were incidence of bradycardia, nausea, vomiting in the mother, and neonatal outcome. Methodology: A total of 80 singleton full term pregnant patients of American Society of Anesthesiology (ASA) grade II scheduled for elective cesarean section were randomly assigned to 2 groups of 40 patients each. Group P received phenylephrine 50 mcg and Group N received norepinephrine 10 mcg as intravenous bolus over 1 min immediately after the patient had been made supine after giving spinal anesthesia. The vital parameters, adverse effects, and neonatal outcome were assessed and analyzed statistically. Results: Intraoperatively, norepinephrine group had a significantly higher mean heart rate than phenylephrine group. Neonatal outcome was similar in both the groups with respect to appearance, pulse, grimace, activity, and respiration (Apgar) scores and umbilical arterial pH. Conclusions: In cesarean section under spinal anesthesia, norepinephrine efficacy in rescuing maternal hypotension is similar to that of phenylephrine without obvious maternal or neonatal adverse outcomes and with a lower incidence of bradycardia.

The Efficacy of Inferior Vena Cava Diameter, Perfusion Index and Pleth Variability Index on Predicting Hypotension in Spinal Anesthesia

Objective: One of the most common side effects of spinal anesthesia (SA) is hypotension. The aim of the study was to evaluate the efficacay of inferior vena cava (IVC) diameter measurements, perfusion index (PI) and pleth variability index (PVI) values in determining the risk of developing hypotension after SA. Materials and Methods: This study was conducted on 81 patients who underwent transurethral prostatectomy. Before administration of SA, PI and PVI values, IVC diameters (IVCmin: during inspiration and IVCmax: during expiration) and IVC collapsibility index (IVCCI) values and non-invasive blood pressure were recorded. Patients with a baseline systolic arterial pressure reduction rate of ≥25% were determined as the group developing hypotension. IVC diameter measurements were measured immediately after SA then 5 min, and at the end of the operation. The heart rate, mean arterial pressure, PI and PVI values were recorded at regular intervals. Results: Hypotension occured in 32 patients (39.5%). In the hypotensive group, IVCmax and IVCmin values were observed lower and IVCCI values higher. The optimal threshold value of IVCmin was ≤0.99 and threshold value of IVCCI was &gt;%44.5 for predicting hypotension after SA. Conclusion: While IVCmin and IVCCI values were effective in determining hypotension risk after SA, PI and PVI values were not. To predict hypotension by IVC diameter measurements after SA will allow a more effective intervention and avoid hypotension.

Maternal heart rate responses in the supine position and their relationship with hypotension and phenylephrine requirements during elective caesarean delivery using spinal anaesthesia: An observational study

BackgroundHypotension is the main side effect of spinal anaesthesia (SA) for elective caesarean delivery (CD). An increased in heart rate in response to inferior vena cava (IVC) compression has been reported to be predictive of hypotension and vasopressor requirements in this setting. The objective of the study was to evaluate the prevalence of an increase in heart rate in response to IVC compression and its potential effect on hypotension and phenylephrine requirements. MethodsHealthy parturients scheduled for elective CD under SA were preoperatively investigated for a positive supine stress test (SST). It was defined as an increase in heart rate (HR) > 10 beats/min after 5 min of supine position. A crystalloid coload and prophylactic phenylephrine infusion were systematically used to maintain systolic arterial pressure (SAP) between 90–100% of baseline. Hypotension was defined as SAP < 80% of baseline. ResultsAmong 100 women, 26% had a positive SST. There was no significant difference in the incidence of hypotension: 38% versus 24.3% (p = 0.17) in women with positive SST or without, respectively. The cumulative dose of phenylephrine (450 µg [325–625] versus 350 µg [250–500], p = 0.09) was not significantly different between the two groups. Incidences of reactive hypertension, bradycardia, nausea or vomiting and neonatal outcomes were comparable. ConclusionsA positive SST to IVC compression was found in a quarter of term women scheduled for elective CD under SA. This condition has no significant impact on hypotension and phenylephrine requirements when using a crystalloid coload and a phenylephrine infusion targeted at maintaining SAP close to baseline.

Comparison of weight-adjusted dose versus fixed dose ondansetron in Prevention of shivering following spinal anaesthesia for caesarean deliveries

Spinal anaesthesia is a safe and efficient procedure for regional anaesthesia, Shivering is a prevalent side effect of spinal anaesthesia. Ondansetron, a 5-HT3 receptor blocker, should be used to treat and avoid shivering after spinal anaesthesia. The aim of this study was to decide if a weight-adjusted dose of ondansetron is superior to a fixed-dose in preventing shivering following spinal anaesthesia for caesarean delivery. While secondary objectives included determining the prevalence of ondansetron and pethidine adverse reactions. Patients and methods; This was a prospective, randomised, double-blinded, controlled clinical trial involving 129 people, Three equal groups of women were randomly assigned. 1st. received a fixed dose of ondansetron (4mg), 2nd. received ondansetron at a weight controlled dose of 0.1mg/kg, and 3rd. received 0.5 mg/kg pethidine after spinal anaesthesia. the incidence and severity of shivering were measured, as well as the incidence of headache, pruritus, nausea, and vomiting perioperatively were studied. Results; Shivering was observed in 13 patients (30.2 %) in the first group (FDO), 11 patients (25.6 %) in the second group (WAO), and 11 patients (25.6 %) in the third group (PC), but no significant difference between the groups was observed (p-value˃ 0.05). Shivering was more severe (grade II) in the first group (FDO) 5 patients (11.6 %) than in the second group (WAO) 3 patients (6.9 %). Conclusions: A weight-adjusted dosage of 0.1 mg/kg significantly decreased the rate and severity of postspinal shivering while causing less adverse effects and improving hemodynamic stability.

To Study the Role of Perfusion Index as a Predictor of Hypotension during Spinal Anesthesia in Lower Segment Cesarean Section - A Prospective Observational Study.

Background and Aims:Spinal anesthesia has become the choice of neuraxial anesthesia for cesarean delivery. Hypotension, the most common side effect of spinal anesthesia is more in parturients. Perfusion index (PI) is one of the newest methods, used noninvasively for the prediction of hypotension postspinal anesthesia, evaluation of regional block success, and a tool for pain assessment. In our study, we have used PI for predicting the occurrence of hypotension postsubarachnoid block in elective lower segment cesarean section (LSCS).Methods:In this prospective observational study, parturients posted for elective LSCS under spinal anesthesia were included. Spinal anesthesia was performed at L3-L4 interspace using 25G (gauge) Quincke needle, with 1.8 mL of 0.5% hyperbaric bupivacaine plus 20 μg fentanyl. Hypotension was defined as a decrease in systolic blood pressure >25% from the baseline.Statistical Analysis Used:Statistical analysis was performed using the paired sample t-test, Chi-square test, and independent t-test.Results:From our study, we had found that a positive correlation exists between the baseline PI of the patient and the occurrence of hypotension intraoperatively. A cutoff value of 1.75 (with P < 0.001) was found to be significant; above which the occurrence of hypotension was definite. The sensitivity of this cutoff value was 75% and specificity was 71% for this value.Conclusion:Baseline perfusion of >1.75 can predict hypotension postspinal anesthesia in LSCS. The incidence of hypotension was about 93% in parturients whose baseline was above the cutoff value.

HUBUNGAN LAMA OPERASI DENGAN TERJADINYA SHIVERING PADA PASIEN OPERASI DENGAN ANESTESI SPINAL DI KAMAR OPERASI RSUD NGANJUK

Introduction: The risk of shivering is higher if the duration of surgery is longer, because it will increase the time of exposure to the body with cold temperatures and the accumulation of side effects of spinal anesthesia. The purpose of this study was to determine the relationship of surgical duration and shivering event of surgical patients with spinal anesthesia in surgical suite of Nganjuk General Hospital. Methods: The design of this study was correlation with a cross sectional approach. The research was conducted on August 13-20 2018, at surgical suite of Nganjuk General Hospital. The population was all surgical patients with spinal anesthesia in the Operating Room of Nganjuk General Hospital during on August 13-20 2018, as many as 27 patients. Samples were taken by total sampling technique and obtained a total sample of 27 respondents. The independent variable was surgical duration and the dependent variable was the shivering event. This research instruments were check list sheet and medical record data. Data was analyzed using Coefficient Contingency test with α = 0.05. Results: The results showed that surgical duration in surgical suite of Nganjuk General Hospital, almost half the duration was in middle level (31-60 minutes) as many as 13 respondents (48.1%). Shivering event in the Operating Room of Nganjuk General Hospital, almost half of them were in grade 3 as many as 12 respondents (44.4%). The results of the Coefficient Contingency test showed p-value of 0.002 ≤ α (0.05). So that it can be concluded that Ha was accepted, meaning that there was a relationship between the surgical duration and shivering event of surgical patients with spinal anesthesia in surgical suite of Nganjuk General Hospital. Conslusions: The longer of surgical duration carried out by respondents in the surgical suite of Nganjuk Hospital, the greater the risk of the respondent experiencing shivering events. Conversely, the of shorter surgical duration undertaken by respondents in the surgical suite of Nganjuk General Hospital, the smaller the risk of the respondent experiencing shivering. Keywords: Surgical Duration, Shivering Event, Surgical Patient, Spinal Anesthesia.

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial.

Background and Aims:Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH.Methods:This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25.Results:Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group.Conclusion:Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

Measurements of Inferior Vena Cava Diameter for Prediction of Hypotension and Bradycardia during Spinal Anesthesia in Spontaneously Breathing Patients during Elective Knee Joint Replacement Surgery

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was <0.7, p > 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.

Laparoscopic cholecystectomy under spinal anesthesia in high risk patients: A single center experience

Aim: Laparoscopic cholecystectomy is routinely done with general anesthesia except for patients that are considered too sick for general anesthesia. The goal of this study was to investigate the availability, safety, and side effects of spinal anesthesia in laparoscopic cholecystectomy. Material and Methods: Patients with high risk for general anesthesia who admitted for laparoscopic cholecystectomy were given the choice of spinal anesthesia instead of general anesthesia. In Ortadogu Private Hospital, Adana, Turkey; 371 subjects were prospectively admitted for laparoscopic cholecystectomy under spinal anesthesia between January 2015 and January 2018. All volunteers provided informed consent. The spinal anesthesia procedure was done similar to the general anesthesia protocol with no modifications. Intra-abdominal pressure was sustained within the 8-10 mmHg range. A 3.5mL bupivacaine (0.5%)/fentanyl (20 μg) mixture was used for spinal anesthesia. Data collected for demographics, ASA scores, surgery duration, comorbidities, and sedation medication/dosage were reviewed. Results: A total of 232 women (62.6%) and 139 men (37.4%) comprised the study. The subjects averaged 51 years of age (range: 37-89). Patients were classified into the following ASA categories: ASA II: 48 subjects (12.9%), ASA III: 197 subjects (53.1%), ASA IV: 126 subjects (34.0%). Surgery was performed successfully in 371 patients. Spinal anesthesia was adapted to general anesthesia for 2 (0.5%) subjects. The average operation time was 38.1 minutes (range: 16-74 minutes). O2 saturation was 97.8% on average for all patients. Right shoulder pain was documented in 14.5% of the patients, and a shoulder massage alleviated the discomfort in most subjects. Conclusions: Spinal anesthesia should be the anesthesia of choice dues to its numerous advantages in high-risk patients related to general anesthesia.

Baseline heart rate as a predictor of post-spinal hypotension in patients undergoing a caesarean section: An observational study

Background: Hypotension is a well-known side effect of spinal anaesthesia in obstetrics patients undergoing caesarean section. This is likely to affect both mother and fetal well-being. Systemic haemodynamics are modulated by autonomic nervous system (ANS). Evaluation of ANS may be helpful in predicting hypotension. The present study is designed to identify the subset of pregnant patients at higher risk of developing post-spinal hypotension based on baseline heart rate (HR) prior to administration of anaesthesia. Materials and Methods: This was a prospective study conducted on 100 patients aged 20–30 years, of American Society of Anaesthesiologists (ASA) grade I or II, scheduled for elective caesarean section under spinal anaesthesia. Patients were divided into two groups based on their baseline HR. Incidence of hypotension and ephedrine requirement following spinal anaesthesia were noted. Results: Thirty nine patients out of 100 developed hypotension (39%), of whom 27 were in the group with HR >91 beats per minute (bpm) (50.9%) and 12 patients were in the group with HR 91 bpm than group with HR