Spinal Anaesthesia For Caesarean Section Research Articles

Successful Spinal Anesthesia for Cesarean Section in a Patient With Marfan Syndrome Complicated by Dural Ectasia

(Int J Obstet Anesth. 2018;35:88–92) Marfan syndrome (MFS) is an autosomal dominant condition characterized by connective tissue abnormalities across multiple systems. Patients with MFS may have a dilated aortic root, and this can place the parturient at increased risk during labor and delivery. Cesarean delivery is sometimes recommended for women with MFS who have an aortic root diameter >40 mm. However, reduced effectiveness of spinal anesthesia has been reported in some patients with MFS. The failure is thought to possibly be related to the dural ectasia that is present in many patients with MFS; this may lead to incomplete cephalad distribution of intrathecal local anesthetic. This case report detailed a parturient who was undergoing her second cesarean delivery after failed neuraxial anesthesia during her first delivery, with the author postulating that warmed isobaric bupivacaine, injected as far away as possible from the ectatic dural sac, may be able to overcome inconsistent intrathecal distribution.

Relationship between changes in regional cerebral blood volume and oxygenation and changes in cardiac output and systemic vascular resistance during spinal anesthesia in women undergoing cesarean section

The decrease in maternal regional cerebral blood volume (rCBV) and oxygenation (rCBO) during spinal anesthesia for cesarean section depends on the severity of hypotension. We examined the relationships between changes in the systemic circulatory parameters, cardiac output (CO) and systemic vascular resistance (SVR), and rCBV and rCBO after induction of spinal anesthesia, evaluated by near-infrared spectroscopy (NIRS) and an arterial pressure-based cardiac output monitoring system (APCOs). Seventeen patients undergoing elective cesarean section under spinal anesthesia were monitored every 1min for mean arterial pressure (MAP), heart rate (HR), end-tidal carbon dioxide (EtCO2) and oxygen saturation (SpO2), and at 20s intervals for CO, SVR, concentrations of oxy-hemoglobin (Hb), deoxy-Hb, total-Hb, and tissue oxygenation index (TOI), until 15 min after the intrathecal injection of bupivacaine. We investigated changes in the parameters from baseline and evaluated correlations between the changes in total-Hb and TOI and changes in CO and SVR, respectively, at the same timepoints. Oxy-Hb, total-Hb, TOI, and SVR significantly decreased and HR significantly increased with a decrease in MAP (P < 0.01). Deoxy-Hb, CO, SpO2, and EtCO2 levels did not change from baseline. There were statistically significant, although weak, positive correlations between both total-Hb and TOI with SVR (total-Hb; r = 0.18, P < 0.01, TOI; r = 0.38, P < 0.01). The decreases in both rCBV and rCBO after induction of spinal anesthesia for cesarean section are probably dependent on the decrease in SVR due to spinal anesthesia.

Closed-loop Double-vasopressor Automated System to Treat Hypotension During Spinal Anaesthesia for Caesarean Section

Closed-loop Double-vasopressor Automated System to Treat Hypotension During Spinal Anaesthesia for Caesarean Section

Comparison between 2, 4 and 6 Minute Sitting Positions versus Immediately Lying Down on Hemodynamic Variables, Fluid and Ephedrine Requirement after Spinal Anesthesia in Elective Cesarean Section

Background: hypotension is one of the most common complications of spinal anesthesia in patients undergoing cesarean section. In this regard, the patient’s position may affect the incidence of hypotension. Objective: to compare the incidence of hypotension and ephedrine requirement after spinal anesthesia with variable time in sitting position before lying down. Patients and Methods: a total of 100 patients, scheduled for cesarean section under spinal anesthesia, with 10 mg of hyperbaric bupivacaine 0.5% (2 ml) mixed with 25 µg (0.5 ml) fentanyl, were randomly divided into 4 groups (25 patients per group). Groups M2, M4 and M6 remained in a sitting position for 2, 4 and 6 minutes after the induction of spinal anesthesia, respectively, while group M0 was immediately placed in a lying position. Results: there were highly significant differences between the four groups as regard the incidence of hypotension based on Chi-square test; **p-value <0.001 HS. The frequency of hypotension was higher in group M0 in comparison with other groups. There was high consumption of ephedrine and fluid in group M0 than other groups as the total dose used in group M0 was bigger than other groups while M6 had the smaller dose. Conclusion: the present study revealed that the patient’s position is an important factor, which affects the frequency of hypotension, ephedrine and fluid requirements, and the onset of sensory block during the administration of spinal anesthesia for cesarean section.

Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section.&#x0D; Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine.&#x0D; Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p&lt;0.05) and Nausea and vomiting (16.20% vs. 27%, p&lt;0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group.&#x0D; Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.

Antihypotensive effect of oxytocin mini-dose at the beginning of spinal anaesthesia for elective caesarean section

Oxytocin is widely used after child delivery for preventing postpartum haemorrhage. Rather high level of spinal block for for Caesarean section has a disadvantage of frequent arterial hypotension. The aim of our study was to assess maternal circulation after mini-dose (0.5 IU) oxytocin administered before, not after, delivery.Methods. Spinal anaesthesia (L3, hyperbaric 0.5% bupivacaine, 13.5 mg) for Caesarean section was performed in 80 women, randomly divided into study (n=40) and control (n=40) groups. In the study group, oxytocin (0.5 IU, slow intravenous bolus) was administered immediately after anaesthesia performance. In both groups, after delivery the slow oxytocin bolus was administered (4.5 IU in study and 5 IU in control group), then another 5 IU were infused in normal saline over 20-25 min.Results. During anaesthesia, minimal systolic arterial pressure (M±SD) in the study group (107±11 Torr) was significantly (p&lt;0.0001) higher than in the control group (88±10 Torr). Phenylephrine administration before delivery was needed in the study group (28 of 40) significantly (Fisher exact p = 0.0015) more rarely than in the control group (39 of 40); whereas during the whole surgery the difference was insignificant (36 of 40 vs 40 of 40, Fisher exact p = 0.1156). Time to first phenylephrine administration in the study group (10.7±4.0 min) was significantly (p&lt;0.0001) longer than in the control group (1.8±1.0 min). Cumulative phenylephrine dose before delivery (Median: min–max) in the study group (1.25: 1,25–2,5 mg) was significantly (p=0.00424) less than in the control group (5: 2.5–6.25 mg). Cumulative phenylephrine dose during the whole surgery in the study group (3.625: 1.25–7.5 mg) was significantly (p&lt;0.00001) less than in the control group (10: 5–12.5 mg). Our results can be explained by blood mobilization from uterine vasculature. Conclusions. Oxytocin mini-dose (0.5 u), administered at the beginning of spinal anaesthesia for Caesarean section, attenuates arterial hypotension and allows less phenylephrine use.

Low-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension.

Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension. Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training.

Comparative Evaluation of Different Needle Gauge of Needle for Spinal Anesthesia in Cesarean Section for Post-Operative Complication

Comparative Evaluation of Different Needle Gauge of Needle for Spinal Anesthesia in Cesarean Section for Post-Operative Complication

Height-based dosing algorithm of bupivacaine in spinal anaesthesia for decreasing maternal hypotension in caesarean section without prophylactic fluid preloading and vasopressors: study protocol for a randomised controlled non-inferiority trial

IntroductionEffectively preventing or treating spinal-induced maternal hypotension is considered to be the Holy Grail of obstetric anaesthesia. Prophylactic fluid preloading and vasopressors decrease hypotension but may aggravate heart load, induce...

Effects of isothermic crystalloid coload on maternal hypotension and fetal outcomes during spinal anesthesia for cesarean section: A randomized controlled trial

ObjectiveSpinal anesthesia induced hypotension (SAIH) is a common occurrence during spinal anesthesia for cesarean section resulting in perturbing effects on maternal and fetal outcomes. Previous studies conducted to attenuate SAIH focused on the timing of intravenous fluid infusion and demonstrated the superiority of coload strategy on traditional preload strategy but neither of them focused on the effect of the temperature of crystalloid infused on SAIH and fetal outcomes. The current study aimed to assess the effect of the temperature of the crystalloid infused with coload strategy on the incidence of SAIH and fetal outcomes. Materials and methodsSeventy-six parturients were enrolled into the study and data of 60 parturients were analyzed. Patients were randomly assigned to receive crystalloid coload at room temperature (Group RT, n = 30) or warmed at 37 °C (Group W, n = 30). The incidence of hypotension, cumulative hypotension episodes, heart rate, core body temperature, ephedrine dose, and fetal outcomes were recorded. ResultsThere was no significant difference in the incidence of maternal hypotension, cumulative hypotension episodes, and ephedrine dose (p = 0,625, p = 0,871, p = 0,460 respectively). Umbilical arterial pH and fetal Apgar scores at first and fifth minutes were higher in Group W than in Group RT (p = 0.013, p = 0.006 and p = 0.045 respectively). One fetus in Group RT but none in Group W had umbilical arterial pH lower than seven. Fetal birth weight and rectal temperature measurements were comparable in both groups (p = 0.639 and p = 0.675 respectively). Demographic data, patient characteristics, and surgery data were comparable between groups. ConclusionsIsothermic crystalloid coload strategy results in higher umbilical pH values and Apgar scores in parturients scheduled for cesarean section under spinal anesthesia.

Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in cesarean section

Background: Post-caesarean section pain is an important issue in obstetrics. Several studies have shown the importance of adequate postoperative analgesia on mobilization, rehabilitation and decreasing the length of hospital stay. Large amounts of opioid analgesic drugs are often required in the management of intense post-operative pain. However, this option is associated with many side effects.Objective: The aim of the study was to assess the efficacy of adding dexamethasone to bupivacaine for spinal anesthesia in prolonging the duration and anesthetic effect in women undergoing cesarean section.Patients and Methods: Populations of the study were comprised of 100 pregnant full term female planed for cesarean section. All patients had cesarean section under spinal anesthesia. Pain was assessed using 10 cm visual analogue scale (VAS) after 0, 15, 30 min and 2, 4, 6 hours post-operatively and until the mother asked for an analgesic. The duration of sensory block as well as postoperative analgesia were calculated.The study population had been randomized into 2 groups: The 1st group C (n=50 women) included 50 women receiving intrathecal dexamethasone added to bupivacaine. The 2nd group B (n=50 women) included 50 women receiving placebo which was added to intrathecal bupivacaine.Results: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia as the duration of sensory block in the study group was 122 + 7.9 minutes while in the control group it was 91.8 + 10.8 minutes and p 6 and the first analgesic dose prescription in the case group was significantly longer than that in the control group (P<0.001) as the pain free period in the study group was 434.3 + 43.8 minutes while in the control group it was 215.3 + 40.3minutes. Also, the motor block duration in the study group was significantly prolonged when compared with control group (p<0.01).There was no difference in onset time between the two groups and the addition of dexamethasone cause no complications.Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications, and has increased the pain free period statistically.Recommendations: Further studies are needed to evaluate the optimal dose of dexamethasone to be used in spinal anesthesia.

Progress in vasopressors-induced prevention of hypotension after spinal anaesthesia for caesarean section

Progress in vasopressors-induced prevention of hypotension after spinal anaesthesia for caesarean section

Comparative Study between Setting Position Versus Left Lateral Position Effects During Spinal Anesthesia Block in Caesarean Section

Background: A caesarean section is recommended when vaginal delivery is a threat to the mother or child. Aim of study: The aim of the study was to compare the effect of position (sitting versus left lateral) during spinal anesthesia application in cesarean section. The sample of the study was 60 patients. Patients and Methods: Half of the patients received spinal analgesia consisting of 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 25μg fentanyl in the sitting position, while the other half received spinal analgesia consisting of 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 25μg fentanyl in the left lateral position. Results: both Left lateral and sitting position in spinal anesthesia in cesarean section have the same effect on hemodynamics, also satisfactory sensory and motor block can be achieved in both positions. So left lateral position is safe and can be performed in parturient who are sedated, in pain or using entonox. Conclusion: Satisfactory sensory and motor blockade were successfully achieved in both sitting and lateral positions during intrathecal injection in cesarean section without significant difference in the hemodynamic changes or motor blockade. With superiority of faster onset of sensory blockade in lateral position, while sitting position is more comfortable for he parturient.

Antihypotensive drugs in cesarean sections : Treatment of arterial hypotension with ephedrine, phenylephrine and Akrinor® (cafedrine/theodrenaline) during cesarean sections with spinal anesthesia

Arterial hypotension is afrequent complication following spinal anesthesia for cesarean sections. Afast treatment is necessary to maintain the well-being of the mother and to avoid deficiencies in the intrauterine supply to the child. The aim of this analysis was to evaluate the effects of the most frequently used vasoactive substances for treatment of hypotension in patients undergoing cesarean sections in Germany, i.e. ephedrine (E), phenylephrine (P) and Akrinor (A, cafedrine/theodrenaline), a20:1 combination of cafedrine and theodrenaline. Aretrospective single center analysis of 772 patients (16-50years old) with arterial hypotension following spinal anesthesia for cesarean section and requiring treatment with vasoactive substances (July 2012-April 2017) was carried out. In the three observation periods the respective current clinical standard treatment of E, P or A was applied. The primary end-points were changes in maternal hemodynamics, pH and base excess (BE) in the child and the resulting blood pressure values. The statistical analysis plan of the study was registered in the German registry for clinical trials (DRKS-ID: DRKS00012520). The initial blood pressure before the intervention was comparable in all three groups, with no clinically relevant differences between the individual groups. In the course of anesthesia the largest blood pressure decrease as well as the largest resulting increase after the intervention were found in group A. In group P there was an increased need for an alternative catecholamine in comparison to the other two groups (P : 13patients, 3.7%, E: 5patients, 3.3% and A: 0patients (0%), p 0.007). Differences were detected in the BE of the child (mean E: -1.36, P : -2.03, A: -2.57, p 0.0001) and the incidence of bradycardia requiring drug intervention (E: 0.7%, P : 5.4%, A: 1.9%, p = 0.007). No significant differences were found for the arterial pH of the child and APGAR scores. The differences of the individual vasoactive substances seemed to be much smaller than one would expect based on the results of randomized clinical trials. The incidence and extent of bradycardia and neonatal acidosis were much lower than previously reported. The determined differences seemed to have no major clinical relevance. Although the A group required less bolus administrations and seemed to be the most potent substance, the results imply that the assessment of the effects of vasoactive substances should not be carried out without consideration of the accompanying measures.

Magnitude of post dural puncture headache and associated factors in obstetric mothers undergone spinal anesthesia for caesarean section

Background: Although modern anesthesiology has made great progress in the last decades, neuraxial anesthesia (NA) is still the keynote of regional blockade. It is popular for its effectiveness in producing anesthesia and analgesia. As the NA techniques popularly used in clinics, post dural puncture headache (PDPH), a common iatrogenic complication resulted from post-spinal taps or accidental dural puncture (ADP) subsequent to epidural block, frequently reported and becomes a challenging to health caregivers. The objective of the study was to assess the magnitude of post dural puncture headache (PDPH) and Associated Factors in Obstetric Mothers Undergone Spinal Anesthesia for Cesarean Section from February 1 – June 30, 2018 Methods and Materials: Institutional based cross-sectional study design conducted in Dilchora Hospital and Sabian Primary Hospital from February 1 – June 30, 2018. 391 obstetric mothers was systematically selected every 2 other patient interval. The data was collect from both patient chart review and interview using structured checklist. Results: 85/391 (21.7%) obstetric mothers present with headache characteristic of post-dural puncture headache (PDPH). Larger gauge spinal needle [AOR= 3.105: 95% CI (1.116 - 8.638), P = 0.03] and multiple spinal attempts [AOR 0.374; 95% CI (0.220 - 0.635) P = 0.000] was statistically significantly related with PDPH after Spinal anesthesia. Conclusion and Recommendation: In our study, we observe a relatively higher prevalence of PDPH (21.7%), as compared to other literatures. Large gauge spinal needles (≥ 23 G) and multiple spinal attempts is also find statistically significantly related with PDPH after Spinal Anesthesia. In order to decrease the higher prevalence of PDPH in those Hospitals, Anesthetists should avoid utilization of large gauge spinal needles, and repeated dural puncture during Spinal Anesthesia.

The effects of prophylactic infusing ephedrine combined with phenylephrine versus ephedrine alone in maternal and neonate undergoing spinal anesthesia for cesarean section: A Meta-analysis of randomized trials

Objective Used a Meta-analysis to evaluate the effects of prophylactic infusing ephedrine alone or combined with phenylephrine on maternal hemodynamics and neonatal blood gas analysis undergoing spinal anesthesia for cesarean section. Methods Randomized controlled trial(RCT) about the effects of prophylactic infusing ephedrine alone or combined with phenylephrine on maternal and neonate undergoing spinal anesthesia for cesarean section were retrieved from Cochrane Library, PubMed, Embase, Wangfang Database, CNKI and SinoMed from the date of their establishment to September, 2017. The documents were screened and the relevant data were extracted according to the inclusion criteria. The methodological quality of the included RCT was evaluated by Jadad scale. Using RevMan 5.3 software for Meta-analysis. Continuous variables were dealt with mean differences(MD) and 95% confidence intercal(CI), and the dichotomous variables were dealt with odd ratio(OR) and 95%CI. Descriptive analysis of the RCTs which is not available for Meta-analysis. Results We identified 9 RCTs including 590 patients, including 5 RCTs in English and 4 RCTs in Chinese. Among them, 294 patients were in the ephedrine group(E group) while 296 patients were in the ephedrine combined with phenylephrine group(EP group). The results of Meta-analysis showed that the incidence of maternal hypotension [OR=0.49, 95%CI(0.3, 0.8), P<0.01], hypertension [OR=0.52, 95%CI(0.30, 0.92), P=0.02], nausea and vomiting [OR=0.32, 95%CI (0.19, 0.53), P<0.01] and the incidence of neonatal acidosis [OR=0.22, 95%CI(0.10, 0.49), P<0.01] were significantly lower in the ephedrine combined phenylephrine group than these parameters in the ephedrine alone groups. The neonatal umbilical artery pH [MD=0.1, 95%CI(0.07, 0.13), P<0.01], base excess(BE) [MD=2.24, 95%CI(0.78, 3.69), P<0.01], oxygen partial pressure(PO2) [MD=1.53, 95CI (0.08, 2.98), P<0.01] value in the ephedrine combined with phenylephrine group was significantly higher than those parameter in the ephedrine alone group. Moreover, the umbilical artery lactic acid [MD=-1.39, 95%CI (-1.73, -1.05), P<0.01], partial pressure of cardon dioxide(PCO2) [MD=-8, 95%CI(-13.2, -2.8), P<0.01] value were lower than those in the ephedrine alone group. The neonatal 1 min and 5 min Apgar score were not significant difference between the two groups. Conclusions Ephedrine combined with phenylephrine can prevent maternal hypotension undergoing spinal anesthesia for cesarean section and to maintain intraoperative hemodynamic stability. It also can reduce the incidence of maternal nausea and vomiting and neonatal acidosis. Key words: Ephedrine; Phenylephrine; Cesarean section; Hemodynamics; Heonate; Meta-analysis

Intrathecal dexmedetomidine can decrease the 95% effective dose of bupivacaine in spinal anesthesia for cesarean section: A prospective, double-blinded, randomized study.

Background:Dexmedetomidine (Dex), as an adjuvant, has been reported to prolong the duration of spinal analgesia when adding to local anesthetic. We hypothesized that Dex could enhance the efficiency of intrathecal bupivacaine for spinal anesthesia in cesarean section. The aim of his study is to test our hypothesis that 5 μg Dex could enhance the efficiency of intrathecal bupivacaine and reduce the dose requirement of spinal bupivacaine for patients undergoing cesarean section.Methods:Ninety patients with ASA I or II, who underwent cesarean section, were randomized into 2 groups: group D (bupivacaine + 5 μg Dex) and group C (bupivacaine + the same volume of saline). The subsequent dose of spinal bupivacaine was determined by the improved up–down allocation method. The initial dose of bupivacaine in the 2 groups was 4 mg, and the subsequent dose for the following patient was depended on the probability of the current dose. ED95 of spinal bupivacaine was calculated using logistic regression model.Results:The ED95 and 95% confidence intervals (95% CI) of spinal hyperbaric bupivacaine in group D and group C were 7.4 mg (95% CI, 5.6–12.4 mg) and 11.0 mg (95% CI, 4.4–56.8 mg), respectively. The duration of sensory block was 120.5 ± 37.0 minutes in Dex group and 70.5 ± 34.5 minutes in Control group, respectively (P < .05). The duration of analgesia was 230.5 ± 40.5 minutes in Dex group and 145.1 ± 28.5 minutes in Control group, respectively (P < .001). The consumption of postoperative rescued sufentanil was significantly lower in Dex group than in the Control group (56.3 ± 9.4 vs 65.9 ± 10.7 μg). There was not significantly different in the patient satisfaction of analgesia, incidence of side effects, neonatal outcomes and neurological deficit between the 2 groups.Conclusion:Intrathecal 5 μg Dex enhances the efficacy of spinal bupivacaine by 24% in patients undergoing cesarean section with spinal anesthesia. No additional side effect was observed by adding spinal Dex.

Volume Preload versus Ephedrine Infusion for Prevention of Hypotension Due to Spinal Anesthesia for Cesarean Section

Introduction: Spinal anesthesia is used for 95% of planned cesarean sections in Bangladesh. It provides a fast and profound sensory and motor block. However, hypotension is a very common complication of spinal anesthesia during cesarean section, causing significant maternal and fetal morbidity and mortality. It could be associated with severe nausea, vomiting and even unconsciousness and pulmonary aspiration in the mother and for the baby hypoxia, acidosis and neurological injuries may result.&#x0D; Materials and Methods: This prospective randomized comparative study was conducted in the Department of Anesthesiology at Institute of Child and Mother Health (ICMH) from July 2017 to December 2017, on 110 adult pregnant women who underwent caesarean delivery. All study patients were randomly allocated into two groups. Group I (F group) patients received volume preloading with 15 ml/kg Ringer lactate solution before induction of spinal anesthesia and group II (E group) patients received IV ephedrine (5 mg in 1st minute after spinal anesthesia, 5 mg in 2nd minute and thereafter 1 mg in every minute for 15 minutes).&#x0D; Results: A statistically significant difference in the incidence of hypotension between group F (48%) and group E (24%) was found (p = 0.03). Regarding side effects, statistically significant (p = 0.23) incidence of nausea and vomiting was found in group F (20%) in comparison to group E (12%).&#x0D; Conclusion: We conclude that prophylactic IV ephedrine infusion is more effective than fluid preload to prevent spinal anesthesia-induced hypotension during caesarean section without causing significant tachycardia or hypertension.&#x0D; Medicine Today 2019 Vol.31(1): 39-41

Role of Fentanyl With Bupivacaine During Spinal Anaesthesia for Caesarean Section in Reducing Hypotension

Background and Objectives: The hypotension following spinal anaesthesia is a common problem incaesarean section. The combination of reduced dose of local anaesthetics with intrathecal opioids makesit possible to achieve adequate spinal anaesthesia with minimum hypotension. We investigated whetherthis synergistic phenomenon could be used to provide less frequent hypotension while incurring adequatespinal anaesthesia for caesarean section. Methods: Sixty women scheduled for caesarean delivery (thirty in each group) were divided into twogroups of patients who received a spinal injection of either 12.5 mg of hyperbaric bupivacaine or 10 mgof hyperbaric bupivacaine with 25 mg fentanyl added. Each measurement of a systolic blood pressureless than 95 mmHg or a decrease in systolic pressure of greater than 25% from baseline was consideredas hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of surgicalanaesthesia was evaluated also. Results: Spinal block provided excellent surgical anaesthesia in almost all patients. Peak sensory levelwas higher (D2-3 vs. D4-5) and motor block was more intense in the hyperbaric bupivacaine group; thepatients from bupivacaine group were more likely to require treatment for hypotension (75% vs. 15%)and had more persistent hypotension (4.6 vs. 1.0 hypotensive measurements per patient) than patients inthe reduced bupivacaine-fentanyl group. Mean ephedrine requirements were 15.0 mg and 3.5 mg,respectively. Patients in the bupivacaine group also complained of emetic effects more frequently thanpatients in the reduced dose bupivacaine-fentanyl group. Conclusions: Bupivacaine 10 mg plus fentanyl 25 mg provided spinal anaesthesia for caesarean deliverywith less hypotension and vasopressor requirements while ensuring excellent perioperative surgical anaesthesia. JBSA 2019; 32(1): 28-34

Metaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials

IntroductionDuring caesarean section, the use of a vasopressor is often required to achieve haemodynamic stability of the parturient. Metaraminol is a vasopressor used in this context in some countries. However, the differences between metaraminol and other vasopressors remain unclear. MethodsA search of the PubMed, Cochrane Library, and Embase databases was performed to identify randomised controlled trials comparing the use of metaraminol with other vasopressors during spinal anaesthesia at caesarean section. The selected studies were subjected to meta-analysis and risk-of-bias assessment. ResultsFour randomised, controlled trials met the selection criteria and 409 parturients who underwent an elective caesarean section were included in this meta-analysis. The quality of these trials was good. Metaraminol was associated with higher umbilical arterial pH (standardised mean difference [SMD] 0.82, 95% CI 0.01 to 1.62, P=0.05); a lower incidence of fetal acidosis (RR 0.08, 95% CI 0.01 to 0.63, P=0.02); and a lower incidence of nausea or vomiting (RR 0.16, 95% CI 0.04 to 0.57, P=0.0005) than was ephedrine. Metaraminol resulted in higher umbilical arterial pH (SMD 0.42, 95% CI 0.15 to 0.68, P=0.002) but a higher incidence of reactive hypertension (RR 1.80, 95% CI 1.32 to 2.46, P=0.0002) than did phenylephrine. ConclusionThe results of this study showed that for spinal anaesthesia at elective caesarean section, metaraminol may be a more suitable vasopressor than ephedrine and its effects are at least not inferior to those of phenylephrine.