Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section (original) (raw)
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Nepal Journal of Obstetrics and Gynaecology
Aims: To compare the incidence of hypotension after intrathecal administration of hyperbaric bupivacaine and fentanyl in two different syringes against standard injection of mixed fentanyl with hyperbaric bupivacaine. Methods: This was a prospective comparative study conducted in 174 parturients undergoing elective caesarean section at Paropakar Maternity & Women’s Hospital. Hemodynamic effects and characteristics of block were monitored and recorded and compared between the two groups, group S (single syringe) and group D (double syringe). Results: The incidence of hypotension was almost similar in the two groups but the drop in systolic blood pressure and mean arterial pressure at 5 minutes and 7.5 minutes after subarachnoid block was significant in group S as compared to group D (p<0.005 and p<0.005 respectively). Conclusion: Hyperbaric bupivacaine with fentanyl, which when injected separately without mixing, is associated with lesser incidence of hypotension following suba...
Post-spinal anesthesia hypotension during cesarean delivery, a review article
Egyptian Journal of Anaesthesia, 2017
Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Prevention and treatment of post-spinal hypotension (PSH) in cesarean delivery has been frequently investigated. Fluid loading is superior to no-fluid regimen; however, the incidence of PSH is still high with all fluid loading protocols; thus, the use of fluid loading as a sole method for prophylaxis might be not satisfactory for many anesthetists. Phenylephrine is the preferred vasopressor for prevention and management of PSH in most cases. Ephedrine may be more beneficial in patients with bradycardia, patients with uteroplacental insufficiency and pre-eclamptic patients. Norepinephrine infusion was recently investigated as an alternative for prophylaxis of PSH with minimal cardiac side effects. The high incidence of PSH with most of the pharmacological and non-pharmacological methods suggests the need for multimodal protocols for prevention and management of this problem. PSH in cesarean delivery is a common daily situation facing all anesthetists; thus, future research should focus on simple and rapid protocols that can be easily applied by anesthetists with moderate and low experience with minimal need to complex devices or costly drugs.
Turkish Journal of Medical Sciences
Aim: To determine if hypotension frequency changes when hyperbaric or isobaric formulations of bupivacaine, or their sequential administrations, are used for cesarean section. Hypotension aft er spinal anesthesia for cesarean section is common. Materials and methods: A total of 144 patients who were to undergo cesarean section with spinal anesthesia were allocated into 4 groups. Spinal anesthesia was achieved with 10 mg of hyperbaric bupivacaine in Group H10, sequential 5-mg administrations of hyperbaric and isobaric bupivacaine in Group H5P5, sequential 5-mg administrations of isobaric and hyperbaric bupivacaine in Group P5H5, and 10 mg of isobaric bupivacaine in Group P10. Hemodynamic parameters were determined and the incidence of hypotension, incidence of bradycardia, and amount of ephedrine required to treat hypotension were recorded. Fetal Apgar scores, the pH of the umbilical cord blood, and side eff ects were also noted. Results: American Society of Anesthesiologists risk group, surgical duration, and demographic values were similar among the groups. Th e incidence of hypotension was found to be 69.4%, 66.7%, 75.0%, and 83.3% in the H10, H5P5, P10, and P5H5 groups, respectively. Th e incidences of hypotension were not signifi cantly diff erent. Bradycardia incidence, ephedrine consumption, the pH of cord blood, and side eff ects were not diff erent among the groups. Conclusion: When the dose of local anesthetic is the same, the incidence of spinal-induced hypotension cannot be lowered using hyperbaric, isobaric, or sequential injections of a half dose of bupivacaine for spinal anesthesia during cesarean section.
Open Journal of Anesthesiology, 2016
Background: Spinal anesthesia is used for 95% of planned cesarean sections in the United States. 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 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. Methodology: Fifty patients were randomly allocated into two groups. Group I (F group) patients received preloading with 15 ml/kg Ringer lactate before induction of spinal anesthesia, and group II (E group) patients received IV ephedrine (5 mg in 1 st minute after spinal anesthesia and 5 mg in the 2 nd minute and 1 mg every minute after that for 15 minutes). Results: A statistically significant difference in the incidence of hypotension between group F (48%) and group E (24%) was seen, (p-value 0.03). Regarding side effects, the incidence of nausea and vomiting was higher in the group F (20%) when compared to group E (12%), (p-value 0.23). Conclusions: We concluded that IV infusion of ephedrine after induction of spinal anesthesia was more effective than crystalloid preloading in a prevention of hypotension in parturient undergoing cesarean section and did so without causing significant tachycardia.
Anesthesia and Analgesia, 2002
This quantitative systematic review compared the efficacy and safety of ephedrine with phenylephrine for the prevention and treatment of hypotension during spinal anesthesia for cesarean delivery. Seven randomized controlled trials (n ϭ 292) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were maternal hypotension, hypertension and bradycardia, and neonatal umbilical cord blood pH values and Apgar scores. For the management (prevention and treatment) of maternal hypotension, there was no difference between phenylephrine and ephedrine (relative risk [RR] of 1.00; 95% confidence interval [CI], 0.96 -1.06). Maternal bradycardia was more likely to occur with phenylephrine than with ephedrine (RR of 4.79; 95% CI, 1.47-15.60). Women given phenylephrine had neonates with higher umbilical arterial pH values than those given ephedrine (weighted mean difference of 0.03; 95% CI, 0.02-0.04). There was no difference between the two vasopressors in the incidence of true fetal acidosis (umbilical arterial pH value of Ͻ7.2; RR of 0.78; 95% CI, 0.16 -3.92) or Apgar score of Ͻ7 at 1 and 5 min. This systematic review does not support the traditional idea that ephedrine is the preferred choice for the management of maternal hypotension during spinal anesthesia for elective cesarean delivery in healthy, nonlaboring women.
Anesthesiology and Pain Medicine
Background: Local anesthetics for spinal anesthesia in one-single injection are known to induce more severe hypotension than a fractionated dose in healthy obstetric patients. Hypotension in obstetric patients with pregnancy-induced hypertension, including preeclampsia, during spinal anesthesia, could compromise fetal well-being. Objectives: This study aimed to compare the mean arterial pressure (MAP), the total dose of ephedrine required, and level of sensory blockade between the fractionated-dose and single-dose spinal anesthesia injection in obstetric patients with pregnancy-induced hypertension who underwent a cesarean section. Methods: This single-blind randomized clinical trial was conducted from January to April 2018 after being approved by the Research Ethics Committee of Universitas Indonesia (No. 1174/UN2.F1/ETIK/2017) and recorded at ClinicalTrials.gov (NCT03693638). After obtaining informed consent, 42 parturients with hypertension in pregnancy (gestational hypertension or preeclampsia), ASA II-III, aged 18-40 years, and BMI of 18.5-35 kg/m 2 with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (Marcaine TM , Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD). Results: There was no significant difference between the two groups in MAP in the first 15 minutes after anesthesia (P > 0.05) and median total dose of ephedrine required (10 (0-25) mg in the FD group vs. 15 (0-30) mg in the SD group, P = 0.30). However, in the FD group, MAP tended to be higher in the first three minutes compared to the SD group. The level of sensory blockade was mostly at T4, which was not significantly different between the groups (52.4% in FD vs. 42.9% in SD, P = 0.59). Conclusions: In obstetric patients with pregnancy-induced hypertension who underwent a cesarean section, the mean arterial pressure after spinal anesthesia was not significantly different between the fractionated dose of spinal anesthesia injection and single-dose injection. Total ephedrine required and levels of sensory blockade were not significantly different between the groups.
Open Journal of Obstetrics and Gynecology, 2012
Background and Objective: The effectiveness of ephedrine and/or phenylephrine, in treatment of hypotension secondary to spinal anesthesia for cesarean section and their effects on fetal/neonatal outcome were studied. Methods and Materials: Sixty healthy parturients were randomly assigned to two groups; group E (n = 33) received boluses 5 mg/ml increments ephedrine and group P (n = 27) received a boluses of phenylephrine 100 µg/ml increments for treatment of hypotension after spinal block during cesarean section. Changes in maternal blood pressure and heart rate, and incidence of nausea-vomiting, neonatal Apgar score at 1 and 5 minutes of delivery, and umbilical arterial blood gas values were recorded. Results: There were no differences in treatment of hypotension following sympathectomy after spinal block with two drugs. Neonatal outcome was similar in two groups. There were not significant differences in umbilical arterial values in two groups. Conclusion: Ephedrine and phenylephrine are both effective vasopressores for treatment of hypotension associated to spinal block during cesarean section without adverse effects on infants/neonates.
Anesthesia & Analgesia, 2006
Hypotension remains an important side effect of spinal anesthesia for cesarean delivery. There is limited evidence that reducing the spinal dose has a favorable effect on maternal hemodynamic stability. We designed the present randomized trial to test the hypothesis that reducing the spinal dose of local anesthetics results in equally effective anesthesia and less maternal hypotension. Fifty term pregnant patients were randomly assigned to two study groups. In the HIGH-group combined spinal-epidural anesthesia was performed using 9.5 mg hyperbaric bupivacaine combined with 2.5 microg sufentanil. In the LOW-group combined spinal-epidural anesthesia was performed using 6.5 mg hyperbaric bupivacaine combined with 2.5 microg sufentanil. Demographic data, obstetrical data, visual analog scale score for pain, number of medical interventions for pain, maternal hemodynamics, and neonatal outcome were recorded. Patients in the HIGH-group experienced more pronounced and longer hypotensive periods as compared with the LOW-group. The mean lowest recorded systolic blood pressure was higher in the LOW-group (102 +/- 16 versus 88 +/- 16 in the HIGH-group; P &amp;amp;amp;amp;amp;lt; 0.05). More patients in the HIGH-group experienced hypotension compared with the LOW-group (68% versus 16%; P &amp;amp;amp;amp;amp;lt; 0.05). In the HIGH-group 15 patients required pharmacological treatment for hypotension compared with 5 in the LOW-group. Duration of effective anesthesia (block to cold sensation above or at T3) was longer in the HIGH-group as compared with the LOW-group (95 +/- 25 versus 68 +/- 18 min, respectively, P &amp;amp;amp;amp;amp;lt; 0.05). We conclude that small-dose spinal anesthesia (6.5 mg hyperbaric bupivacaine combined with sufentanil) better preserves maternal hemodynamic stability with equally effective anesthesia that is of shorter duration.
Prophylactic ephedrine and hypotension associated with spinal anesthesia for cesarean delivery
International journal of obstetric anesthesia, 1998
Hypotension commonly accompanies induction of spinal anesthesia for cesarean section. To determine whether intravenous ephedrine prophylaxis would benefit prehydrated obstetrical patients presenting for elective cesarean section, we studied 30 patients randomly assigned to one of three experimental groups. All patients were preloaded with crystalloid (15 ml/kg), given spinal anesthesia and positioned with left uterine displacement (LUD). During induction, all patients received a 2 ml intravenous bolus and intravenous infusion of the study drug or placebo. The control group (n=10) received a saline bolus and saline infusion, the bolus group (n=10) received an ephedrine bolus (10 mg) and a saline infusion and the infusion group (n=10) received a saline bolus and a two-stage ephedrine infusion (20 mg over 12 min). After induction of anesthesia, systolic blood pressure decreased in the first 5 min in all groups. Hypotension occurred in 6/10 control patients, 5/10 bolus patients and 5/10...
Pakistan Journal of Medical and Health Sciences, 2022
Background: Hypotension following spinal block can be reduced or minimized prophylactically left lateral uterine displacement, volume loading with crystalloid solutions, phenylephrine infusion or ephedrine administration. Fluid pre loading does not negate the hypotension entirely but decreases the risk. This however is time consuming and vasopressors are often required to correct associated hypotension. Prophylactic ephedrine administration lowers the risk of hypotension at the expense of reactive hypertension if spinal block fails and subsequent conversion to general anesthesia. Aim: To compare the efficacy of prophylactic use of ephedrine versus fluid (Hartmann's solution) preload in women undergoing cesarean section under spinal anesthesia at a teaching hospital. Study design: Randomized controlled trial. Place and duration of study: Department of Anesthesiology, Nishtar Hospital Multan, from 1 st March 2020 to 30 th September 2020. Methodology: A total of 100 women, twenty to forty years of age undergoing cesarean section were included. Patients with known hypertension, eclampsia, bleeding diathesis, injection site infection, deformity of spinal column or patients having valvular heart diseases were excluded. Group A women were given prophylactic ephedrine while Group B were given fluid (Hartmann's solution) preload. After induction of spinal anesthesia continuous blood pressure monitoring was done for fifteen minutes to diagnose hypotension. Hypotension was noted and recorded by the researcher. Results: The mean age of women in group A was 28.04±6.07 years and in group B was 28.26±6.13 years. Majority of the patients, 56, were between twenty to thirty years of age. The mean BMI in group A was 29.06±3.37kg/m2 and in group B was 29.38±3.50 kg/m 2. Efficacy of prophylactic use of ephedrine to prevent hypotension was observed in 37(74%) patients and in 25(50%) patients in fluid preload group undergoing cesarean sections under spinal anesthesia. Conclusion: The frequency of hypotension is lower in parturient undergoing spinal anesthesia with prophylactic use of ephedrine as compared to women having fluid (Hartmann's solution) preload.