Conversion of regional to general anaesthesia for caesarean section - A one-year prospective observational study (original) (raw)
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Spinal anaesthesia for caesarean section: plain vs hyperbaric bupivacaine
JPMA. The Journal of the Pakistan Medical Association, 2012
To compare the clinical characteristics of sensory and motor block as well as haemodynamic stability using plain and hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Two equal groups were formed from a total of 60 patients who were enrolled in this prospective randomised double-blinded study that was done at tertiary care hospital in Karach, during 2005 to 2006. Equal volume of plain and hyperbaric bupivacaine 10 mg with 25 mcg of fentanyl was used for spinal anaesthesia in the two groups that were formed on the basis of random allocation. Characteristics of sensory and motor block, episodes of hypotension and bradycardia as well as use of ephedrine and atropine were recorded by blinded investigator. There was no difference in the onset of block, time to achieve maximum level of block and haemodynamic parameters between the two groups. However, plain bupivacaine took more time for two dermatomes sensory level regression below T4, and resulted in prolonged block du...
IP Innovative Publication Pvt. Ltd., 2018
Introduction: A prospective observational study was conducted in 4085 caesarean sections performed under Regional anaesthesia (RA) from February 2014 to January 2017 in tertiary care centre. The incidence and various contributing factors leading to total or partial failure of RA and the conversion rate to GA were determined. Materials and Methods: All parturients posted for elective or emergency caesarean section received 10-12 mg 0.5% of hyperbaric bupivacaine added to 25 µg of inj. Fentanyl, administered through a 25-27G Whitacre needle. A structured proforma was prepared to note the demographic data, type of RA, insertion position, position after insertion, local anesthetic volume, loss of sensation to pin prick and grade of motor block. Results: In this 3 year period 4085 CS were performed, out of which 4054 (99.27%) were conducted under RA, [4034 (99.5%) under spinal anesthesia, 14 (0.34%) under CSE and 6 (0.14%) under epidural]. 30 (0.73%) cases received GA primarily, the incidence of conversion rate from neuroaxial anesthesia to GA was 100 (2.5%) out of which 1.77% were of elective surgery and 3.1% were in emergency surgery. Partial failure occurred in 1.68% and complete failure in 0.79% patients. Spinal failure occurred due to anesthetic factors like early start of surgery, before establishment of adequate block, inadequate dose of LA, inappropriate recording of block, ineffective batch of drug and technical or surgical factors. Conclusion: Minimizing the incidence of block failure requires close attention to minute details. Keywords: Failed Spinal, Failed Intubation, Regional Anesthesia.
Survey of Anesthesiology, 2017
The purpose of this retrospective cohort study was to investigate factors associated with failed and high spinal blocks in patients who received spinal anesthesia for Cesarean delivery following a labour epidural that was inadequate for surgical anesthesia. Methods We searched our perioperative database for women with a labour epidural who received spinal or combined spinal-epidural anesthesia for Cesarean delivery due to the inadequacy of the existing epidural. The primary outcome was the occurrence of failed spinal blocks, and the secondary outcome was the occurrence of high blocks following spinal administration. Results Of the 263 patients in the analysis, there were 29 (11%) failed spinals and nine (3%) high spinals. There was a significant difference between patients with failed spinals and those with successful spinals with regards to receipt of an epidural top-up dose for Cesarean delivery within 30 min of the spinal, type of neuraxial block, body mass index, age, and dose of hyperbaric bupivacaine. In a multivariable analysis, only receipt of an epidural top-up dose was associated with failure (OR, 6.0; 95% CI, 2.1 to 17.0; P \ 0.001). As for the risk of a high spinal, patient characteristics and block details were not different amongst patients, except for a younger age in those with a high block. Conclusions Administration of spinal anesthesia within 30 min of an epidural top-up dose is associated with increased
Retrospective Evaluation of Anaesthetic Techniques for Caesarean
Turkish journal of anaesthesiology and reanimation, 2015
This study aimed to evaluate the maternal, foetal and neonatal effects of anaesthetic techniques used in caesarean sections (C/S) retrospectively over 6 years at the Hospital of Medical School of Dokuz Eylül University and to compare the results with the literature from Turkey and developed countries. After obtaining approval from the ethics committee, anaesthetic and gestational data from all caesarean operations performed over a 6-year period between 2005 and 2010 was retrospectively obtained from hospital archives. During this period, a total of 10,819 labours was conducted and C/S ratio was 55% with 5953 patients. General anaesthesia was performed in 1479 patients (24.8%) and regional anaesthesia was performed in 4474 patients (75.2%) [Spinal anaesthesia for 1203 patients (26.9%), epidural anaesthesia for 830 patients (18.5%) and combined spinal-epidural anaesthesia for 2441 patients (54.6%)]. In 2010, regional anaesthesia ratio increased to 84.6%, whereas in 2005, it was 63.8%....
Anaesthesia Techniques for Caesarean Operations: Retrospective Analysis of Last Decade
Turkish Journal of Anesthesia and Reanimation, 2014
Objective: The technique of anaesthesia in caesarean sections is selected according to the patient's clinical presentation, experience of the anaesthesist and the patient's wishes. The purpose of this study was to evaluate the anaesthesia methods employed in our clinic in the last decade (2003-2012). Methods: Records of caesarean operations performed between 2003-2012 in the Anaesthesia department of Atatürk University Medical Faculty and stored in the hospital computer system were examined. The annual distribution of methods of anaesthesia in operations was analysed. Results: During 2003-2012, 9049 caesarean operations were performed in our clinic. General anaesthesia was used in 45% of operations and regional anaesthesia in 54%. Whereas the rate of regional anaesthesia in 2003 was 34%, this increased to 69% in 2012. The most commonly used method of regional anaesthesia was spinal anaesthesia (34%) in 2003, and spinal anaesthesia (41%) and combined spinal-epidural anaesthesia (27%) in 2012. Conclusion: The most commonly used anaesthesia technique for caesarean operations in our clinic between 2003-2012 was spinal anaesthesia. The most widely used regional anaesthetic method in our clinic was spinal anaesthesia. A significant increase in the use of the combined spinal-epidural anaesthetic technique occurred in the last two years of the study period.
Sri Lankan Journal of Anaesthesiology, 2014
Results The median time to surgery were 8mins (IQR= 7.25-10) in group A and 8mins in group B (IQR= 8-10) and that to delivery were 12mins (IQR= 10-14.75) in group A and 11mins (IQR= 10-13) in group B, both being statistically insignificant (p value= 0.47 and 0.19). Other time limits were also comparable in both the groups. The haemodynamic parameters did not reveal any significant difference between the groups. Conclusion Category 1 caesarean section can be performed effectively adopting rapid sequence spinal anaesthesia in comparable lower doses as used during routine caesarean section.
European Journal of Anaesthesiology, 2008
Background and objective: Epidural volume extension via a combined spinal-epidural is the enhancement of a small-dose intrathecal block by an epidural injection of physiological saline solution. We evaluated the effect of epidural volume extension on the combined spinal-epidural technique of providing spinal anaesthesia for Caesarean section with hyperbaric or plain 0.5% bupivacaine. Methods: Patients (n 5 240) with height .163 cm received 9 mg and patients ,163 cm received 8 mg of bupivacaine. Each study drug was combined with 20 mg fentanyl. Using the combined spinal-epidural technique, Group A (n 5 60) received hyperbaric bupivacaine, and Group B (n 5 60) received hyperbaric bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. Group C (n 5 60) received plain bupivacaine and Group D (n 5 60) received plain bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. An anaesthetist blinded to the anaesthetic solution injected examined the level of analgesia by the pinprick method and motor block with the modified Bromage scale for 30 min after subarachnoid injection, during the intraoperative period and subsequently every 15 min for 135 min during the recovery period. Results: Time to reach a sensory block at T4 was significantly shorter in Groups C and D than in Groups A (P 5 0.003 and 0.017) and B (P 5 0.006 and 0.048), respectively. During the intraoperative period, sensory block levels were significantly higher in Group C than in Group A. Recovery was similar in all groups; only onset was faster in Groups C and D. Conclusion: There was no effect of epidural volume extension on the profile of spinal anaesthesia with the combined spinal-epidural technique for Caesarean section using hyperbaric or plain bupivacaine.
2016
Introduction: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to compare the clinical effects (sensory block, motor block, hemodynamic effects, Apgar score at 1 and 5 minutes and adverse effects if any) of intrathecal 2.5 ml 0.5% isobaric levobupivacaine with 2.5 ml 0.5% hyperbaric bupivacaine in spinal anaesthesia for lower segment caesarean section. Material and Methods: 150 pregnant women in ASA I II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. The combinations 12.5 mg levobupivacaine (0.5%) for Group L (n = 75) patients, 12.5 mg hyperbaric bupivacaine (0.5%) for Group B (n = 75) patients were intrathecally administrated a total of 2.5 cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Modified Br...
Pakistan Armed Forces Medical Journal, 2019
Objective: To compare the effect of 7.5mg versus 10mg of 0.75% hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesia, Combined Military Hospital Rawalpindi, from Sep 2014 to Mar 2015. Material and Methods: One hundred and thirty patients fulfilling the inclusion/exclusion criteria were included in this study and they were divided into two groups. Group A was given 7.5mg and group B was given 10mg of 0.75% Bupivacaine. Blood pressure was recorded before and 03 minutes after administration of spinal anesthesia. Findings were recorded in the proforma. All the data collected through proforma was entered in the Statistical Package for Social Sciences (SPSS) Version 13.0 and analyzed using its statistical package. Results: The mean age in group A was 30.58 ± 3.12 years and in group B was 28.32 ± 2.53 years. The mean weight in group A was 64.45 ± 3.99 kg and in group B was 65.00 ±...