BackgroundSuccess of spinal anesthesia in pregnant females is strongly influenced by the position of the patient at the time of spinal insertion. Pendant position is a new position introduced to increase the intervertebral spaces. The current study aimed at comparing successful spinal puncture among the patients with pendant position in comparison with the ones with traditional sitting position for the elective caesarean section.MethodsThe current study was a non-blinded, randomized controlled trial (RCT) (registration code: NCT02753660 (ClinicalTrial.gov) on pregnant females undergoing spinal anesthesia. The participants were divided into 2 groups by the random consecutive sampling method; group A (pendant position) and group B (traditional sitting position). The successful placement of spinal needle was determined by the number of attempts, the amount of bone contact, and the time of spinal puncture. The inclusion criteria were pregnant females aged 18 to 45 years, body mass index (BMI) of 18 to 35 kg/m2, and the physical status I to III, based on American society of anesthesiologists classification (ASA).ResultsFollowing the approval of the ethical committee, 308 subjects were enrolled in the study. The rate of successful puncture on the 1st attempt of group A was significantly high (92% vs. 78%, P value = 0.001). Additionally, group A had significantly less total amount of bone contact (185 vs. 421, P value < 0.001) and shorter time for spinal puncture (9 seconds vs. 12 seconds, P value < 0.001).ConclusionsPendant position was significantly better than traditional sitting position to provide successful 1st attempt spinal puncture in pregnant females undergoing cesarean section.

BackgroundLocal 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.ObjectivesThis 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.MethodsThis 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/m2 with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (MarcaineTM, Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD).ResultsThere 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).ConclusionsIn 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.

Background:The practice of anesthesia requires good awareness, parallel decision-making and fine motor skills. The duration of working hours of anesthesiology residents is often more than 12 hours.Objectives:This study aimed to measure cognitive and psychomotor functions of anesthesiology residents after 12 working hours.Patients and Methods:This was an observational study on anesthesiology residents who underwent 12 working hours. Each subject, who fulfilled inclusion and exclusion criteria, had their cognitive and psychomotor functions tested at 0 and 12 hours. The cognitive function was measured by “Cognitive Stimulation” test, while the psychomotor function was measured by the grooved pegboard. Statistical analysis was conducted to compare the results between 0 and 12 hours.Results:Cognitive Stimulation” test revealed statistically significant decrease at sequential image frequency stimulation (P = 0.035). Other stimulation tests did not show any statistically significant result. Grooved pegboard test showed statistically significant decrease in psychomotor function from 0 to 12 hours (P = 0.037).Conclusions:There was a decrease in cognitive function, including attention, visual memory, naming, and executive function, as well as psychomotor function among residents of Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, who underwent 12 working hours.

Background Maternal hypotension in cesarean delivery related to spinal anesthesia results in increasing morbidity of both mothers and children. Studies show that low dose spinal anesthesia was able to prevent hypotension while providing adequate analgesia. However, the dose used in those studies varies and this leaves the debate of the dose scheme of spinal anesthesia open. Objectives This study aimed to compare the effectiveness of 5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl with 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl to prevent hypotension in spinal anesthesia for cesarean delivery. Methods This study was a double-blinded randomized controlled trial of 112 mothers undergoing cesarean delivery with spinal anesthesia. The intervention group received 5 mg bupivacaine and 25 mcg fentanyl. The comparison group received of 7.5 mg bupivacaine and 25 mcg fentanyl. The primary outcome was the incidence of hypotension. The adequacy of anesthesia, duration of recovery from the motoric block, the quality of analgesia as perceived by patients and surgeons, and the side effects of anesthesia were also recorded. Results There was no difference of effectiveness to prevent hypotension in both groups. The 7.5 mg dose provided better adequacy of anesthesia as reflected in lower incidence of conversion into general anesthesia. More surgeons reported adequacy of relaxation in the 7.5 mg dose. The 5 mg dose offered faster motoric recovery and fewer side effects. Conclusions The dose of 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl can be used as a prevention measure against hypotension due to spinal anesthesia cesarean delivery.