Anästhesiologisches Management der Sectio caesarea

Marcus, Hanke; Behrend, Albert; Schier, Robert; Dagtekin, Oguzhan; Teschendorf, Peter; Böttiger, Bernd W.; Spöhr, Fabian

doi:10.1007/s00101-011-1931-y

Cited by 36 publications

(25 citation statements)

References 24 publications

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“…Withdrawing from the use of intrathecal morphine could be discussed in context of other large studies that report usage of intrathecal opioids in obstetrics 5 - 7 .…”

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confidence: 99%

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

2017

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Background: Neuraxial opioids improve labour analgesia and analgesia after caesarean section (CS) and hysterectomy. Undesirable side effects and difficulties in arranging postoperative monitoring might influence the use of these opioids. The aim of the present survey was to assess the use of intrathecal and epidural morphine in gynaecology and obstetrics in Sweden. Methods: A questionnaire was sent to all anaesthetic obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia. Results: A total of 32 of 47 (68%) units responded representing 83% of annual CS in Sweden. In CS spinal anaesthesia, 20/32 units use intrathecal morphine, the most common dose of which was 100 μg (17/21). Intrathecal fentanyl (10-20 μg) was used by 21 units and sufentanil (2.5 -10 μg) by 9/32 of the responding units. In CS epidural anaesthesia, epidural fentanyl (50-100 μg) or sufentanil (5-25 μg) were commonly used (25/32), and 12/32 clinics used epidural morphine, the majority of units used a 2 mg dose. Intrathecal morphine for hysterectomy was used by 20/30 units, with 200 μg as the most common dose (9/32). Postoperative monitoring was organized in adherence to the National Guidelines; the patient is monitored postoperative care or an obstetrical ward over 2-6 hours and up-to 12 hours in an ordinary surgical ward. Risk of respiratory depression/difficult to monitor was a reason for not using intrathecal opioids. Conclusions: Neuraxial morphine is used widely in Sweden in CS and hysterectomy, but is still restricted in some units because of the concern for respiratory depression and difficulties in monitoring.

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“…Withdrawing from the use of intrathecal morphine could be discussed in context of other large studies that report usage of intrathecal opioids in obstetrics 5 - 7 .…”

mentioning

confidence: 99%

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

2017

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“…16,17 Considering the global situation, there is an increase in the use of regional anaesthesia techniques in Germany after 2002, and it has been reported that the most frequently used anaesthetic method in caesarean section surgeries is SA with a 90.8% usage rate. 18 In Spain, the usage rate of regional anaesthesia in caesarean sections is 98%, and among them the usage rate of SA is 75%. 19 In our study, the use of RA in CS was 90.76% and both in elective and emergency cases mostly RA was used.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of anaesthetic techniques for caesarean

2018

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Background: The anaesthetic technique to be used in Caesarean section is determined according to factors such as urgency, presence of coexisting health problems, preference of patient and preference and experience of the anaesthetist and surgeon.Methods: This is a retrospective study of all the caesarean deliveries that occurred in the period between 1st Jan 2010 to 31st Dec 2017 in the department of obstetrics and Gynaecology in Silchar Medical College. The anaesthesia techniques used for caesarean sections were evaluated in this study. Anaesthesia methods were recorded as general anaesthesia (GA) and regional anaesthesia (RA), and RA was classified into spinal anaesthesia (SA), epidural anaesthesia (EA) and combined spinal epidural anaesthesia (CSEA) subgroups.Results: During the study period a total of 75685 patients delivered and 25805 patients had undergone caesarean section. The caesarean section rate at the institution comes to be around 34.1%. Among the indications, it was observed that foetal distress (32.8%) was the commonest cause followed by post caesarean pregnancy (26.76%). The majority of the CS (75.6%) were done as an emergency procedure. Regional anaesthesia was the most frequently used method both in emergency (92.87%) and elective caesarean section (84.21%). SA was the commonest used RA (89.2%).Conclusions: In recent years, the rate of regional anaesthesia administration in caesarean section is gradually increasing, and the spinal anaesthesia technique is the mostly preferred regional anaesthesia. There is need to explore the use of the other forms of regional anaesthesia also.

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“…If morphine is not used as intrathecal adjunct, like e.g. in Germany [18], a TAP block may be of potential benefit in this setting.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound anatomy of the transversus abdominis plane region in pregnant women before and after cesarean delivery

et al. 2016

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BackgroundAfter cesarean delivery, analgesia is often incomplete and a multimodal approach to analgesia is necessary. Transverse abdominal plane (TAP) block has been advocated in this setting, yet no systematic description of the ultrasound anatomy in pregnant women exists in the literature. Therefore, we aimed to describe the sonographical features of relevant structures in pregnant women before and after elective cesarean.MethodsSixty women at, or close to term scheduled for elective cesarean delivery underwent a standardized ultrasound examination before and after delivery. We assessed the visibility of the muscular layers and measured the distance from the skin to the layers of the abdominal wall muscles in the region for TAP block before and after cesarean section on both side.ResultsThe three muscular layers of the lateral abdominal wall (external oblique, internal oblique and transversus abdominis muscle) were visible in all examinations. Before cesarean section the median TAP distance was shorter: 2.9 cm (interquartile range 2.6–3.6) compared to 3.9 cm (3.1–4.5) after cesarean section (left side, p < 0.001). The external and internal oblique muscles were located closer to the skin surface before cesarean section. An increased body mass is associated with increased the TAP distance before and after birth (p < 0.001).ConclusionRelevant anatomical landmarks for a TAP block are sonographically well visible after cesarean delivery. Postoperatively, depth of the TAP as compared to before birth is increased significantly. Scanning the abdominal wall before CD will underestimate the target depth of the TAP after delivery. The obstetric anesthetist needs to be aware of these changes when planning a TAP block in the context of cesarean delivery.

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Anästhesiologisches Management der Sectio caesarea

Cited by 36 publications

References 24 publications

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

Evaluation of anaesthetic techniques for caesarean

Ultrasound anatomy of the transversus abdominis plane region in pregnant women before and after cesarean delivery

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