Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section

McNaught, A.F.; Stocks, Gary M.

doi:10.1016/j.ijoa.2007.03.013

Cited by 57 publications

(39 citation statements)

References 69 publications

(89 reference statements)

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“…(45,46) The drawback of lowering the doses (<5mg) was the increasing incidence of spinal block failures with pain, slower onset and shorter duration of the block and also the increasing rate of conversions into general anaesthesia. (42,44,47,48) In contrast to the above mentioned studies, Langesaeter et al (20) showed that there was a difference in the incidence of hypotension with the same sensory block level, but a different local anaesthetic dosage. According to the above described findings, the focus of our study was the level of spinal block as the underlying factor for the difference in haemodynamic parameters during a spinal anaesthesia excluding different doses and/ or baricities of local anaesthetic.…”

Section: Discussionmentioning

confidence: 98%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Section: Discussionmentioning

confidence: 98%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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“…The conclusion of majority of studies was that with a lower dose of the local anaesthetic patients were more haemodynamically stable and that it was most probably the consequence of a different level of sympathetic block (45,46). The drawback of lowering the doses (<5mg) was the increasing incidence of spinal block failures with pain, slower onset and shorter duration of the block and also the increasing rate of conversions into general anaesthesia (42,44,47,48). In contrast to the above mentioned studies, Langesaeter et al (20) showed that there was a difference in the incidence of hypotension with the same sensory block level, but a different local anaesthetic dosage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

2017

View full text Add to dashboard Cite

Background: For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods: in a prospective, randomized study 44 ASA 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results: The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant

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“…An alternative CSE technique is the extradural volume extension (EVE) technique [43][44][45]. In this technique, spinal administration of a small dose of local anesthetic is followed by the administration of saline through the epidural catheter.…”

Section: Spinal Epidural Combined Spinal-epidural or General Anesthmentioning

confidence: 99%

“…In this technique, spinal administration of a small dose of local anesthetic is followed by the administration of saline through the epidural catheter. Although there were conflicting findings, this technique has been related to a higher rostral spread of the blockade [43][44][45]. Table 2 demonstrates the main differences regarding the various neuraxial anesthetic techniques for cesarean delivery.…”

Section: Spinal Epidural Combined Spinal-epidural or General Anesthmentioning

confidence: 99%

“…However, a satisfactory block has been reported with plain bupivacaine drug doses as low as 4.5 mg [57]. Nonetheless, the CSE technique may use a lower dose of spinal bupivacaine (7.5 to 10 mg) followed by incremental injection of local anesthetic through the epidural catheter to achieve a T4 level of anesthesia [43,44], a procedure called sequential CSE. The purported advantage of this approach is a lower incidence of hypotension.…”

Section: Spinal Epidural Combined Spinal-epidural or General Anesthmentioning

confidence: 99%

See 1 more Smart Citation

Evidence-Based Obstetric Anesthesia: An Update on Anesthesia for Cesarean Delivery

Schmidt¹,

Auler²

2012

Cesarean Delivery

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Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section

Cited by 57 publications

References 69 publications

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Evidence-Based Obstetric Anesthesia: An Update on Anesthesia for Cesarean Delivery

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