Hyperbaric Bupivacaine for Spinal Anesthesia in Cesarean Section

Santos, Alan C.; Pedersen, H.; Finster, Mieczyslaw; Edström, H. H.

doi:10.1213/00000539-198411000-00009

Cited by 55 publications

(31 citation statements)

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“…The mother's head was rested on two pillows, primarily lor comfort but also to limit the ascent of blockade. Oxygen was given at a rate of [4][5] litres; minute until delivcry of the infants. lntravcnous ephedrine was given in 3-6-mg increments if hypotension less than 90 rnmHg systolic occurred.…”

Section: Tcchniquementioning

confidence: 99%

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Subarachnoid anaesthesia for elective Caesarean section

et al. 1988

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The use of extradural analgesia in operative obstetrics has been investigated and retined in recent years so that it has become an established, safe and generally reliable method to provide anaesthesia for lower segment Caesarean section. Thc use of a two-stage top-up technique' has been particularly effettive in achieving adequate analgesia without blockade that extends to cervical segments. Subarachnoid anaesthesia is less well established in this area and the use of an isobaric agent, such as 0.5% bupivacaine plain solution, has been shown to be unreliable and to produce occasional high blocks.*-' The aim of this study was to identify a technique of subarachnoid anaesthesia that would produce adequate analgesia for a sufficient duration of time but without dangerously high blockade. The volumes chosen of the respective agents were based on our previous clinical experience. MethodsMothers admitted to the study were those who had requested regional analgesia for their elective Caesarean section arid had given conscnt for spinal anaesthesia. They were randomly allocatcd to two groups: 20 received 2.0 ml O.S"/i, cinchocaine in 64'0 dextrose, and 20 received 2.5 ml 0.5'.;, hupivacainc in 8"% dextrose. Tc.chniqueIn all mothers the circulation was prcloaded with 1 .S litres Hartmann's solution given over 20.-30 minutes before injection of local anaesthetic. Lumbar puncture was performed at the level of the Lz , interspace. using a %-gauge spinal needle with the niothcr o n the operating table in thc left lateral position. L,,2 or L, were used only if lumbar puncture was not possible at Lz 3. The predetermined volume of local anaesthetic was then injected over [20][21][22][23][24][25][26][27][28][29][30] seconds without barhotage. and the mother immediately returned to the supine position with left lateral tilt to avoid aortocaval compression. The mother's head was rested on two pillows, primarily lor comfort but also to limit the ascent of blockade. Oxygen was given at a rate of 4-5 litres; minute until delivcry of the infants. lntravcnous ephedrine was given in 3-6-mg increments if hypotension less than 90 rnmHg systolic occurred. Ub s~~r v u i i o n sObservations were made on a double-blind basis in that the assessor had no knowledge of the agent or volume used. Arterial blood prcssure and heart rate were recorded at one-minute intervals for 5 ininutcs and thereafter every 5

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Section: Tcchniquementioning

confidence: 99%

“…Arterial blood prcssure and heart rate were recorded at one-minute intervals for 5 minutcs, using an automated, noninvasive device (CritikonDinam;tp 845). Cutaneous analgesia levels were determined by pinprick at 5-minute intervals.…”

Section: Ub S~~r V U I I O N Smentioning

confidence: 99%

Subarachnoid anaesthesia for elective Caesarean section

et al. 1988

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“…After the discovery of opioid receptors in spinal cord and direct opioid action at this level, possibility of synergism between opioids and local anaesthetics ,, co administered intrathecally has been explored extensively in obstetric population undergoing caesarean delivery. 1,2,3,4 The presumed underlying mechanism is that spinal anesthetic blocks ascending somatosensory drive on to reticulo-thalamocortical projection pathways, thereby reducing their excitability and hence decreasing the arousal level of brain. Furthermore, muscle spindle activity regulates the excitability of brain and arousal system.…”

Section: Introductionmentioning

confidence: 99%

“…Bupivacaine is a long acting amide local anaesthetic with duration of action of 1 ½ -2 hours it produces adequate pain relief, without a major effect on motor fibers. 1,2,3 Fentanyl is one of the most extensively used opioids for this purpose. It improves the quality of sensory blockade intra-operatively without increasing sympathetic or motor blockage, it also enhances the quality and duration of post-operative analgesia to a significant extent and has been found to be safe and effective both in terms of neonatal and maternal outcome not only in normal parturients but also in severely preeclamptic patients for labour analgesia and elective caesarean section.…”

Section: Introductionmentioning

confidence: 99%

A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH 25 mcg FENTANYL IN SPINAL ANAESTHESIA IN OBSTETRIC PATIENTS UNDERGOING ELECTIVE LSCS

Abhinav¹,

Harshavardhan²

2015

jemds

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“…Dieses beinhaltet Symptome wie das ständige Wiedererleben der Ereignisse, teils in immer wiederkehrenden Alpträumen, einem Vermeidungsverhalten von Situationen, die vom Patienten mit dem Ereignis in Verbindung gebracht werden und die ständige Angst, eine derartige Episode könne ihnen noch einmal widerfahren. [29,45]. Die postoperativen Verhaltens-und Befindlichkeitsstörun-gen, bis hin zu schweren Depressionen, können zum Teil jahrelang anhalten und das weitere Leben des Patienten erheblich beeinflussen.…”

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Messung der Narkosetiefe, Awareness und EEG

Daunderer¹,

Schwender²

2001

Der Anaesthesist

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Inapparent adverse intraoperative wakefulness is still a relevant problem in modern anaesthetic routine. It can be associated with serious negative effects on the postoperative recovery of the patients. Several different procedures have been developed to monitor and therefore avoid intraoperative situations of wakefulness during general anaesthesia. The most promising methods are the PRST-score, calculated from changes in the blood pressure, heart rate, sweating and tear production, the so-called isolated forearm technique, spontaneous EEG and its derived parameters such as spectral edge frequencies or BIS and finally mid-latency auditory evoked potentials. The observation of clinical autonomic signs, even including the calculation of the PRST-score does not seem to be valid enough to indicate or predict intraoperative wakefulness. The isolated forearm technique can be regarded as the most reliable tool to detect intraoperative wakefulness, but it can only be applied for a very limited period of time. The processed EEG with the median frequency, spectral edge frequency or bispectral index are important scientific tools to quantify central anaesthetic effects especially to develop pharmacodynamic-pharmacokinetic models of anaesthetic action. But they seem to be less suitable to indicate situations of intraoperative wakefulness or awareness. The mid-latency auditory evoked potentials are depressed dose-dependently by a series of anaesthetic agents, which correlate with the occurrence of situations of intraoperative wakefulness and awareness. There is a hierarchical correlation between certain values of the MLAEP and intraoperative wakefulness defined by purposeful movements, amnesic awareness with only implicit recall and conscious awareness with explicit recall. For some of the most commonly used anaesthetics reasonable threshold values of the MLAEP for the different states of consciousness have already been determined. Future studies in broad patient populations with all of the different routinely used anesthetics and procedures will have to finally identify the importance of the recording of mid-latency auditory evoked potentials as a routine method to assess the depth of anaesthesia.

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Hyperbaric Bupivacaine for Spinal Anesthesia in Cesarean Section

Cited by 55 publications

References 0 publications

Subarachnoid anaesthesia for elective Caesarean section

Subarachnoid anaesthesia for elective Caesarean section

A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH 25 mcg FENTANYL IN SPINAL ANAESTHESIA IN OBSTETRIC PATIENTS UNDERGOING ELECTIVE LSCS

Messung der Narkosetiefe, Awareness und EEG

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