Levels of anaesthesia and intraoperative pain at caesarean section under regional block

Russell, I.F.

doi:10.1016/0959-289x(95)82995-m

Cited by 129 publications

(64 citation statements)

References 27 publications

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“…While situations will always exist in which a general anaesthetic is the most prudent management, premature or unnecessary abandonment of an adequate regional anaesthetic block, based on a single method of assessment, may result in the mother's being unable to participate in the birth experience, and risks maternal morbidity and even mortality. The inherent inaccuracy of assessment of block height has been well documented and considerable variation may exist between individual anaesthetists [10][11][12][13][14]. The critical importance of communication and the way anaesthetists question patients about their block have been emphasised [12].…”

Section: Discussionmentioning

confidence: 99%

“…However, the reliance on touch alone could lead to unnecessarily increasing the dose of local anaesthetic injected during spinal anaesthesia, delaying the start of caesarean section, or even abandoning perfectly adequate anaesthesia [7]. Modalities available to assess block height include the Neurotip TM (Owen Mumford, Oxford, UK), ethyl chloride spray and light pressure with a finger to assess touch; an 18-G needle to assess pinprick; and ethyl chloride spray, alcohol swab and ice to assess temperature [5,[8][9][10]. There are problems with some of these methods of assessment.…”

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Assessment of block height for satisfactory spinal anaesthesia for caesarean section

et al. 2012

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Assessment of block height for satisfactory spinal anaesthesia for caesarean section

et al. 2012

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“…1 Pour y parvenir, on procède par exemple à l'administration intrathécale de bupivacaïne hyperbare à des doses variant entre 9 et 12 mg à laquelle on rajoute un opiacé lipophile tel que le fentanyl (10-15 lg). L'hypotension artérielle (souvent arbitrairement définie dans les études comme étant une tension artérielle systolique \ 100 mmHg ou \ 80 % de la valeur de base) induite par la rachianesthésie est particulièrement fréquente et très souvent symptomatique chez la femme enceinte à terme (dans 55 % à 90 % des cas).…”

Section: La Physiologie De L'hypotension Maternelle Revisitéeunclassified

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Loubert

2012

Can J Anesth/J Can Anesth

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Purpose The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. Principal findings Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 lgÁmin -1 ) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In preeclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended.Conclusion A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Describe the main hemodynamic changes induced by spinal anesthesia in a pregnant woman undergoing a scheduled Cesarean delivery. 2. Recognize the clinical implications of those hemodynamic changes in the mother and fetus. 3. Explain the various strategies of vascular loading, and their main hemodynamic repercussions. 4. Assess the impact of using phenylephrine and ephedrine for the prevention and treatment of maternal hypotension. 5. Plan the fluid and vasopressor therapy in the case of an urgent Cesarean delivery.The increased popularity of regional anesthesia in clinical practice has led to a decrease in maternal mortality and morbidity related to complications in airway management. Spinal anesthesia is now the most popular technique for Cesarean delivery as it is easy to perform and provides a rapid onset, dense surgical block. It is not associated with a maternal or fetal risk of toxicity to local anesthetics. However, spinal anesthesia is often associated with significant maternal hypotension, with potentially significant consequences on maternal comfort, organ perfusion, and fetal well-being. Several studies suggest that the traditional approach that con...

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“…Because motor nerve fibers are typically larger and more difficult to block, the complete absence of hip flexion and ankle dorsiflexion most likely indicates that a functional sensory and sympathetic block is also present in a similar (primarily lumbosacral) distribution. However, because afferent nerves innervating abdominal and pelvic organs accompany sympathetic fibers that ascend and descend in the sympathetic trunk (T 5 to L 1 ), a sensory block that extends rostrally from the sacral dermatomes to T 4 should be the goal for cesarean delivery anesthesia [46][47][48]. The majority of anesthesiologists use the absence of cold temperature sensation to a T 4 level to indicate an adequate blockade height for cesarean delivery [46][47][48].…”

Section: Spinal Epidural Combined Spinal-epidural or General Anesthmentioning

confidence: 99%

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

Schmidt¹,

Auler²

2012

Cesarean Delivery

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Levels of anaesthesia and intraoperative pain at caesarean section under regional block

Cited by 129 publications

References 27 publications

Assessment of block height for satisfactory spinal anaesthesia for caesarean section

Assessment of block height for satisfactory spinal anaesthesia for caesarean section

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

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

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