Spinal anesthesia hypotension in elective cesarean section in parturients wearing extra-strong compression stockings

Abstract

We have routinely applied an extra-strong graduated compression stocking to cesarean section patients to reduce the incidence of spinal anesthesia hypotension. Because bupivacaine has recently become available in Japan, we compared the incidence of spinal hypotension using either 2.0 ml of hyperbaric 0.3% dibucaine or 0.5% bupivacaine. There were 98 full-term parturients wearing the stocking who received 2.0 ml injection of dibucaine or bupivacaine for elective cesarean section. When systolic blood pressure decreased to 90-100 mm Hg or to less than 70% of the pre-anesthesia value, ephedrine was injected intravenously. There was no significant difference in systolic blood pressure or heart rate during spinal anesthesia between the dibucaine and bupivacaine groups. Although the demographic data and various data related to anesthesia or surgery were similar in the groups, the fluid volume and the dose and incidence of ephedrine injection during anesthesia showed significant differences: the mean dose was 3.6 and 1.5 mg and the incidence was 41% and 19% in the dibucaine and bupivacaine groups, respectively. Spinal anesthesia using bupivacaine results in a lower incidence of spinal hypotension compared with dibucaine and, in combination with fitting the extra-strong stockings onto both legs, is clinically useful for cesarean sections.

Assessment of psychological tension after premedication by measurement of salivary chromogranin A

“…Cephalad placement at 7 cm is our regimen to prevent catheter migration from the epidural space [15]. Thereafter, 8 to 10 mL of 1% ropivacaine was injected epidurally according to our formula for estimating anesthetic spread [16], which was then confirmed by ice packed in a surgical glove that also is our routine regimen [17,18]. The patient was given general anesthesia using propofol alone according to our anesthetic protocol [19][20][21].…”

Effect of Lower Limb Compression Stockings on Hemodynamic Stability in Obstetric Patients undergoing Lower Segment Cesarean Section under Spinal Anaesthesia

“…It occurs in 80-85% of pregnant women after spinal anaesthesia and presents with symptoms of nausea, vomiting or apprehension. 7,8 Preloading with crystalloids, use of inotropic agents (Ephedrine and phenylephrine etc. ), prevention of aortocaval compression, use of compression stockings, and initial frequent blood pressure monitoring prevent hemodynamic instability.…”