Strategies for prevention of spinal-associated hypotension during Cesarean delivery: Are we paying attention?

Uppal, Vishal; McKeen, Dolores M.

doi:10.1007/s12630-017-0930-0

Cited by 13 publications

(11 citation statements)

References 15 publications

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“…A single, small case series suggested the possibility of excessive intra-operative hypotension when prophylactic vasopressors were not used [17]; however, hypotension following neuraxial anaesthesia has not otherwise been reported. Anaesthetists should be prepared to manage hypotension following neuraxial procedures as for any other patient [57,58].…”

Section: Recommendationsmentioning

confidence: 99%

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

et al. 2020

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Summary Coronavirus disease 2019 (COVID‐19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID‐19 contamination in operating rooms and significantly exposes the healthcare teams to COVID‐19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol‐generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID‐19 pandemic are limited. The goal of this review is to provide up‐to‐date, evidence‐based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID‐19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post‐anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.

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Section: Recommendationsmentioning

confidence: 99%

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

et al. 2020

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“… Si el paciente requiere oxígeno suplementario, este se debe administrar por cánulas nasales a un flujo ≤ 2 l, para evitar la propagación de aerosoles. Se recomienda prevenir y tratar los episodios de hipotensión arterial asociados a la anestesia intradural con vasoconstrictores 31 , 32 . Los pacientes con anestesia regional deben llevar siempre una mascarilla quirúrgica o una máscara N95 durante el tiempo que permanezcan en el quirófano (tengan o no cánulas nasales o máscara cerrada), para reducir la propagación de gotas.…”

Section: Fracturas Por Fragilidad De La Cadera Y Covid-19unclassified

“…Se recomienda prevenir y tratar los episodios de hipotensión arterial asociados a la anestesia intradural con vasoconstrictores 31 , 32 .…”

Section: Fracturas Por Fragilidad De La Cadera Y Covid-19unclassified

COVID-19 y fractura por fragilidad de la cadera. Recomendaciones conjuntas de la Sociedad Española de Fracturas Osteoporóticas y la Sociedad Española de Geriatría y Gerontología

Caeiro-Rey

Ojeda-Thies

Cassinello

et al. 2020

Revista Española de Geriatría y Gerontología

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“…Hypotension occurred in 65 of 125 cases (52%) and was A mean ephedrine dose of 10.15 ± 6.31 mg was used in these patients; the mean dose administered for all patients was 5.28 ± 6.81 mg. Four patients required atropine for bradycardia (Table 5). The median maximum sensory block level was 4 (2-5) in hypotensive patients and 4 (3)(4)(5) in the other subjects. Correlation analyses showed an inverse relationship between BMI and maximum sensory block level (P ˂ 0.0001) (Table 3).…”

Section: Resultsmentioning

confidence: 89%

“…These findings may be because patients in the group without hypotension were taller than those in the group that developed hypotension (mean height 164.22 ± 6.52 cm and 161.75±5.6 cm, respectively). Thus, the median maximum sensory block level was T4 (2)(3)(4)(5) in the hypotensive patients and T4 (3)(4)(5) in the other subjects.…”

Section: Discussionmentioning

confidence: 84%

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Günüşen¹,

Sargın²,

Akdemir³

et al. 2019

Turk J Med Sci

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Introduction Spinal anesthesia is a safe, simple, rapid, effective, and easy-to-apply anesthetic technique for cesarean sections. Despite the advantages of spinal anesthesia, hypotension is a common complication with an incidence of 70%-85% in parturients (1-4). Many factors including the characteristics of the injected solution, patient position, age, height, weight, pregnancy, intraabdominal pressure (IAP), length of the vertebral column, and lumbosacral cerebrospinal fluid (CSF) volume determine the intrathecal spread of local anesthetics. In obstetric patients, physiological changes due to pregnancy, including changes in spinal curvature, venous pooling secondary to progesterone-induced decreases in vascular tone and aortocaval compression by the gravid uterus, contribute to hypotension during cesarean section under regional anesthesia (1-6). Many recent studies have addressed the effects of uterine size, abdominal girth, and IAP on sensory block level, ephedrine dose, and the incidence of hypotension in pregnant women. Large abdominal girth, big uterus, and increased IAP may be significant factors in greater cephalad spread of local anesthetics. The mechanisms explained in these studies are that the increased IAP secondary to the compression of the inferior vena cava due to the growing uterus leads to a reduction in CSF in the spinal canal (1,7-14). We hypothesized that there may be differences in the sensory block level and ephedrine requirements among pregnant women based on uterine size and the presence of abdominal obesity. The primary purpose of this study was to determine whether there is a relationship between uterine size and sensory block level and ephedrine dose in parturients receiving spinal anesthesia. Since Katulanda et al. (15) reported that the distance between the lower border of the xiphisternum and the center of the umbilicus could be used as an anthropometric measure to define abdominal obesity, we considered SPX to be a marker of both abdominal obesity and uterine size that contains abdominal obesity, easily identified anatomical landmarks Background/aim: Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methods: This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results: Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block leve...

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Strategies for prevention of spinal-associated hypotension during Cesarean delivery: Are we paying attention?

Cited by 13 publications

References 15 publications

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

COVID-19 y fractura por fragilidad de la cadera. Recomendaciones conjuntas de la Sociedad Española de Fracturas Osteoporóticas y la Sociedad Española de Geriatría y Gerontología

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

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