The ongoing challenges of regional and general anaesthesia in obstetrics

Sia, Angelia; Fun, W. L. L.; Tan, Terry U.

doi:10.1016/j.bpobgyn.2009.12.001

Cited by 38 publications

(29 citation statements)

References 68 publications

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“…10 Spinal anaesthesia is a preferred anaesthetic technique as it is simple to perform, is rapid in onset and has a high success ratio, and provides excellent post-operative analgesia when intrathecal opioids are used. 11,12 Although the results of present study were akin to Khatri et al 13 yet it was distinctive as we added 20 µg Fentanyl as an adjuvant to prolong the neuraxial blockade and our choice of vasopressor was Phenylephrine unlike ephedrine as used by them. Fentanyl was chosen as an adjuvant homologous to study of Siddiqui et al 14 In the present study we compared the heart rate, the SBP, DBP and MAP after spinal anaesthesia in normotensive and severely pre-eclamptic parturients undergoing caesarean section and the Phenlyephrine requirements for managing hypotension in the same.…”

Section: Fig 1: Comparison Of Mean Arterial Pressurementioning

confidence: 51%

Intraoperative requirement of Phenylephrine for spinal anaesthesia, with comparison of hemodynamic parameters between severe pre-eclamptic and normotensive parturients for elective caesarean section: A prospective study

2020

IJCA

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Aim: The aim of this study is to assess the efficacy and safety of spinal anaesthesia by comparing the severity of hypotension and intraoperative requirement of Phenylephrine to treat it in severe pre-eclamptic and normotensive parturients undergoing elective caesarean section. Materials and Methods: A total of 50 parturients, 25 each of normotensive and pre-eclamptic were given spinal anaesthesia with 12.5mg of hyperbaric bupivacaine after preloading with 10ml/kg of Ringer lactate solution. The vitals namely heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the mean arterial blood pressure (MAP) were monitored during caesarean section. Severity of hypotension and the mean requirement of Phenylephrine to manage this hypotension were compared in the two groups. Foetal outcome was compared in two groups by studying the Apgar score. Results: There was statistically less hypotension following spinal anaesthesia and less requirement of vasopressor in preeclamptic as compared to normotensive parturients. The mean requirement of Phenylephrine was 156.3±62µg in normotensive (group I) and comparatively more than the requirements of pre-eclamptic (group II) parturients and was statistically significant (p<0.05). The Apgar score at 1 and 5 minutes were equal in both the groups. Conclusion: Spinal anaesthesia is ideal and safe option for severe pre eclamptics undergoing elective caesarean section without any additional risk to baby. IntroductionPre-eclampsia in severe form creates risks for the parturient and fetus. The reported incidence of preeclampsia in obstetrics practice is 5-7%.

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Section: Fig 1: Comparison Of Mean Arterial Pressurementioning

confidence: 51%

Intraoperative requirement of Phenylephrine for spinal anaesthesia, with comparison of hemodynamic parameters between severe pre-eclamptic and normotensive parturients for elective caesarean section: A prospective study

2020

IJCA

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“…It also provides excellent post-operative analgesia when intrathecal opioids are used. [303132] It has no effect on Apgar scores and umbilical artery pH in preeclampsia as along as the systolic blood pressure is maintained greater than 80% or more of the baseline. [33] The incidence of spinal induced hypotension and the vasopressor requirement were found to be two times lower in preeclamptic parturients when compared with normal parturients undergoing CS delivery.…”

Section: Anesthetic Considerations For Cesarean Delivery In Pih Withomentioning

confidence: 99%

Regional anesthesia in patients with pregnancy induced hypertension

Ankichetty

Chin

Chan

et al. 2013

J Anaesthesiol Clin Pharmacol

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Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.

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“…GA should be used with caution as inhalational anaesthetics have the capability of providing profound uterine relaxation and possible chances of post-partum haemorrhage. [1819]…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

“…[394041] The more plausible reasons for these surgical interventions include advanced and timely foetal monitoring, which diagnose the early foetal compromise as well as increasing patient preference for the operative deliveries. [18] Now it has been successfully well established that regional anaesthesia is much safer than GA for caesarean section and the majority of the operative procedures for delivery are being carried out under regional anaesthesia throughout the world. [42] Maternal preference, comorbid diseases and urgency of surgery also determine to a large extent the type of anaesthesia to be employed.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

“…Regional anaesthesia also enables the parturient to remain awake during the surgical intervention and feel the first cry of the baby, which is a good psychological boost for overly anxious patients. [1852] Though spinal and epidural techniques have been equally useful, spinal is more common and significant when quick delivery is required and also the cost effectiveness of spinal anaesthesia is more comforting to the patient's relatives as compared with epidural especially in developing countries. [4253] Epidural is more versatile technique as it can be used for labour analgesia and if the need arises operative intervention can be performed with the same catheter.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

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Anaesthetic challenges and management during pregnancy: Strategies revisited

Bajwa

2013

Anesth Essays Res

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During pregnancy, an obstetrician can encounter various complications and sometimes require surgery or operative intervention for delivery. However, the role of anaesthesiologists during such clinical scenario is grossly under-estimated. Without any close coordination and team work among obstetricians, neonatologists and an anaesthesiologist, morbidity and mortality can increase during these surgical interventions. The clinical scenario can become more challenging if the parturient suffers from any comorbid diseases. The present article reviews some of the common challenging scenarios during pregnancy that an anaesthesiologist frequently encounters during routine practice. Anaesthetic management has been discussed briefly and separately for each trimester and post-partum period. The article also aims at gaining in-depth knowledge of these obstetrical and surgical emergencies so as to ensure close-knit team work among obstetricians, anaesthesiologists, intensivists and a neonatologist.

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The ongoing challenges of regional and general anaesthesia in obstetrics

Cited by 38 publications

References 68 publications

Intraoperative requirement of Phenylephrine for spinal anaesthesia, with comparison of hemodynamic parameters between severe pre-eclamptic and normotensive parturients for elective caesarean section: A prospective study

Intraoperative requirement of Phenylephrine for spinal anaesthesia, with comparison of hemodynamic parameters between severe pre-eclamptic and normotensive parturients for elective caesarean section: A prospective study

Regional anesthesia in patients with pregnancy induced hypertension

Anaesthetic challenges and management during pregnancy: Strategies revisited

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