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Eficacia de opioides lipofílicos vs opioides lipofóbicos adicionados a bupivacaína hiperbárica en cesárea del segmento inferior
Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section.
Abstract
BACKGROUND: Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section. Various pharmacological agents in added to local anesthetics (LA) modify their original effects in terms of block characteristics and quality of analgesia. However, there is ongoing debate about this practice of using adjuncts with LA. We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia. SUBJECTS AND METHODS: Sixty American Society of Anesthesiologists I and II parturients, undergoing elective cesarean sectionrequiring subarachnoid block, were included in our study. The parturients were allocated randomly to three groups of 20 each to receive bupivacaine 12.5 mg (Group I), bupivacaine 12.5 mg + morphine 0.2 mg (Group II), bupivacaine 12.5 mg + fentanyl 25 μg (Group III), preservative free physiological saline 0.9% was added to all the solutions to achieve a total volume of 4 ml. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects, and fetal outcome. RESULTS: Onset of block was early 4.30 ± 0.12 min in Group III as compared to Group I 4.64 ± 0.28 min and Group II 4.505 ± 0.22 min. Mean duration of analgesia (hours) was higher in Group II 15.91 ± 0.96 h as compared to Group I 1.95 ± 0.55 h and Group III 4.39 ± 0.2 h. Incidence of nausea, vomiting, and shivering was more in the control group as compared to study groups, whereas sedation and pruritus were seen more in the study groups. No adverse effects on fetus were seen with use of opioids and comparable Apgar scores were noted. CONCLUSION: Addition of intrathecal fentanyl causes rapid onset of block whereas intrathecal morphine provides prolonged analgesia with comparable neonatal wellbeing.
KEYWORDS: Anesthesia; fentanyl; intrathecal; morphine; spinal
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Hetastarch 6% vs solución Ringer lactado para precarga antes de raquia en cesárea
Six percent hetastarch versus lactated Ringer's solution - for preloading before spinal anesthesia for cesarean section.
Abstract
BACKGROUND: Regional anesthesia has been the choice of preference for elective cesarean sections. This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence of hypotension. MATERIALS AND METHODS: This study was conducted on 50 nonlaboring American Society of Anesthesiologists class I and II women undergoing elective cesarean section. Patients were randomly divided into two groups and were preloaded either with 1000 ml Ringer's lactate (RL) or 500 ml of 6% hetastarch 30 min prior to the surgery. Spinal anesthesia was performed with patients in the left lateral position and 2 cc (10 mg) of 0.5% of bupivacaine injected into subarachnoid space. Hemodynamic variables (heart rate, noninvasive blood pressure, and SpO2) were recorded from prior to preloading until the recovery from the subarachnoid blockade. RESULTS: Our study showed the incidence of hypotension to be 28% in the hetastarch group and 80% in the RL group. Rescue ephedrine requirements for the treatment of hypotension were significantly less in patients who were preloaded with 6% hetastarch prior to cesarean section. The neonatal outcome, as determined by Apgar scores was good and similar in both groups. CONCLUSION: Hence, we conclude that 6% hydroxyl ethyl starch is more effective than lactated Ringers solution and that its routine use for preloading prior to spinal anesthesia should be considered.
KEYWORDS: Cesarean; preloading; spinal
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Estudio retrospectivo para correlacionar la presentación de nalgas y el aumento del riesgo de hipotensión post-espinal durante la cesárea.
A retrospective study to correlate breech presentation and enhanced risk of postspinal hypotension during cesarean delivery.
Abstract
BACKGROUND: Subarachnoid blockade for cesarean section still poses a threat of profound hypotension and can result in unstable maternal and fetal hemodynamics. The correlation of fetal breech and vertex presentation with the occurrence of hypotension under spinal anesthesia is reviewed in this retrospective, double-blind study. PATIENTS AND METHODS: The study was conducted on pregnant females scheduled for a lower segment cesarean section between January 2014 and December 2014. After applying inclusion criteria, 568 patients were recruited in the study out of which 363 had vertex and 184 patients had breech presentation. They were divided into two groups, Group I and Group II. The monitoring and therapeutic data (blood pressure, heart rate, arterial oxygen saturation, and dose of vasopressor/atropine) recovered from automated data analysis were analyzed retrospectively for prevalence of hypotension, bradycardia, and hypotension with bradycardia and nausea ± vomiting. RESULTS: Among Group I, prevalence of hypotension, bradycardia, and hypotension together with bradycardia was 152 (41.83%) patients, eight (2.20%) patients, and seven (1.92%) patients, respectively. In Group II, the prevalence of hypotension, bradycardia, and hypotension with bradycardia was 93 (50.5%) patients, five (2.71%) patients, and six (3.2%) patients, respectively. The difference between the two groups was statistically significant for hypotension. For Group I, 152 patients (41.87%) experienced one, 23 patients (6.33%) experienced two, and three patients (0.82%) experienced three episodes of hypotension. In Group II, 93 (50.5%), 19 (7.89%), and two (1.08%) patients experienced such episodes. The difference was significant with respect of one and two episodes. The prevalence of intraoperative nausea was 11.01% (40 patients) in Group I, whereas 11.41% (21 patients) in Group II. Intraoperative vomiting occurred in 19 patients (5.23%) of Group I and 14 patients (7.60%) of Group II. The height of the block was comparable in both the groups for T6, and the difference was significant in respect to T4 level. CONCLUSION: Incidence of hypotension is more in pregnant females with breech fetal presentation.
KEYWORDS: breech; cesarean section; hypotension; spinal anesthesia
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Aditivos espinales en anestesia subaracnoidea para cesárea
Spinal Additives in Subarachnoid Anaesthesia for Cesarean Section
Hala M. Goma, Juan C. Flores-Carrillo and Víctor Whizar-Lugo
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Parto por cesárea
Cesarean Delivery
Edited by Raed Salim, ISBN 978-953-51-0638-8, 210 pages, Publisher: InTech, Chapters published May 23, 2012 under CC BY 3.0 license
DOI: 10.5772/1459
Edited Volume
This book provides broad, science-based information regarding the most common major surgical procedure performed, i.e. Cesarean Delivery. The book provides relevant scientific literature regarding epidemiology and rates of cesarean delivery in low and high income countries and the impact of the disparities in the rate of cesarean delivery between countries. In addition, the book systematically reviews the relevant scientific literature regarding all perioperative considerations with a broad cover of anesthetic techniques, drugs and difficulties that anesthesiologists may encounter during cesarean delivery. Care of the neonate after cesarean and crucial guidelines for obese women undergoing cesarean are also provided. The book was written by distinguished experts from different disciplines to ensure complete and accurate coverage of the recent scientific and clinical advances and to bring care providers and purchasers up to date including essential information to help improve health care quality.
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Segundo Curso-Taller de Anestesia y Dolor
Zapopan Jalisco, México
Dic 1-2, 2016
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California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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