Spinal Anaesthesia for Caesarean Section
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SUMMARY The technique of peridural spinal anaesthesia commonly used by the authors in Caesarean section is described. The advantages of this type of anaesthesia and its possibilities of success both as regards the mother and the foetus are considered. The conditions in which it may be contra‐indicated, or in which the technique may prove unsuccessful, are discussed.
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CORKE, B. C.; DATTA, S.; OSTHEIMER, G. W.; WEISS, J. B.; ALPER, M. H. Author Information
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A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine
(In the branch of Anaesthesiology).
February 2013
Regional anaesthesia
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Spinal anaesthesia has emerged as the preferred anaesthesia technique for caesarean sections in last few decades due to lesser number of complications and ease of administration compared to general or epidural anaesthesia.However failed spinal anaesthesia causes a huge physiological & psychological impact on the patient.In this study we aimed at finding the incidence of failed spinal anaesthesia along with the factors that may influence the occurrences of failure in patients undergoing caesarean section.A retrospective analysis was done for all the caesarean sections performed under spinal anaesthesia in our institute from January 2019 to June 2020.Patient & anaesthetic procedure related factors influencing the failure rate were analysed statistically.The incidence of failed spinal anaesthesia was 4.5% of which 0.7 % were documented as total failure & 3.7% as inadequate block.Failure rate was higher in emergency caesarean section, in patients with BMI ≥25 and having active labour pain (p-value <0.05).Spinal injection in lateral position and procedure done by anaesthesia trainee had a statistically significant higher failure rate.A proper positioning of patients in active labour and those with high body mass index along with extra serenity and alertness during emergency procedure is expected to reduce the failure rate.A better understanding and knowledge about the patient and procedure related factors influencing the block height, duration and quality of spinal anaesthesia amongst the trainee would improve the overall success rate.
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Background: Spinal Anaesthesia (SA) is the most common preferred anaesthesia technique for Caesarean section (CS), because of its superior analgesia, favourable relaxation and decreased risk of complications over general anaesthesia 1,2,3,4 .Incidence of hypotension after spinal anaesthesia is highest in Caesarean section, and it can be significantly severe so that it can jeopardize the mother and foetus 5,6,7,8,9,10,11,12,13 .So early detection and prevention of hypotension is of atmost importance for better maternal and foetal outcome.This study aim to assess the incidence of spinal anaesthesia induced hypotension in parturients and confirm the existing risk factors and also to identify new risk factors if any in a population, where published studies are nil. Methods: After obtaining approval from Research committee and institutional ethical committee a total of 200 patients who satisfied the inclusion and exclusion criteria were included in the study and evaluated for the development of hypotension after spinal anaesthesia. The population was divided in to two groups with and without hypotension after spinal anaesthesia for Lower segment caesarean section (LSCS). The two groups were then compared with respect to their demographic, maternal, anaesthetic and foetal variables to see whether any association exist with the development of maternal hypotension.Results: In the present study the proportion of hypotension following spinal anaesthesia for CS was 54.5% (109/200).Univariate analysis identified 3 maternal risk factors such as age>30 years, ASA class II, and BMI>30kg /m 2 .Anaesthesia related variable identified was sensory block height ≥ T5.Neonatal birth weight >2.5.kg was found as the significant foetal variable. Conclusion:The incidence of maternal hypotension in the parturient after SA still remains high.Knowledge of the incidence and risk factors as well as timely intervention will definitely contribute to early detection and prevention of severity maternal hypotension.
Elective caesarean section
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Risk Stratification
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BACKGROUNDMaternal hypotension produces unpleasant symptoms such as nausea, vomiting and light headedness.More importantly, when severe and sustained, hypotension can impair uterine and intervillous blood flow and ultimately result in foetal acidosis and neonatal depression.Preventive measures include fluid preload, left lateral tilt, and use of vasopressors.Aims and Objectives-1.To study the effectiveness of Ephedrine and Phenylephrine in the treatment of hypotension secondary to spinal anaesthesia.2. To study the effect of vasopressors on foetal/neonatal outcome. MATERIALS AND METHODSIn this open labelled randomised controlled trial, parturients were randomly divided into two groups.They were assigned to receive one of the two vasopressor solutions whenever maternal systolic arterial pressure (SAP) and heart rate (HR) decreased to 80% of baseline or less.SAP is measured every minute by automated oscillometry and the maternal HR by finger pulse oximetry.The sample size estimation was also done at conveniences. RESULTSThere was no statistically significant difference between two groups in age, gender and weight of the patient and both groups were comparable.Both ephedrine and phenylephrine were effective in managing hypotension.Phenylephrine has high efficacy in increasing blood pressure.There was a decrease in pH in patients who received ephedrine as bolus dose for hypotension, but APGAR scores were good for all newborn infants. CONCLUSIONPhenylephrine proves to be a better option in managing hypotension with minimal effects on foetus.
Elective caesarean section
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