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Spinal anaesthesia hypotension

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https://www.readbyqxmd.com/read/28571237/dexmedetomidine-as-an-additive-to-spinal-anaesthesia-in-orthopaedic-patients-undergoing-lower-limb-surgeries-a-randomized-clinical-trial-comparing-two-different-doses-of-dexmedetomidine
#1
Arati Rai, Meyong Pincho Bhutia
INTRODUCTION: Use of dexmedetomidine as an additive to spinal anaesthesia is gaining popularity; but there seems to be no clear consensus on the ideal dose to be used. Because of dose related prolongation of duration of motor blockade along with increase in the incidence of side effects of dexmedetomidine namely hypotension and bradycardia, use of higher doses is not recommended. AIM: To evaluate the efficacy of two different doses of dexmedetomidine (3 μg and 5 μg) given in combination with 0...
April 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28553766/intravenous-dexmedetomidine-during-spinal-anaesthesia-for-caesarean-section-a-meta-analysis-of-randomized-trials
#2
Zeqing Bao, Chengmao Zhou, Xianxue Wang, Yu Zhu
Objective To evaluate the efficacy and safety of spinal anaesthesia using dexmedetomidine for caesarean section. Methods PubMed, The Cochrane Library, and CNKI were searched for relevant literature. Results The incidence of nausea and vomiting in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.21, 95% CI: 0.12-0.35, P < 0.00001). No difference was found in the incidence of pruritus between the two groups (OR = 1.21, 95% CI: 0.36-4.09, P = 0.76).The dexmedetomidine group had a higher incidence of bradycardia than did the control group (OR = 2...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28494915/injection-speed-of-spinal-anaesthesia-for-caesarean-delivery-in-asian-women-and-the-incidence-of-hypotension-a-randomised-controlled-trial
#3
Chun Fai Chiang, M Shahnaz Hasan, Sin Wan Tham, Sebastian Sundaraj, Ahmad Faris, Nagappan Ganason
STUDY OBJECTIVE: The purpose of this investigation was to determine if a slower speed of spinal anaesthesia injection would reduce the incidence of hypotension. STUDY DESIGN: Randomised controlled trial. SETTING: Tertiary level hospital in Malaysia. PATIENTS: 77 patients undergoing elective Caesarean delivery. INTERVENTION: Differing speeds of spinal injection. MEASUREMENTS: Systolic blood pressure was assessed every minute for the first 10min and incidence of hypotension (reduction in blood pressure of >30% of baseline) was recorded...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28375713/comparing-spinal-blockade-effectiveness-and-maternal-hemodynamics-using-25-gauge-and-29-gauge-spinal-needles-with-the-same-volumetric-flow-rate-in-patients-undergoing-caesarean-section
#4
Taner Ciftci, Hayrettin Daskaya, Serdar Efe
Spinal needles with different diameters can be used to prevent side effects in patients undergoing spinal anaesthesia. However, the velocity of local anaesthetic changes through the spinal needle depending on the diameter of it. Local anaesthetic injection velocity has been reported to be associated with the spinal block level. We aimed to compare spinal needles of different diameters with the same local anaesthetic volumetric flow rate in terms of spinal blockade and hemodynamics in obstetric patients. Eighty-four patients received spinal anaesthesia by either a 25G needle or 29G with the same volumetric flow rate...
April 4, 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28289667/laparoscopic-cholecystectomy-under-spinal-epidural-anesthesia-vs-general-anaesthesia-a-prospective-randomised-study
#5
Turgut Donmez, Vuslat Muslu Erdem, Sinan Uzman, Dogan Yildirim, Huseyin Avaroglu, Sina Ferahman, Oguzhan Sunamak
PURPOSE: Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. METHODS: Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups...
March 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28277383/the-use-of-vasopressors-during-spinal-anaesthesia-for-caesarean-section
#6
Warwick D Ngan Kee
PURPOSE OF REVIEW: Hypotension remains one of the most researched subjects in obstetric anaesthesia. The purpose of this study is to review the most recent published articles on the use of vasopressors during spinal anaesthesia for caesarean section. RECENT FINDINGS: Despite continued research indicating advantages of phenylephrine over ephedrine, practitioners in some countries continue to favour ephedrine. Recent research has continued to compare the two drugs with some work emerging on high-risk patients...
June 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28255987/a-randomised-double-blind-trial-of-phenylephrine-and-metaraminol-infusions-for-prevention-of-hypotension-during-spinal-and-combined-spinal-epidural-anaesthesia-for-elective-caesarean-section
#7
N J McDonnell, M J Paech, N A Muchatuta, S Hillyard, E A Nathan
Prophylactic vasopressor administration is commonly recommended to reduce maternal hypotension during spinal anaesthesia for caesarean section. Metaraminol has undergone limited investigation in obstetric anaesthesia for this purpose, particularly in comparison with phenylephrine. In this multicentre, randomised, double-blind, non-inferiority study, we compared prophylactic phenylephrine or metaraminol infusions, started immediately after spinal anaesthesia, in 185 women who underwent elective caesarean section...
May 2017: Anaesthesia
https://www.readbyqxmd.com/read/28216705/comparison-of-fractionated-dose-versus-bolus-dose-injection-in-spinal-anaesthesia-for-patients-undergoing-elective-caesarean-section-a-randomised-double-blind-study
#8
Jigisha Prahaladray Badheka, Vrinda Pravinbhai Oza, Ashutosh Vyas, Deepika Baria, Poonam Nehra, Thomas Babu
BACKGROUND AND AIMS: Spinal anaesthesia (SA) with bolus dose has rapid onset but may precipitate hypotension. When we inject local anaesthetic in fractions with a time gap, it provides a dense block with haemodynamic stability and also prolongs the duration of analgesia. We aimed to compare fractionated dose with bolus dose in SA for haemodynamic stability and duration of analgesia in patients undergoing elective lower segment caesarean section (LSCS). METHODS: After clearance from the Institutional Ethics Committee, the study was carried out in sixty patients undergoing elective LSCS...
January 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28133720/heart-rate-variability-as-a-predictor-of-hypotension-following-spinal-for-elective-caesarean-section-a-prospective-observational-study
#9
D G Bishop, C Cairns, M Grobbelaar, R N Rodseth
Post-spinal hypotension remains a common and clinically-important problem during caesarean section, and accurate pre-operative prediction of this complication might enhance clinical management. We conducted a prospective, single-centre, observational study of heart rate variability in 102 patients undergoing elective caesarean section in a South African regional hospital. We performed Holter recording for ≥ 5 min in the hour preceding spinal anaesthesia. The low-frequency/high-frequency ratio component of heart rate variability was compared, using a logistic regression model, with baseline heart rate and body mass index (BMI) as a predictor of hypotension (defined as systolic arterial pressure < 90 mmHg) occurring from the time of spinal insertion until 15 min after delivery of the baby...
January 30, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28007522/the-pupillary-light-reflex-for-predicting-the-risk-of-hypotension-after-spinal-anaesthesia-for-elective-caesarean-section
#10
Céline Riffard, Truong Quoc Viêt, François-Pierrick Desgranges, Lionel Bouvet, Bernard Allaouchiche, Adrienne Stewart, Dominique Chassard
INTRODUCTION: The balance between the sympathetic and parasympathetic systems could be used to predict the onset of hypotension following spinal anaesthesia. The autonomic innervation of the pupil may reflect this balance. The aim of this study was to evaluate the ability of pupillometry to predict the risk of hypotension after spinal anaesthesia for caesarean section. METHODS: Two hundred patients receiving spinal anaesthesia for caesarean section were recruited...
December 19, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28003695/anaesthesia-for-foetoscopic-laser-ablation-a-retrospective-study
#11
Vaishali Kumbhar, M Radhika, Parameswara Gundappa, Jayashree Simha, Prathima Radhakrishnan
BACKGROUND AND AIMS: Twin pregnancy with monochorionic placenta may be associated with arteriovenous vascular anastomosis of the placental vessels resulting in twin-to-twin transfusion syndrome (TTTS) and twin reversed arterial perfusion syndrome (TRAP). Foetoscopic LASER ablation (FLA) is the treatment of choice in reducing foetal mortality related to this. METHODS: A retrospective review of medical records of 41 FLA procedures for TTTS and TRAP were analysed for anaesthetic management...
December 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27770448/impact-of-spinal-anaesthesia-vs-general-anaesthesia-on-peri-operative-outcome-in-lumbar-spine-surgery-a-systematic-review-and-meta-analysis-of-randomised-controlled-trials
#12
REVIEW
T Meng, Z Zhong, L Meng
Lumbar spinal surgery is most commonly performed under general anaesthesia. However, spinal anaesthesia has also been used. We aimed to systematically review the comparative evidence. We only included randomised, controlled trials in this meta-analysis and calculated the risk ratio or standardised mean difference for haemodynamics, blood loss, surgical time, analgesic requirement, nausea and/or vomiting, and length of hospital stay. Eight studies with a total of 625 patients were included. These were considered to be at high risk of bias...
March 2017: Anaesthesia
https://www.readbyqxmd.com/read/27766904/intraspinal-hypotension-syndrome-presents-as-transient-quadriplegia
#13
Miki Katzir, Svetlana Tov, Ayelet Eran, Gill E Sviri
Intracranial hypotension can be a complication of epidural anaesthesia. Pure clinical spinal hypotension manifesting as acute transient quadriplegia following epidural anaesthesia is a severe, life-threatening complication that have not been described before. This complication can be solved with an epidural blood patch; thus, it should be familiar to doctors across all specialities.
October 21, 2016: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/27756210/prevalence-associated-factors-and-treatment-of-post-spinal-shivering-in-a-sub-saharan-tertiary-hospital-a-prospective-observational-study
#14
Tonny Stone Luggya, Richard Nicholas Kabuye, Cephas Mijumbi, Joseph Bahe Tindimwebwa, Andrew Kintu
BACKGROUND: Surgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat. Due to paucity of data Mulago Hospital's post spinal shivering burden is unknown yet it causes discomfort and morbidity. METHODS: Ethical approval was obtained to perform the study among consenting mothers due for elective caesarean section from March to May 2011...
October 18, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27630930/analgesic-efficacy-of-ultrasound-guided-ficb-in-patients-with-hip-fracture
#15
Devender Kumar, Sarla Hooda, Shashi Kiran, Jyoti Devi
INTRODUCTION: Hip fractures are often encountered in the elderly and present special problems to the anaesthesiologist. Fascia iliaca compartment block is another technique with the intent to block all the three nerves like 3-in-1 nerve block. AIM: To evaluate the analgesic efficacy of ultrasound guided fascia iliaca compartment block to facilitate positioning of patients with hip fracture for spinal anaesthesia. MATERIALS AND METHODS: This prospective study was conducted in 50 patients aged between 40-80 years, belonging to American Society of Anesthesiologists (ASA) physical status I-III undergoing surgery for hip fracture...
July 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27605955/a-randomised-controlled-trial-comparing-weight-adjusted-dose-versus-fixed-dose-prophylactic-phenylephrine-infusion-on-maintaining-systolic-blood-pressure-during-caesarean-section-under-spinal-anaesthesia
#16
RANDOMIZED CONTROLLED TRIAL
Lucy Mwaura, Vitalis Mung'ayi, Jimmie Kabugi, Samina Mir
BACKGROUND: Spinal anaesthesia is the standard of care for elective caesarean delivery. It has advantages over general anaesthesia. However the sympathetic blockade induced by spinal anaesthesia results in an 80 percent incidence of hypotension without prophylactic management. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in the parturient...
June 2016: African Health Sciences
https://www.readbyqxmd.com/read/27601104/recipes-for-obstetric-spinal-hypotension-the-clinical-context-counts
#17
David G Bishop, Reitze N Rodseth, Robert A Dyer
Hypotension following obstetric spinal anaesthesia remains a common and important problem. While recent research advances have brought us closer to the perfect recipe for the obstetric spinal anaesthetic, these advances have not been translated into practical guidelines able to reduce the unacceptable number of fatalities that occur in environments where resources are limited. In South Africa, more than half of anaesthetic deaths are still related to spinal hypotension. A gap exists between the 'perfect recipe', developed from a clinical context rooted in resource-rich research environments, and its application and performance in real-world resource-poor environments - conditions experienced by more than 75% of the world's population...
August 1, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/27366558/massive-blood-transfusion-during-revision-total-hip-arthroplasty-under-combined-spinal-epidural-anaesthesia
#18
Tünay Kandemir, Erbin Kandemir, Tuğba Aşkın, Tülay Dal, Yeliz Kılıç, Süheyla Ünver
Revision total hip arthroplasty (THA) is an orthopaedic surgery that is known to be associated with excessive bleeding. The rates of mortality and morbidity are high in patients with massive haemorrhage. The patient in this study was administered blood products with high fresh frozen plasma/red blood cell (RBC) suspension ratio and high platelet/RBC suspension ratio without waiting for haemostasis test results. This study suggests that this approach might prove beneficial in reducing the incidence of intra- and postoperative complications...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27330198/comparative-evaluation-of-intrathecal-morphine-and-intrathecal-dexmedetomidine-in-patients-undergoing-gynaecological-surgeries-under-spinal-anaesthesia-a-prospective-randomised-double-blind-study
#19
Pranjali Kurhekar, S Madan Kumar, D Sampath
BACKGROUND AND AIMS: Inrathecal opioids like morphine added to local anaesthetic agents have been found to be effective in achieving prolonged post-operative analgesia. Intrathecal dexmedetomidine may be devoid of undesirable side effects related to morphine and hence, this study was designed to evaluate analgesic efficacy, haemodynamic stability and adverse effects of both these adjuvants in patients undergoing gynaecological surgeries. METHODS: This was a prospective, randomised, double blind study involving 25 patients in each group...
June 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27242357/continuous-paravertebral-block-for-post-cardiothoracic-surgery-analgesia-a-systematic-review-and-meta-analysis
#20
REVIEW
Anje J Scarfe, Susanne Schuhmann-Hingel, Joanna K Duncan, Ning Ma, Yasoba N Atukorale, Alun L Cameron
A continuous paravertebral block is used when pain relief is required beyond the duration of a single-injection paravertebral block. Surgical procedures requiring an incision into the pleural cavity are some of the most painful procedures postoperatively and, if not managed appropriately, can lead to chronic pain. The current gold standard for post-cardiothoracic surgery pain management is epidural analgesia, which has contraindications, a failure rate of up to 12% and risk of complications such as epidural abscess and spinal haematoma...
December 2016: European Journal of Cardio-thoracic Surgery
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