Anaesthesia Techniques for Caesarean Operations: Retrospective Analysis of Last Decade

Intrathecal dexamethasone-bupivacaine combination with bupivacaine alone in spinal anesthesia for cesarean delivery

Background

Postoperative pain management can be achieved by adjuvant medications during the analgesia procedure. The study investigated the effect of intrathecal dexamethasone-bupivacaine combination with bupivacaine alone in spinal anesthesia for cesarean delivery.

Methods

This randomized, double-blind clinical examination included 50 females who had previously experienced a cesarean section. The participants were assigned randomly into two categories: the intervention group, received intrathecal bupivacaine-dexamethasone, and the control group, received intrathecal bupivacaine-normal saline. Levels of pain were evaluated using a 10 cm visual analog scale (VAS) at intervals of 30 minutes, 1 hour, 2 hours after the operation. The span of the sensory block and postoperative analgesia were assessed.

Results

The inclusion of intrathecal dexamethasone with bupivacaine resulted in a significant enhancement in the duration of pain relief during the intervention, lasting for an average of 473.4 ± 39.95 minutes (p<0.001). The duration of sensory and motor block analgesia in the intervention group was more than the control group (128.32 ± 7.30 vs. 92.84 ± 7.84) and (155.6±12.34 vs. 126.16±11.89), respectively (p<0.001). Pain score on the VAS scale at 30, 60, and 120 minutes was significantly lower in the intervention group (p<0.001). There was no difference in side effects and onset time between the study groups.

Conclusion

The inclusion of intrathecal dexamethasone alongside bupivacaine has demonstrated enhancement in the duration of sensory block during spinal anesthesia. This improvement was observed without any alterations in the time it takes for the anesthesia to take effect and without any adverse effects during the postoperative period.

The current practice of aspiration prophylaxis in obstetric anesthesia: a survey among non-physician anesthetic providers working in hospitals in Ethiopia

BACKGROUND

Pulmonary aspiration is one of the most important complications of obstetric anesthesia. Prevention of pulmonary aspiration is commonly performed by the application of different anesthetic maneuvers and administration of drugs. This study aimed to assess the non-physician anesthetic providers current practice of aspiration prophylaxis during anesthesia for cesarean section in Ethiopia.

METHODS

This survey study was conducted from October 01 to November 05, 2020, on a total of 490 anesthetic providers working in hospitals in Ethiopia. A structured checklist was used to collect data from non-physician anesthetic providers.

RESULTS

Four hundred and ninety (490) anesthetic providers participated in our study. The majority of the respondents (84%) were working in the public sector. Most of the cesarean delivery was done under regional anesthesia and more than half of anesthetic providers in Ethiopia administered aspiration prophylaxis routinely. Metoclopramide was the most frequently given as a prophylaxis for pulmonary aspiration.

CONCLUSIONS

More than half of the anesthetic providers administered aspiration prophylaxis routinely. Metoclopramide was the commonest administered aspiration prophylaxis for parturients who underwent cesarean delivery to prevent aspiration.

Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial

STUDY OBJECTIVE

This study aimed to compare the effects of high doses of ondansetron and granisetron before spinal anesthesia on hemodynamic parameters in patients undergoing elective cesarean section.

DESIGN

A double-blinded randomized placebo-controlled trial.

SETTING

Operating room.

PATIENTS

A total of 120 parturients with term pregnancy undergoing elective cesarean section with combined spinal-epidural anesthesia were included.

INTERVENTIONS

Three groups (n = 40 for each group) were formed by randomization. Five minutes before the anesthesia procedure, Group I received 8 mg intravenous (IV) ondansetron diluted in 10 ml normal saline, Group II received IV 3 mg granisetron diluted in 10 ml normal saline, and Group III received IV 10 ml normal saline.

MEASUREMENTS

Following intrathecal drug administration, intraoperative hemodynamic changes were recorded every 2 min for 20 min and then every 5 min until the end of the operation.

MAIN RESULTS

Twenty patients (50%) in Group I, 12 patients (30%) in Group II, and 29 patients (72.5%) in Group III had hypotension requiring treatment with IV ephedrine (P = 0.001). The ephedrine requirement in Group III was significantly higher than in Groups I (P = 0.033) and II (P < 0.001). Also, the ephedrine requirement in Group II was lower than in Group I, but the difference was not statistically significant (P = 0.055). The mean arterial pressure for the three groups differed in the 10th, 18th, and 60th minutes. The number of patients with nausea or vomiting was lower in Groups I and II than in Group III (P < 0.001). At 5 min, the Apgar scores were higher than 8 for all neonates. Postoperative scores for the visual analogue scale were similar for all groups.

CONCLUSIONS

It was concluded that prophylactic IV administration of 3 mg of granisetron or 8 mg of ondansetron before spinal anesthesia results in a significantly lower ephedrine requirement compared to placebo.

Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis

Objective

This meta-analysis was performed to evaluate the effect of spinal anesthesia (SA) using bupivacaine combined with dexmedetomidine (DEX) in cesarean section, analyze the adverse drug reactions induced by this mixture, and provide a reference for rational drug use.

Methods

Randomized controlled trials were obtained from the PubMed, Cochrane Library, and Embase databases. The primary outcome measure was the time to the highest sensory block level (min), and the secondary outcome measure was adverse effects.

Results

The time to the highest sensory block level was significantly shorter in the bupivacaine-DEX group than in the control group (standardized mean difference, −0.23; 95% confidence interval, −0.43 to −0.03). The incidence of shivering during the process of anesthesia, especially at a dose of 5 µg DEX, was significantly lower in the bupivacaine-DEX group than in the control group (odds ratio, 0.26; 95% confidence interval, 0.14–0.49). No significant differences were observed in the symptoms of hypotension, bradycardia, nausea/vomiting, or pruritus.

Conclusion

Compared with the use of bupivacaine alone for SA in cesarean section, adding dexmedetomidine during SA can significantly shorten the onset time and decrease the rate of shivering during anesthesia.

The Effect of Anaesthetic Techniques on Maternal and Cord Blood Brain-Derived Neurotrophic Factor Levels

Objective

Brain-derived neurotrophic factor (BDNF), a member of neurotrophins, plays a critical role in neuronal tissue. In this study, the effects of spinal or general anaesthesia on cord and maternal peripheral blood BDNF and malondialdehyde (MDA) levels were investigated in patients undergoing elective caesarean section.

Methods

Eighty patients with term pregnancy were included. General anaesthesia was induced with intravenous (IV) propofol 2 mg kg^-1 in the general anaesthesia group (n=36). In the spinal anaesthesia group (n=35), hyperbaric bupivacaine 0.5%, 9 mg (1.8 mL) was injected intrathecally. Maternal blood samples were taken immediately after positioning the patient on the operating table (T1), before clamping the umbilical cord (T2) and 24 hours after the first sample was obtained (T3). Cord blood samples were drawn from the umbilical artery (T4).

Results

Maternal BDNF levels (pg mL^-1) measured at T2 time point were higher in the general anaesthesia group compared to the spinal anaesthesia group (p<0.001). Cord blood BDNF levels were higher in the general anaesthesia group compared to the spinal anaesthesia group (p<0.001). In both groups, cord blood BDNF levels were significantly lower compared to the maternal blood samples collected at any time point (p<0.001, for all). There was a negative association between both maternal and cord blood BDNF levels with maternal MDA and cord blood MDA levels, respectively (r=-0.379, p<0.001; r=-0.375, p=0.001, respectively).

Conclusion

The anaesthetic technique may have an influence on maternal peripheral and cord blood BDNF levels.

Effects of remifentanil and dexmedetomidine on the mother's awareness and neonatal Apgar scores in caesarean section under general anaesthesia

Objective

This study aimed to compare the effects of remifentanil and dexmedetomidine on awareness during the induction of general anaesthesia.

Material and Methods

Ninety patients scheduled for elective caesarean section under general anaesthesia were included and randomly divided into three anaesthesia groups: 2 mg/kg propofol (control group); 2 mg/kg propofol and 1 µg/kg dexmedetomidine (dexmedetomidine group); and 2 mg/kg propofol and 1 µg/kg remifentanil (remifentanil group). All patients received routine monitoring, and Apgar scores at 1 and 5 minutes were recorded. The bispectral index and the isolated forearm technique were used to determine the depth of anaesthesia.

Results

Bispectral index values at skin and uterine incisions and at delivery were similar among the groups. The number of patients who responded positively to the isolated arm technique during the induction period was also similar. One-minute Apgar scores in the control group were significantly lower and 5-minute Apgar scores significantly higher than those in the other groups.

Conclusion

The effects of remifentanil and dexmedetomidine added to propofol on maternal awareness, neonatal Apgar scores, and bispectral index values were similar compared with propofol alone. However, it was observed that remifentanil controlled the haemodynamic responses to sympathetic stimuli in a better manner than dexmedetomidine.