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Rahmati J, Shahriari M, Shahriari A, Nataj M, Shabani Z, Moodi V. Effectiveness of Spinal Analgesia for Labor Pain Compared with Epidural Analgesia. Anesth Pain Med 2021; 11:e113350. [PMID: 34336624 PMCID: PMC8314089 DOI: 10.5812/aapm.113350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives This study aimed to compare the analgesic effect of single-dose spinal versus epidural analgesia for labor pain to verify if applying a single dose spinal analgesia is an efficient technique for labor pain management as an alternative for epidural analgesia. Methods A total of 128 women in the active phase of labor were randomly allocated into two groups of spinal analgesia (n = 64) and epidural analgesia (n = 64). The latter received a bolus dose of 16 mL of 0.125% bupivacaine and 50 μg fentanyl and repeated 5 - 10 mL of bolus dose. The former received 2.5 mg hyperbaric bupivacaine plus 50μg fentanyl. Pain intensity was measured using the visual analog scale (VAS). The duration of analgesia, mode of delivery, the duration of labor, side effects, and maternal satisfaction were also compared. Results There were no significant differences in the rate of cesarean section, duration of labor, postpartum hemorrhage, and the frequency of the fetal heart deceleration until 30 min after analgesia between the two groups. Measured pain after 30 (P = 0.0001) and 90 min (P = 0.01) was significantly lower in the spinal group than the epidural group. However, there was no significant difference between the spinal and epidural groups concerning the VAS scores at 150, 210, and 270 minutes. Maternal satisfaction was higher in the spinal group (P = 0.002). The mean duration of analgesia was longer in the spinal group than the epidural group (P = 0.0001). Conclusions According to the findings, single-dose spinal analgesia, compared to epidural analgesia, is a safe, fast, and efficient technique for labor analgesia, which can be easily performed. In addition, it provides a high satisfaction level in the parturient.
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Affiliation(s)
- Javad Rahmati
- Aesthetic Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Shahriari
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoomeh Nataj
- Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Shabani
- Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vihan Moodi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Imani F, Lotfi S, Aminisaman J, Shahmohamadi A, Ahmadi A. Comparison of Spinal Versus Epidural Analgesia for Vaginal Delivery: A Randomized Double Blinded Clinical Trial. Anesth Pain Med 2021; 11:e108335. [PMID: 34221934 PMCID: PMC8241817 DOI: 10.5812/aapm.108335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background Recently, one of the problems in developing countries is pregnant women who insist on cesarean section for fear of painful vaginal delivery. There are various methods to reduce labor pain, including medical and non-medical methods. Neuraxial analgesia is classified as one of the best ways to reduce labor pain. Epidural analgesia is a classic and popular procedure to decrease labor pain. Nevertheless, other methods, such as spinal or combined spinal-epidural analgesia, is more effective compared with the epidural. Objectives In this study, we investigated a single intrathecal versus epidural injection in pregnant women during childbirth. Methods In our research, after obtaining informed consent, the patients were randomly assigned to two equal groups: epidural and spinal. Each group contained 50 parturient women in advanced labor. In the epidural group, 2.5 mL isobaric bupivacaine 0.5%, sufentanil (0.2 mcg/mL), and 7 mL saline 0.9% were injected by an 18-gauge Tuohy needle at the L4-5 or L5-S1 intervertebral space, and in the spinal group, 0.5 mL isobaric bupivacaine 0.5%, 2.5 mcg sufentanil, and 0.5 mL saline 0.9% were injected by a 25-gauge pencil-point Quincke needle at the L4-5 or L5-S1 intervertebral spaces. For pain intensity, the visual analog scale (VAS) was used at serial intervals, and other variables, such as the onset and duration of analgesia, hypotension, neonatal APGAR score, fetal heart rate (FHR) changes, and other variables were examined. Results The mean time to onset analgesic effect was 4.6 min in the spinal group compared with 12.5 minutes in the epidural (P < 0.001). Duration of analgesia was 121 minutes in the spinal group compared with 104 min in the epidural group (P < 0.001). The time to reach the maximum block was 8.4 min in the spinal group vs. 22.2 min in the epidural group (P < 0.001). The duration of the second and third gestation stages was the same in both groups. Conclusions Spinal analgesia is short and easy to perform and does not require advanced equipment and technical experience. Spinal analgesia can be a good option for labor analgesia and leads to achieving a lower pain score than epidural analgesia.
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Affiliation(s)
- Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sarah Lotfi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Qom University of Medical Sciences, Qom, Iran
| | | | | | - Abbas Ahmadi
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Qom University of Medical Sciences, Qom, Iran
- Corresponding Author: Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Manouchehrian N, Moradi A, Torkashvand L. Comparative Study of Effect of Spinal Anesthesia in Sitting and Lateral Positions on the Onset Time of Sensory Block and Hemodynamic Condition in Cesarean Section: A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e111483. [PMID: 34221941 PMCID: PMC8241818 DOI: 10.5812/aapm.111483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Spinal anesthesia is the method of choice for the cesarean section. Hypotension is a common complication of this method. OBJECTIVES This study aimed to compare the effect of spinal anesthesia in the sitting and lateral positions on the onset time of sensory block and hemodynamic condition in cesarean sections. METHODS In this clinical trial, 106 elective cesarean section candidates under spinal anesthesia were selected and randomly divided into two groups: spinal anesthesia in the sitting position (group S) and the lateral position (group L). The onset time of the sensory block, quality of sensory and motor block, hemodynamic condition, frequency of hypotension, nausea, and vomiting, and the doses of ephedrine and atropine were compared between both groups. Data were analyzed with SPSS version 16 software at a 95% confidence level. RESULTS There was no statistically significant difference between the two groups in terms of age. The frequency of hypotension in L and S groups was 24.5% and 57.7%, respectively (P = 0.001), in minute 6 after spinal anesthesia and 5.7% and 36.5%, respectively (P < 0.001), in minute 8 after spinal anesthesia. The mean time to reach the sensory level of T6 was 1.30 ± 0.43 min versus 4.54 ± 2.12 min (P < 0.001), motor block score in minute 5 was 2.98 ± 0.14 versus 2.82 (P = 0.044), and ephedrine dose was 11.5 mg and 16.92 mg in the L and S groups, respectively (P = 0.010). The maximum sensory-motor block and satisfaction of women with spinal anesthesia were significantly higher in the lateral position than in the sitting position (P < 0.05). CONCLUSIONS Cesarean sections under spinal anesthesia in the lateral position than in the sitting position lead to a more rapid sensory and motor block, reduced ephedrine consumption, and enhanced satisfaction of women.
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Affiliation(s)
- Nahid Manouchehrian
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moradi
- Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leyla Torkashvand
- Medical Sciences Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
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Nikooseresht M, Seifrabiei MA, Hajian P, Khamooshi S. A Clinical Trial on the Effects of Different Regimens of Phenylephrine on Maternal Hemodynamic After Spinal Anesthesia for Cesarean Section. Anesth Pain Med 2020; 10:e58048. [PMID: 33134140 PMCID: PMC7539049 DOI: 10.5812/aapm.58048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 05/05/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. Objectives The present study aims to investigate the effects of different regimens of phenylephrine on blood pressure of candidates for the cesarean section. Methods In this double-blind, randomized clinical trial, a total of 120 candidates of elective cesarean delivery under spinal anesthesia was randomly categorized into three groups. Groups 1, 2, and 3 received bolus and prophylactic saline (control group), prophylactic bolus phenylephrine (100 µg), and prophylactic phenylephrine infusion (50 µg/min), respectively. The incidence of hypotension, maternal hemodynamics, hypertension, rescue phenylephrine dose, nausea, and vomit were compared between the groups. Results In all the three groups, the incidence of nausea and vomit, bradycardia, hypertension, and neonatal Apgar score were not statistically different (P > 0.05). However, the adjuvant phenylephrine dose requirement was remarkably different. Moreover, the mean systolic blood pressure differed significantly in the second and 7th minutes after the spinal block (P < 0.05). 35% in the first group, 15% in the second group, and 2.5% in the third group had hypotension (P = 0.001). Apart from the first measurement after spinal anesthesia, the mean heart rate showed no significant difference between the groups. Conclusions The use of prophylactic phenylephrine infusion is recommended to control the optimal blood pressure in parturients undergoing cesarean section after spinal anesthesia.
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Affiliation(s)
- Mahshid Nikooseresht
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Pouran Hajian
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shadab Khamooshi
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
- Corresponding Author: Department of Anesthesiology, Hamadan University of Medical Sciences, Be'sat Hospital, Resalat Sq., Motahari Blvd., Postal Code: 65148-45471, Hamadan, Iran.
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Chandra S, Nugroho AM, Agus H, Susilo AP. How Low Can We Go? A Double-Blinded Randomized Controlled Trial to Compare Bupivacaine 5 mg and Bupivacaine 7.5 mg for Spinal Anesthesia in Cesarean Delivery in Indonesian Population. Anesth Pain Med 2019; 9:e91275. [PMID: 31341830 PMCID: PMC6615063 DOI: 10.5812/aapm.91275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background Maternal hypotension in cesarean delivery related to spinal anesthesia results in increasing morbidity of both mothers and children. Studies show that low dose spinal anesthesia was able to prevent hypotension while providing adequate analgesia. However, the dose used in those studies varies and this leaves the debate of the dose scheme of spinal anesthesia open. Objectives This study aimed to compare the effectiveness of 5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl with 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl to prevent hypotension in spinal anesthesia for cesarean delivery. Methods This study was a double-blinded randomized controlled trial of 112 mothers undergoing cesarean delivery with spinal anesthesia. The intervention group received 5 mg bupivacaine and 25 mcg fentanyl. The comparison group received of 7.5 mg bupivacaine and 25 mcg fentanyl. The primary outcome was the incidence of hypotension. The adequacy of anesthesia, duration of recovery from the motoric block, the quality of analgesia as perceived by patients and surgeons, and the side effects of anesthesia were also recorded. Results There was no difference of effectiveness to prevent hypotension in both groups. The 7.5 mg dose provided better adequacy of anesthesia as reflected in lower incidence of conversion into general anesthesia. More surgeons reported adequacy of relaxation in the 7.5 mg dose. The 5 mg dose offered faster motoric recovery and fewer side effects. Conclusions The dose of 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl can be used as a prevention measure against hypotension due to spinal anesthesia cesarean delivery.
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Affiliation(s)
- Susilo Chandra
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo National Hospital, University of Indonesia, Jakarta, Indonesia
- Corresponding Author: Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo National Hospital, Faculty of Medicine, University of Indonesia, Jalan Salemba Raya 6, 10430, Jakarta Pusat Indonesia,
| | - Alfan Mahdi Nugroho
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo National Hospital, University of Indonesia, Jakarta, Indonesia
| | - Henry Agus
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo National Hospital, University of Indonesia, Jakarta, Indonesia
| | - Astrid Pratidina Susilo
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo National Hospital, University of Indonesia, Jakarta, Indonesia
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Hassani V, Movaseghi G, Safaeeyan R, Masghati S, Ghorbani Yekta B, Farahmand Rad R. Comparison of Ephedrine vs. Norepinephrine in Treating Anesthesia-Induced Hypotension in Hypertensive Patients: Randomized Double-Blinded Study. Anesth Pain Med 2018; 8:e79626. [PMID: 30271750 PMCID: PMC6150924 DOI: 10.5812/aapm.79626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/04/2022] Open
Abstract
Background Hypotension is a common problem in general anesthesia. Maintaining the mean arterial pressure by choosing a vasopressor with minimal complications is still discussed in various surgeries. Objectives The aim of this study is comparison of ephedrine versus norepinephrine in treating anesthesia-induced hypotension in hypertensive patients in spinal surgery in a randomized double-blinded study. Methods This randomized, double-blinded study was approved by Iran University of Medical Sciences, operating room of medical center. Data collection was completed between Jan to Dec 2017. Inclusion criteria included age between 20 and 75 years, history of high blood pressure (a patient who has been treated for maximum 5 years with a anti hypertensive medication), and patients under general anesthesia in spinal surgery. The exclusion criteria were based on American Society of Anesthesiologists physical status of 3 or higher, history of arrhythmia, heart valve disease, cerebrovascular disease, kidney failure, beta-blocker use and diabetes, as well as intra operative massive blood loss. After initiation of anesthesia, when the pressure reaches less than 60, the patient entered the protocol and simultaneously administration of 5 mL/kg serum crystalloid and vasopressor. Patients were randomized to the ephedrine group (n = 28) who received 5 mg ephedrine intravenous (i.v.) or norepinephrine Group (n = 28) who received 10 µg (i.v.) bolus norepinephrine at anesthesia-induced hypotension. The administration of 5 mL/kg serum crystalloid and vasopressor was simultaneous. If the mean arterial pressure (MAP) had not reached 60 mmHg, the same dose should be repeated at a maximum of three or more times at five-minute intervals in the ephedrine group and at two minutes intervals in the norepinephrine group. All parameters were collected before and at the end of administration anesthesia drug and during episodes of hypotension. Hemodynamic variables, frequency of hypotension, and total number of vasopressors doses during anesthesia were recorded and analyzed. Results The mean number of hypotension times, the number of vasopressors doses in the first hypotension, the total number of doses consumed during the anesthesia, and heart rate at the end of anesthesia were lower in the norepinephrine group (P) respectively. MAP, 5 minutes after the first episode of hypotension and MAP at the end of anesthesia were higher in norepinephrine group. Conclusions Norepinephrine is more effective than ephedrine in maintenance of MAP in hypertensive patients undergoing spinal surgery under general anesthesia.
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Affiliation(s)
- Valiollah Hassani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Movaseghi
- Department of Anesthesiology, Hasheminezhad Hospital, Iran University of Medical Sciences, Tehran,
Iran
| | - Reza Safaeeyan
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Masghati
- Iran University of Medical Sciences (IUMS), Tehran, Iran
- Corresponding Author: Iran University of Medical Sciences (IUMS), Tehran, Iran. Tel: +98-9111931972,
| | - Batool Ghorbani Yekta
- Young Researchers and Elite Club, Tehran Medical Sciences Branch, Islamic Azad University, Tehran,
Iran
- Herbal Pharmacology Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Atashkhoei S, Abri R, Naghipour B, Hatami Marandi P, Fazeli Danesh MT. Effect of Glucose Containing Crystalloid Infusion on Maternal Hemodynamic Status After Spinal Anesthesia for Cesarean Section. Anesth Pain Med 2018; 8:e80184. [PMID: 30271752 PMCID: PMC6150926 DOI: 10.5812/aapm.80184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 12/22/2022] Open
Abstract
Background Despite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean section. Objectives The aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic status after spinal anesthesia for cesarean section. Methods In this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B (n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score, intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups. Results The incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complications (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P < 0.05). Maternal blood sugar (BS), before and after surgery, was not significantly different in the two groups (P = 0.207 and P = 0.239, respectively). There was no statistically significant difference in the APGAR score of neonates at the 1st and 5th minutes of the birth between the two groups (P = 0.076). Conclusions It seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.
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Affiliation(s)
- Simin Atashkhoei
- Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reyhaneh Abri
- Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Assistant professor, Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Tel/Fax:: +98-4135539163,
| | - Bahman Naghipour
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Taher Fazeli Danesh
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Gousheh MR, Akhondzade R, Asl Aghahoseini H, Olapour A, Rashidi M. The Effects of Pre-Spinal Anesthesia Administration of Crystalloid and Colloid Solutions on Hypotension in Elective Cesarean Section. Anesth Pain Med 2018; 8:e69446. [PMID: 30250818 PMCID: PMC6139530 DOI: 10.5812/aapm.69446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
Background Spinal anesthesia is an appropriate alternative for general anesthesia in many operations, particularly in cesarean section. However, the induced hypotension is the main drawback of this method. Therefore, the current study aimed at comparing the effects of crystalloid and colloid solutions used as the preload on the post-spinal hypotension and its complications in females who are candidate for elective cesarean section. Methods The current randomized, controlled, double-blind study was conducted on the female candidate of elective cesarean section (n = 96; age range: 20 to 40 years). The patients were in their 37 to 42 weeks of gestational age during the experiments. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) variation, amount of injected ephedrine during surgery, Apgar score at birth, total solution infused after spinal anesthesia, urine output, nausea, and vomiting were comparatively assessed between the two groups. Results The percentages of reduction in SBP and DBP variables in the crystalloid solution were higher than those of the colloid group and the differences were statistically significant (P = 0.042 and P = 0.008, respectively). Average percentage of HR changes was more significant in the crystalloid than the colloid group (P = 0.032). In contrary, administration of the two types of solutions did not result in significant differences in the Apgar scores. The prevalence of nausea and vomiting in the colloid group subjects was lower than those of the crystalloid solution group; however, the differences were not significant. Conclusions The current study findings recommend colloid solution to prevent hemodynamic instability after spinal anesthesia. However, the costs and availability of the solution and recommendation of anesthesiologist should be considered. Conduction of further clinical trials with larger sample sizes is recommended.
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Affiliation(s)
- Mohammad Reza Gousheh
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Irann
| | - Reza Akhondzade
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Irann
- Corresponding Author: Department of Anesthesiology, Pain Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Ave., Ahvaz, Iran. Tel: +98-6132220168,
| | - Hamid Asl Aghahoseini
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Irann
| | - Alireza Olapour
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Irann
| | - Mahbobe Rashidi
- Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Irann
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Saghafinia M, Jalali A, Eskandari M, Eskandari N, Lak M. The Effects of Hydroxyethyl Starch 6% and Crystalloid on Volume Preloading Changes following Spinal Anesthesia. Adv Biomed Res 2017; 6:115. [PMID: 28989908 PMCID: PMC5627562 DOI: 10.4103/abr.abr_151_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hypotension is one of the most common complications after spinal anesthesia for cesarean delivery. Normally, preloading with fluids, especially crystalloids, is used to prevention of hypotension. METHODS In the present randomized clinical trial study, 120 parturients presenting for elective cesarean section with the American Society of Anesthesiologists Class I and II received either 15 cc normal saline or 7 cc/kg hydroxyethyl starch 6% (Voluven) fluid. Information regarding to systolic, diastolic, mean arterial pressure, and heart rate, incidence of hypotension, adverse effects, the total dose of atropine, and ephedrine were recorded in before and 3, 6, 9, 15, and 20 min after spinal anesthesia. Furthermore, Apgar score of newborn at the 1st and 5th min after birth was recorded. RESULTS There was no significant difference in mean arterial pressure at different stages such as: Exactly after spinal and 3, 6, 15, and 20 min after spinal anesthesia between two groups (P > 0.05). Total dose of ephedrine and atropine were similar between groups (P > 0.05), respectively. There was no significant difference in Apgar score at the 1st and 5th min after birth between two groups. There were not any adverse effects of drugs in two groups. CONCLUSIONS The results of this study show that hydroxyethyl starch 6% compared to normal saline are similar to prevent hypotension during spinal anesthesia for cesarean delivery.
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Affiliation(s)
- Masoud Saghafinia
- From the Department of Anaesthesiology, Faculty of Medical Science, Tehran, Iran
| | - Alireza Jalali
- From the Department of Anaesthesiology, Faculty of Medical Science, Tehran, Iran
| | - Mahnaz Eskandari
- Department of Anesthesiology, Baghyatollah Medical Sciences University, Tehran, Iran
| | - Nahid Eskandari
- Department of Immunology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Marzieh Lak
- From the Department of Anaesthesiology, Faculty of Medical Science, Tehran, Iran
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10
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Naghibi K, Rahimi M, Mashayekhi Z. A Comparison of Intravenous Ephedrine or Phenylephrine, for Prevention of Postspinal Hypotension during Elective Lower Abdominal Surgery: A Randomized, Double-blind Case-control Study. Adv Biomed Res 2017; 6:60. [PMID: 28603701 PMCID: PMC5458406 DOI: 10.4103/2277-9175.207147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In this randomized, double-blinded case-control study, we investigated the intravenous effects of ephedrine or phenylephrine on prevention of post-spinal hypotension in elective lower abdominal surgery under spinal anesthesia. MATERIALS AND METHODS One hundred and thirty-five patients, American Society of Anesthesiologists physical status I or II candidate for elective lower abdominal surgery under spinal anesthesia were randomized to three groups (45 each). According to their allocated group, patients received either ephedrine 2.5 mg (E group), phenylephrine (P group) 25 mic as vasopressor or the same volume of saline normal as placebo (S group) immediately after the spinal anesthesia. hemodynamic parameters, and complications were recorded. RESULTS Patients' demographics were similar in all the groups. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP and also heart rate were similar over time for groups E and P (P > 0.05). The incidence of reactive hypertension was more in group E than group P and placebo (P < 0.05). The incidence of nausea and vomiting were significantly lower in groups E and P in comparison with placebo (P < 0.05). CONCLUSION Although the mean fall of SBP and DBP were significantly less in groups E and P compared with placebo but we did not find significant differences in prophylactic use of ephedrine or phenylephrine for prevention of post-spinal hypotension in elective lower abdominal surgery. Vasopressors infusion have added benefit of lower incidence of nausea and vomiting.
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Affiliation(s)
- Khosrou Naghibi
- From the Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan, Iran
| | - Mojtaba Rahimi
- From the Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan, Iran
| | - Zahra Mashayekhi
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Hajian P, Nikooseresht M, Lotfi T. Comparison of 1- and 2-Minute Sitting Positions Versus Immediately Lying Down on Hemodynamic Variables After Spinal Anesthesia with Hyperbaric Bupivacaine in Elective Cesarean Section. Anesth Pain Med 2017; 7:e43462. [PMID: 28920051 PMCID: PMC5594417 DOI: 10.5812/aapm.43462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/04/2017] [Accepted: 01/28/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hypotension is one of the most common complications of spinal anesthesia in parturients undergoing cesarean section. In this regard, the patient's position may affect the incidence of hypotension. OBJECTIVES In this clinical trial, we evaluated the effects of 1- and 2-minute sitting positions versus immediately lying down after spinal anesthesia on hypotension and vasopressor requirements. METHODS A total of 72 parturients, scheduled for cesarean section under spinal anesthesia, were randomly divided into 3 groups (24 subjects per group). Groups S1 and S2 remained in a sitting position for 1 and 2 minutes after the induction of spinal anesthesia, respectively, while group T was immediately placed in a lying position. Systolic, diastolic, and mean arterial blood pressure, as well as heart rate, was recorded at 1, 2, 3, and 5 minutes after anesthesia induction, every 5 minutes during the first 30 minutes of surgery, and then every 10 minutes until the end of surgery. P-value less than 0.05 was considered statistically significant. RESULTS The overall frequency of hypotension was 50 (69%) cases during surgery; the reported frequency was higher in group T in comparison with group S2 (P = 0.003). The frequency of hypotension before delivery (the first 5 minutes after spinal anesthesia) was 40 (55%) cases, with a higher frequency reported in group T (20, 83%), compared to groups S1 (12, 50%) and S2 (8, 33%) (P = 0.03 and P = 0.001, respectively). The ephedrine requirement in group T (11.73 ± 7.16 mg) was higher than the other two groups (8.69 ± 7.57 and 7.82±7.95 mg in groups S1 and S2, respectively); nevertheless, the difference was not statistically significant (P = 0.19). Moreover, the difference in time to achieve T6 sensory level was only significant between group T (3.25 ± 1.1 minutes) and group S2 (4.73 ± 1.73 minutes) (P = 0.03). CONCLUSIONS The present study showed that 1- or 2-minute sitting position after spinal anesthesia with 2.5 cc of hyperbaric bupivacaine in elective cesarean section results in more hemodynamic stability, compared with immediately lying down.
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Affiliation(s)
- Pooran Hajian
- Department of Anesthesiology, School of Medicine, Hamedan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nikooseresht
- Department of Anesthesiology, School of Medicine, Hamedan University of Medical Sciences, Hamadan, Iran
| | - Tayebe Lotfi
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Nikooseresht M, Seif Rabiei MA, Hajian P, Dastaran R, Alipour N. Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section. Anesth Pain Med 2016; 6:e11519. [PMID: 27642568 PMCID: PMC5018157 DOI: 10.5812/aapm.11519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 04/26/2016] [Accepted: 05/28/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite controversies about the safest anesthetic technique for cesarean delivery in severely preeclamptic women, there is evidence that supports the use of spinal anesthesia in this group of patients. OBJECTIVES This prospective randomized clinical trial was designed to determine the hemodynamic effects of low-dose spinal bupivacaine and the incidence of spinal anesthesia-associated hypotension in severely preeclamptic and healthy parturients undergoing cesarean sections. PATIENTS AND METHODS Spinal anesthesia was performed with 10 mg (= 2 mL) hyperbaric 0.5% bupivacaine plus 2.5 µg sufentanil in two groups of patients after they received 500 mL of IV lactated Ringer's solution. Heart rate and blood pressure were recorded before spinal anesthesia and at two minutes intervals for 15 minutes after the block, and then every five minutes until the end of the surgery. Hypotension was defined as more than 25% of decline in the mean arterial blood pressure compared to the baseline in both groups (or systolic blood pressure < 100 mmHg in healthy parturients) and was treated with 5 mg IV ephedrine. The total amounts of intravenous administered fluid and the total doses of ephedrine were recorded for each patient as well. RESULTS The incidence rate of hypotension among the preeclamptic patients was lower than that of the healthy parturients, despite the former group receiving smaller volumes of intravenous fluids (P < 0.05). The total doses of IV ephedrine for treating hypotension were significantly lower among the preeclamptic patients (3.2 mg in preeclamptic patients versus 7.6 mg in normotensive patients) (P = 0.02). The one-minute Apgar score was significantly lower for the preeclamptic parturients (8.4 ± 0.7 versus 7.2 ± 1.5) (P = 0.001), but there was no significant difference in the five-minute Apgar scores between the two groups. CONCLUSIONS Our results confirm that low-dose bupivacaine spinal anesthesia is associated with a lower risk of hypotension than previously believed, and it can therefore be safely used in severe preeclamptic women undergoing cesarean delivery.
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Affiliation(s)
- Mahshid Nikooseresht
- Department of Anesthesiology, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
- Corresponding author: Mahshid Nikooseresht, Department of Anesthesiology, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran. Tel: +98-8138353090, Fax: +98-8138277459, E-mail:
| | - Mohamad Ali Seif Rabiei
- Department of Community Medicine, School of Medicine , Hamedan University of Medical Sciences, Hamedan, Iran
| | - Pooran Hajian
- Department of Anesthesiology, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Razieh Dastaran
- Anesthesiologist, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Nasim Alipour
- Department of Anesthesiology, School of Para medicine, Hamedan University of Medical Sciences, Hamedan, Iran
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Lewis SR, Butler AR, Brammar A, Nicholson A, Smith AF. Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database Syst Rev 2016; 3:CD003004. [PMID: 26976366 PMCID: PMC7138038 DOI: 10.1002/14651858.cd003004.pub4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Proximal femoral fracture (PFF) is a common orthopaedic emergency that affects mainly elderly people at high risk of complications. Advanced methods for managing fluid therapy during treatment for PFF are available, but their role in reducing risk is unclear. OBJECTIVES To compare the safety and effectiveness of the following methods of perioperative fluid optimization in adult participants undergoing surgical repair of hip fracture: advanced invasive haemodynamic monitoring, such as transoesophageal Doppler and pulse contour analysis; a protocol using standard measures, such as blood pressure, urine output and central venous pressure; and usual care.Comparisons of fluid types (e.g. crystalloid vs colloid) and other methods of optimizing oxygen delivery, such as blood product therapies and pharmacological treatment with inotropes and vasoactive drugs, are considered in other reviews. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9); MEDLINE (October 2012 to September 2015); and EMBASE (October 2012 to September 2015) without language restrictions. We ran forward and backward citation searches on identified trials. We searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for unpublished trials. This is an updated version of a review published originally in 2004 and updated first in 2013 and again in 2015. Original searches were performed in October 2003 and October 2012. SELECTION CRITERIA We included randomized controlled trials (RCTs) in adult participants undergoing surgical treatment for PFF that compared any two of advanced haemodynamic monitoring, protocols using standard measures or usual care, irrespective of blinding, language or publication status. DATA COLLECTION AND ANALYSIS Two review authors assessed the impact of fluid optimization interventions on outcomes of mortality, length of hospital stay, time to medical fitness, whether participants were able to return to pre-fracture accommodation at six months, participant mobility at six months and adverse events in-hospital. We pooled data using risk ratio (RR) or mean difference (MD) for dichotomous or continuous data, respectively, on the basis of random-effects models. MAIN RESULTS We included in this updated review five RCTs with a total of 403 participants, and we added two new trials identified during the 2015 search. One of the included studies was found to have a high risk of bias; no trial featured all pre-specified outcomes. We found two trials for which data are awaited for classification and one ongoing trial.Three studies compared advanced haemodynamic monitoring with a protocol using standard measures; three compared advanced haemodynamic monitoring with usual care; and one compared a protocol using standard measures with usual care. Meta-analyses for the two advanced haemodynamic monitoring comparisons are consistent with both increased and decreased risk of mortality (RR Mantel-Haenszel (M-H) random-effects 0.41, 95% confidence interval (CI) 0.14 to 1.20; 280 participants; RR M-H random-effects 0.45, 95% CI 0.07 to 2.95; 213 participants, respectively). The study comparing a protocol with usual care found no difference between groups for this outcome.Three studies comparing advanced haemodynamic monitoring with usual care reported data for length of stay and time to medical fitness. There was no statistically significant difference between groups for these outcomes in the two studies that we were able to combine (MD IV fixed 0.63, 95% CI -1.70 to 2.96); MD IV fixed 0.01, 95% CI -1.74 to 1.71, respectively) and no statistically significant difference in the third study. One study reported reduced time to medical fitness when comparing advanced haemodynamic monitoring with a protocol, and when comparing protocol monitoring with usual care.The number of participants with one or more complications showed no statistically significant differences in each of the two advanced haemodynamic monitoring comparisons (RR M-H random-effects 0.83, 95% CI 0.59 to 1.17; 280 participants; RR M-H random-effects 0.72, 95% CI 0.40 to 1.31; 173 participants, respectively), nor any differences in the protocol and usual care comparison.Only one study reported the number of participants able to return to normal accommodation after discharge with no statistically significant difference between groups.There were few studies with a small number of participants, and by using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) approach, we judged the quality of the outcome evidence as low. We had included one study with a high risk of bias, but upon applying GRADE, we downgraded the quality of this outcome evidence to very low. AUTHORS' CONCLUSIONS Five studies including a total of 403 participants provided no evidence that fluid optimization strategies improve outcomes for participants undergoing surgery for PFF. Further research powered to test some of these outcomes is ongoing.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryPatient Safety ResearchPointer Court 1, Ashton RoadLancasterUKLA1 1RP
| | - Andrew R Butler
- University Hospitals of Morecambe Bay NHS Foundation TrustResearch DepartmentRoyal Lancaster InfirmaryAshton RoadLancasterUKLA1 4RP
| | - Andrew Brammar
- University Hospital of South ManchesterDepartment of AnaesthesiaManchesterUK
| | - Amanda Nicholson
- University of LiverpoolLiverpool Reviews and Implementation GroupSecond FloorWhelan Building, The Quadrangle, Brownlow HillLiverpoolUKL69 3GB
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Soltani Mohammadi S, Hassani M, Marashi SM. Comparing the squatting position and traditional sitting position for ease of spinal needle placement: a randomized clinical trial. Anesth Pain Med 2014; 4:e13969. [PMID: 24790901 PMCID: PMC3989545 DOI: 10.5812/aapm.13969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/16/2013] [Accepted: 10/19/2013] [Indexed: 11/17/2022] Open
Abstract
Background: previous evidences suggested that traditional sitting position (flexion of knees approximately 90°, and adduction of hips while feet rest on a stool) and hamstring stretch position (sitting position with maximum extension of knees, adduction of hips, and forward bending) both reversed the lumbar lordosis and the number of spinal needle-bone contacts were identical when placing patients in these positions for neuraxial block. Objectives: In this study, we suggested that squatting position reverses the lumbar lordosis and reduces the number of spinal needle bone contacts better than a traditional sitting position. Patients and Methods: Two hundred and thirty six patients ASA (American Society of Anesthesiologist) class I or II aged 18 to 75 years scheduled for elective surgeries under elective spinal anesthesia were randomized into two groups. We compared the traditional sitting and squatting positions. Our primary endpoint was the number of spinal needle-bone contacts, and secondary endpoint was ease of needle insertion or space identification. Results: The total number of spinal needle bone contact was statistically lower in the squatting position compared to traditional sitting position group (222 versus 230 respectively, P = 0.01). Insertion of needle was easy in 97 (87%) and 94 (84%) of patients and difficult in 20 (18%) and 17 (15%) of patients in traditional sitting and squatting positions, respectively (P = 0.59 and P = 0.12). Needle insertion was not impossible in any patients. Conclusions: In squatting position the number of spinal needle-bone contacts was lower compared to the traditional sitting position, nonetheless ease of needle insertion or space identification was the same in the both groups.
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Affiliation(s)
- Sussan Soltani Mohammadi
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Sussan Soltani Mohammadi, Department of Anesthesiology, Dr. Shariati Hospital, North Kargar St., Ale-Ahmad highway, 1411713135, Tehran, Iran. Tel: +98-9121226683, Fax: +98-2188633039, E-mail:
| | - Marzieh Hassani
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mojtaba Marashi
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Marashi SM, Soltani-Omid S, Soltani Mohammadi S, Aghajani Y, Movafegh A. Comparing Two Different Doses of Intravenous Ondansetron With Placebo on Attenuation of Spinal-induced Hypotension and Shivering. Anesth Pain Med 2014; 4:e12055. [PMID: 24790900 PMCID: PMC3997945 DOI: 10.5812/aapm.12055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/24/2013] [Accepted: 08/06/2013] [Indexed: 11/16/2022] Open
Abstract
Background: Side effects of spinal anesthesia are hypotension, bradycardia and shivering. Five-hydroxytriptamine (5-HT), a serotonergic receptor, may be an important factor associated with inducing the Bezold Jarish reflex (BJR) that may lead to the bradycardia and hypotension in the setting of decreased blood volume. Objectives: This study aimed to investigate the effect of intravenous administration of ondansetron, a 5-HT3 receptor antagonist, which could attenuate spinal-induced hypotension, bradycardia and shivering. Patients and Methods: Two hundred and ten patients aged 20-50 years old were scheduled for spinal anesthesia and were divided randomly into three equal groups. The control group received normal saline and intervention groups received 6 mg or 12 mg of intravenous ondansetron 5 minutes before spinal anesthesia. Mean arterial pressure (MAP), heart rate (HR), and shivering were recorded before and after spinal anesthesia every 5 minutes during first 20 minutes of surgery. Results: Demographic data were not statistically different among groups. HR was statistically different between the experimental groups and the control group. Ten patients (14%) in the control group had HR < 50 bpm, that required intravenous atropine compared to experimental groups (P =0.02). In the control group 12 (17%) patients had MAP < 80 mm Hg and required vasopressors compared to experimental groups (P = 0.04). There were no significant differences in MAP and HR between the experimental groups (P =0.06). Incidence of shivering in the control group was 45% (32.70) that was statistically more than experimental groups (P = 0.02). Conclusions: Administration of two different doses of intravenous ondansetron, 6 mg and 12 mg, significantly attenuates spinal induced hypotension, bradycardia and shivering compared to the control saline group. However, the hemodynamic profiles and shivering in experimental groups were not statistically different.
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Affiliation(s)
- Seyed Mojtaba Marashi
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Soltani-Omid
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sussan Soltani Mohammadi
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Sussan Soltani Mohammadi, Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, North Kargar Street, Ale-Ahmad Highway, Tehran, IR Iran. Tel: +98-9121226683, Fax: +98-2188633039, E-mail:
| | - Yasaman Aghajani
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Movafegh
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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