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Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

ABSTRACT: In parturients with increased physiologically intra-abdominal pressure (IAP) and a short stature, a greater cephalad spread of spinal anesthesia is often observed after a fixed amount of plain bupivacaine is administered. Therefore, we designed this prospective study to test whether IAP and vertebral column length (VCL) were predictors of spinal spread in parturients undergoing a cesarean section.A total of 113 parturients, all undergoing elective cesarean sections with single-shot spinal anesthesia, were enrolled. The L3-L4 interspace was entered, and 2 mL of 0.5% plain bupivacaine was injected into the subarachnoid space. Upon loss of temperature sensation at the T4 level, IAP was measured through a bladder catheter while the patient was in the supine position with a 10°left lateral tilt. Parturient demographic variables, including age, height, weight, IAP, and VCL were recorded. Linear regressions and multiple regressions were performed to analyze the relationships between parturient variables and the spread of spinal anesthesia.A total of 109 parturients were included in the analysis. Linear regression analysis showed a significant univariate correlation of height, weight, body mass index (BMI), IAP, and VCL with cephalad spread (all P< 0.004). Multiple linear regression analysis showed that IAP and VCL were the key determinants of spinal spread (both P < 0.0001), where as exclusion of age, weight, and height did not change the result (all P> 0.209).Our data indicated that IAP and VCL were significant predictors of intrathecal spread of plain bupivacaine, and there was a positive association between IAP and abdominal girth in term parturients.

SUBMITTER: Ni TT

PROVIDER: S-EPMC5882131 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

Ni Ting-Ting TT Zhou Ying Y Yong An-Cui AC Wang Lu L Zhou Qing-He QH

PloS one 20180403 4

<h4>Background</h4>In parturients with increased physiologically intra-abdominal pressure (IAP) and a short stature, a greater cephalad spread of spinal anesthesia is often observed after a fixed amount of plain bupivacaine is administered. Therefore, we designed this prospective study to test whether IAP and vertebral column length (VCL) were predictors of spinal spread in parturients undergoing a cesarean section.<h4>Methods</h4>A total of 113 parturients, all undergoing elective cesarean sect ...[more]

PMID: 29614090

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Project description:Background: SARS-CoV-2 infection was referred to sympathetic hyperactivity, which might increase the susceptibility of neuraxial anesthesia-related hypotension resulted from sympathetic inhibition. We conducted a multicenter, retrospective, propensity score matched (PSM) cohort study to determine whether COVID-19 parturients have an increased risk of hypotension after neuraxial anesthesia for cesarean delivery. Methods: Clinical data of COVID-19 parturients were collected from the electronic medical records from 1th January to 31th May, 2020 in three hospitals of Hubei Province, China. Information of Control parturients (without COVID-19) were obtained at the same institutions over a similar period in 2019. All American Society of Anaesthesiologists (ASA) Physical Status II full termed pregnant women who received cesarean delivery under neuraxial anesthesia were included. The primary objective was to obtain and compare the incidence of neuraxial anesthesia-related hypotension. Secondary objectives were the analysis of anesthetic implementation and administration, intraoperative maternal vital signs and adverse reactions, and neonatal Apgar scores at 1 and 5 min after delivery. The clinical characteristics of COVID-19 parturients were also analyzed. PSM was derived to balance the predictors for neuraxial anesthesia-related hypotension based on previous studies. Results: In present study, 101 COVID-19 parturients and 186 Control parturients were derived from 1,403 cases referenced to propensity score matching. The incidence of neuraxial anesthesia-related hypotension was 57.4% in COVID-19 parturients and 41.9% in Control parturients with an incidence risk ratio (IRR) of 1.37 (95% CI 1.08-1.74; P = 0.012; post-hoc Cramér's V = 0.15) in the PSM cohort. The incidences of nausea, vomiting, dizziness, and shaking were significantly higher in the COVID-19 group than Control group (48.5 vs. 17.2%, P < 0.001; 10.9 vs. 4.3%, P = 0.03; 18.8 vs. 3.2%, P < 0.001; 51.5 vs. 18.3%, P < 0.001; respectively). The Apgar scores at 1 min was significantly lower in newborns from COVID-19 parturients than that in Control babies (P = 0.04). Conclusions: An increased risk of neuraxial anesthesia-related hypotension in COVID-19 parturients undergoing cesarean delivery should be stressed.

Project description:BACKGROUND:Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/IV has been associated with difficult tracheal intubation, our present study aims to investigate if Mallampati score (MP) could predict airway outcomes for LMA use in obstetrics. METHODS:This prospective cohort study was performed at a single-center: Quanzhou Women's and Children's Hospital, Fujian Province, China. Five hundred and eighty-four parturients undergoing elective cesarean section under general anesthesia were recruited. The primary outcome was time to effective ventilation, and secondary outcomes included first attempt insertion success, seal pressure, ventilation and hemodynamic parameters, occurrence of clinical aspiration, and maternal and fetal outcomes. RESULTS:The parturients were classified into two groups based on MP of III/IV (High MP: 61) versus I/II (Low MP: 523). BMI was higher in the High MP group than in the Low MP group (mean (SD) 29.3 (7.0) vs 26.8 (3.1), p?<? 0.0001). There was no difference in maternal age, ASA status and gestational age. There was similar time to effective ventilation (mean (SD) High MP: 14.9 (4.5) vs Low MP: 15.7 (4.4) seconds, p?=?0.2172), and first attempt success rate, seal pressure, and peak airway pressure. No clinical aspiration was noted. The incidence of blood on SLMA was higher in the High MP group than in Low MP (4 (6.6%) vs 4 (0.8%), p?=?0.001). There was no difference in sore throat, voice hoarseness, maternal satisfaction and fetal outcomes. CONCLUSION:High MP was not associated with reduced SLMA airway outcomes in cesarean section under general anesthesia, but may increase the risk of blood found on SLMA upon removal. TRIAL REGISTRATION:This study was registered at http://www.clinicaltrials.gov , identifier: NCT02026882 , retrospectively registered. Date of registration: December 31, 2013.

Project description:Background:Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone Cesarean section under spinal anesthesia. Method:A prospective cohort study was conducted from 01 February to 28 May 2019 in preeclamptic and non-preeclamptic parturients. We hypothesized preeclamptic parturients are at high risk of spinal anesthesia induced hypotension than non preeclamptics. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). Parturients with cardiac disease, twin pregnancy, chronic hypertension, gestational hypertension, superimposed hypertension, renal disease, diabetes mellitus, coagulopathy (platelet count <?80?×?109/L), active labor, eclampsia, abruptio placentae, placenta praevia, any adjuvant added with local anesthetics were excluded. The data analysis was done using SPSS version 22 statistical software. Student t test, MannWhitney U test and Fisher exact test were used to compare the data. All P values <?0.05 were considered statistically significant. Result:The incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics. Conclusion:The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients.. Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia.

Dataset Information

Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

Publications

Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

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