scholarly journals Comparison of the effect of general and spinal anesthesia for elective cesarean section on maternal and fetal outcomes: a retrospective cohort study

2021 ◽  
Author(s):  
Tae-Yun Sung ◽  
Hwang-Ju You ◽  
Choon-Kyu Cho ◽  
Young Seok Jee
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Loss ◽  
Retrospective Cohort ◽  
Hemodynamic Parameters ◽  
Cesarean Sections ◽  
General Group ◽  
Apgar Scores ◽  
Estimated Blood Loss ◽  
Spinal Group

Background: Anesthesia is needed to ensure both maternal and fetal safety during cesarean sections. This retrospective cohort study compared maternal and fetal outcomes between general and spinal anesthesia for cesarean section based on perioperative hemodynamic parameters (pre- and postoperative systolic blood pressure, heart rate), mean difference of hematocrit and estimated blood loss, and neonatal Apgar scores at 1 and 5 min.Methods: Data from electronic medical records of 331 singleton pregnancies between January 2016 and December 2018 were analyzed retrospectively; 44 cases were excluded, and 287 cases were assigned to the general group (n = 141) or spinal group (n = 146).Results: Postoperative hemodynamic parameters were significantly higher in the general group than the spinal group (systolic blood pressure: 136.8 ± 16.7 vs. 119.3 ± 12.7 mmHg, heart rate: 93.2 ± 16.8 vs. 71.0 ± 12.7 beats/min, respectively, P < 0.001). The mean difference between the pre- and postoperative hematocrit was also significantly greater in the general than spinal group (4.8 ± 3.4% vs. 2.3 ± 3.9%, respectively, P < 0.001). The estimated blood loss was significantly lower in the spinal than general group (819.9 ± 81.9 vs. 856.7 ± 117.9 ml, P < 0.001). There was a significantly larger proportion of newborns with 5-min Apgar scores < 7 in the general than spinal group (6/141 [4.3%] vs. 0/146 [0%], respectively, P = 0.012). Conclusions: General group is associated with more maternal blood loss and a larger proportion of newborns with 5-min Apgar scores < 7 than spinal group during cesarean sections.

scholarly journals Effect of Anesthesia Techniques on Pain Severity, Hemodynamic Changes, and Patients’ Satisfaction in Elective Cesarean Section

2020 ◽  
Author(s):  
Abdollah Jafarzadeh ◽  
Maryam Hadavi ◽  
Gholamhossein Hasanshahi ◽  
Mohsen Rezaeian ◽  
Reza Vazirinejad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Cesarean Section ◽  
Diastolic Blood Pressure ◽  
Elective Cesarean Section ◽  
Hemodynamic Changes ◽  
Apgar Scores ◽  
Patients Satisfaction ◽  
Elective Cesarean

The severity of postoperative pain and hemodynamic changes during and post-cesarean section have a direct effect on the neonatal and maternal condition. This study aimed to compare pain severity, hemodynamic changes, and patient satisfaction following two anesthesia techniques in elective cesarean section. In this blinded study, 60 women who were candidate for cesarean section were allocated into two equal groups of general anesthesia (GA) and spinal anesthesia (SA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and O2 Saturation at pre cesarean (T0), the uterine incision time (T1), end of surgery (T2), 6h (T3), 12h (T4), and 24 hours post-cesarean (T5) were measured. A Visual Analog Scale assessed post-cesarean pain, 6, 12, and 24 hours post-cesarean. Gender, birth weight, first- and fifth- minutes’ apgar score was recorded in the checklists. The VAS score was significantly higher in the GA group at 6h, 12h, and 24 hours post-cesarean (P=0.014, P=0.002, P=0.017, respectively). SBP and DBP at T1 in the GA group were significantly higher than in the S.A group (P<0.001). The heart rate at T0 and T1 in the GA group was lower than the SA group (P=0.001, P=0.045 respectively). The difference between the apgar scores of the two groups was not significant. SA for cesarean section was associated with lower postoperative pain, systolic and diastolic blood pressure. However, the two groups had no significant difference in terms of patients’ satisfaction and apgar scores. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):424-429.

scholarly journals CHANGE OF FUNCTIONAL AND LABORATORY PARAMETERS AFTER COMPENSATION OF ACUTE BLOOD LOSS WITH COOLED HYPERTONIC SOLUTION IN EXPERIMENT

2018 ◽  
pp. 83-94
Author(s):  
A. V. Krupin ◽  
I. A. Shperling ◽  
P. A. Romanov ◽  
M. I. Shperling
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Loss ◽  
Blood Plasma ◽  
Hypertonic Solution ◽  
Acute Blood Loss ◽  
External Temperature ◽  
Heat Chamber ◽  
Quantitative Indicators ◽  
Experimental Group

Relevance.High efficiency of hypertonic (hyperosmolar) solutions in acute blood loss is known. However, data on changes in the body, developing as a result of infusion of such drugs (including cooled) in the providing of care after acute blood loss is limited or absent. This fact complicates the development of tactics in their use, especially in emergency situations at low temperatures.Intention.To reveal features of functional and laboratory indicators In experiments on animals as a result of infusion of warm (+22 °С) or the cooled (–3 °С) hypertonic solution based on hydroxyethyl starch and sodium chloride (HyperHAES, further – HHES) at the acute blood loss of 50 % of blood volume (BV).Methodology.Animals (20 male sheep) with modeled blood loss were distributed into 2 experimental and 2 control groups of 5 animals each. Sheep in the 1st experimental group were placed in the heat chamber with temperature –7 °С for 15 min. Then they underwent the intravenous infusion of a cooled HHES at a dose of 4 ml/kg of weight through the jugular vein with a disposable syringe (volume 20 ml) evenly with a speed of 60 ml per minute. After that they were left in the heat chamber until the time of 1 hour in total. Individuals in the 2nd experimental group were injected with an equivalent volume of warm solution during the corresponding periods of the experiment at an external temperature of +22 °C. 1 hour after beginning of the infusion all animals were intravenously injected with colloidal solution based on hydroxyethyl starch (“Voluven”) at an external temperature of +22 °C. During 1 day the dynamics of rectal temperature, arterial pressure, heart rate and respiratory movements, osmolarity of blood plasma and content of osmotically active components, quantitative indicators of red blood were evaluated.Results.Animals at a temperature of +22 °C or at a temperature of –7 °C died in (82 ± 3) min and (70 ± 5) min (p < 0.05) respectively after the start of exfusion. Intravenous fluids (warm or cooled HHES) ensured the survival in 100 % of cases. As a result of blood loss, subsequent infusion of cooled HHES and following presence in the heat chamber, rectal temperature in sheep decreased by 4.9 °C (14.2%, p < 0.05) relative to the initial values. Two and 4 min after infusion of cooled or warm HHES systolic blood pressure increased by 24.9 % (p < 0.05) and 14.9 % (p < 0.05), respectively, and were restored to the normal level during the following 40 min. Infusion of “Voluven” contributed to the stabilization of blood pressure within 1 day after infusion of HHES. Blood loss led to increased heart rate by 2.1 times (p < 0.05), infusion of HHES slightly reduced the severity of tachycardia. Within 10 minutes after the introduction of cooled HHES, dynamics of heart rate was less stable. Infusion of warm or cooled HHES increased osmolarity of blood plasma by 9.5–9.9 % (p < 0.05), which was associated with an increase of sodium and glucose concentrations in blood. Infusion of “Voluven” reduced osmolarity of blood plasma, which became similar to initial values at the end of Day 1 after infusion of HHES. Blood loss, infusion of HHES and “Voluven” decreased quantitative indicators of red blood via removal of red blood cells from the bloodstream, as well as compensatory and post-transfusion hemodilution.Conclusion.The infusion of warm or cold hypertonic saline (HyperHAES) ensures the survival of experimental animals in post-hemorrhagic period. The positive effect of the drug is associated with compensatory haemodilution (including increased osmolarity of blood plasma), as well as with better functioning of the cardiovascular system. Specific cooled HHES effects include an earlier and pronounced rise in blood pressure. Considering changes in functional and laboratory parameters after infusion of warm or cooled HHES, a reliable system should be developed to remove casualties from emergency areas and to take earlier and complete diagnostic and treatment measures.

scholarly journals Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dazhi Fan ◽  
Jiaming Rao ◽  
Dongxin Lin ◽  
Huishan Zhang ◽  
Zixing Zhou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Transfusion ◽  
Blood Loss ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Neuraxial Anesthesia ◽  
Estimated Blood Loss ◽  
Maternal And Neonatal Outcomes

Abstract Background The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Methods A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery. Results We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

scholarly journals Effect of Continuous Infusion of Dexmedetomidine on Blood Loss in Orthognathic Surgery: A Retrospective Study

2020 ◽  
Author(s):  
Chenyu Jin ◽  
Hong Jiang ◽  
Xiang Lv ◽  
Yu Sun
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Loss ◽  
Haemoglobin Level ◽  
Continuous Infusion ◽  
Orthognathic Surgery ◽  
Fluid Volume ◽  
Control Group ◽  
Postoperative Haemoglobin ◽  
Decrease Blood Loss

Abstract Background: Patients with maxillofacial deformities require orthognathic surgeries to correct occlusion. The surgical procedure may lead to massive bleeding, which is associated with hematoma, respiratory obstruction, and asphyxia. Dexmedetomidine has been used in controlled hypotension, and may decrease blood loss in orthognathic surgery. We conducted a retrospective cohort study to evaluate the effect of dexmedetomidine on blood loss in orthognathic surgeries.Methods: The primary outcome examined was blood loss, and secondary outcomes were postoperative haemoglobin level, intraoperative heart rate, and blood pressure (T0: preoperative; T1: at incision; T2: 30 minutes after incision; T3: 60 minutes after incision; T4: 120 minutes after incision); dose of fentanyl, remifentanil, urapidil, and esmolol; operation time; incidence of allogeneic blood transfusion; crystalloid fluids volume; and colloidal fluid volume. Results: A total of 1,247 patients were included in the study, and 557 patient pairs were matched via propensity score matching. There were significant decreases in mean blood loss, heart rate at T1–T4, blood pressure at T1, remifentanil and esmolol dosage, and crystalloid fluid volume in the dexmedetomidine group compared with those in the control group. There was also a significant increase in the postoperative haemoglobin level of the dexmedetomidine group. Conclusions: Continuous infusion of dexmedetomidine can decrease blood loss in orthognathic surgery.Trial registration number: ChiCTR1800018794 (retrospectively registered)Name of registry: Chinese Clinical Trial RegistryDate of registration: 2018/10/09URL: www.chictr.org.cn/showproj.aspx?proj=30612

scholarly journals Comparison of two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block for abdominal hysterectomies. A randomized double blinded study.

2017 ◽  
Vol 8 (2) ◽  
pp. 59-63
Author(s):  
R Krishna Prabhu ◽  
A Radhakrishnan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Relief ◽  
Blood Loss ◽  
Motor Block ◽  
Sensory Block ◽  
Abdominal Hysterectomy ◽  
Group A ◽  
Group B ◽  
Different Doses

Background: Abdominal hysterectomy is often a long duration procedure and warrants intense pain relief in the post-operative period. Dexmedetomidine when added to bupivacaine in subarachnoid block prolongs the duration of surgical anaesthesia, decreases blood loss and prolongs duration of post-operative pain relief. Aims and Objective: To compare two different doses dexmedetomidine as an adjuvant to bupivacaine in sub-arachnoid block in abdominal hysterectomy surgeries. Materials and Methods: 60 patients of age group 30-60 years posted for elective abdominal hysterectomies under American Society of Anaesthesiologists (ASA) physical classification I or II were randomly allocated into 2 groups of 30 each. Group A received 5 micrograms (μg) of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Group B received 10 μg of dexmedetomidine along with 3.5 ml of 0.5% bupivacaine in sub-arachnoid block. Changes in blood pressure, heart rate, respiratory rate, oxygen saturation, ephedrine consumption, blood loss, duration of sensory block, duration of motor block, duration of analgesia were compared between two groups. Results: There was no significant difference in change in heart rate, respiratory rate, oxygen saturation, duration of sensory block, duration of motor block between two groups. Patients in group B had significant decrease in blood pressure, blood loss and significant increase in ephedrine consumption compared to Group A. The duration of analgesia was also prolonged in group B compared to Group A. Conclusion: Dexmedetomidine in dose of 10 μg is a better adjuvant to bupivacaine for abdominal hysterectomy surgeries.Asian Journal of Medical Sciences Vol.8(2) 2017 59-63

scholarly journals The ocular cardiac reflex effect study on cardiac hemodynamic parameters in healthy young mans.

2019 ◽  
Vol 40 (1) ◽  
pp. 17-24
Author(s):  
A. I. Palamarchuk
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cardiovascular System ◽  
Peripheral Resistance ◽  
Blood Flow Rate ◽  
Effect Study ◽  
Nonlinear Dependence ◽  
System Response ◽  
Hemodynamic Parameters

Purpose of the study. Investigate changes of cardiac hemodynamic parameters caused by ocular cardiac reflex triggering in healthy men’s in youthful age.Material and methods. 120 healthy male volunteers in youthful age were examined. The mean age was (19,2 ± 0,93 years). For ocular-cardiac reflex (OCR) triggering we used a patented model «Device for dosed compression effects on the eyeballs» and «The method of ocular cardiac reflex triggering». On the basis of the obtained parameters of systolic (SBP) and diastolic (DBP) blood pressure, by arithmetic operations, pulse pressure (PP) and average flow pressure (AFP) and integrative parameters of cardiohemodynamics (CHD) – systolic blood volume (SBV), minute blood flow volume (MBFV), volumetric blood flow rate (V), total peripheral resistance (TPR) were determined. Results. Three main types of cardiovascular system response on OCR triggering were identified. The first type – hypertensive (n = 30 (25%) of the total number of examined subjects) was characterized by a significant (p < 0,05) increase in heart rate, SBP, DBP, PP, AFP and other integrative parameters of CHD. The second, hypotonic type of the response (62 subjects; 51,7%) was characterized by a significant (p < 0,05) decrease in SBP, DBP, PP, AFP. Patients with third, dystonic type, of response (n = 28 (23,3%) of the total number examined subjects) showed significant bilateral changes of blood pressure parameters in a nonlinear dependence of compression power on the eyeballs. Determination CHD parameters directly after and 3 and 5 minutes after decompression of the air in the compression device we enabled to determine the subtype of the mobility of the nervous centers as a feature that complements the basic type. The subtype of normal mobility was revealed in 63,3% (n = 19) of subjects with the main hypertensive type of response, 69,3% (n = 43) of subjects with the main hypotonic and 60,7 % (n = 17) with the main dystonic type of response of the cardiovascular system. The inert subtype in the mobility of the cardiovascular system were identified in 36,7% (n = 11) individuals with hypertension is the main type of response, at 30,7% (n = 19) of individuals with primary hypotonic type of response and 39,3 % (n = 11) – distancing. The obtained typological changes in blood pressure parameters caused by OCR triggering allowed to reveal predisposition to hypertension, hypotension, dystonia and to predict the development of hypertension in patients with hypertensive type of response usin appropriate primary prevention changes in life style. The highest risk of hypertension development may be in persons with hypertensive inert type of reaction of the system of regulation of blood pressure on OCR triggering. Further studies are being conducted to confirm this assumption. Keywords: oculo-cardiac reflex, blood pressure, heart rate, young age.

Hypoxia attenuates the renin response to hemorrhage

1992 ◽  
Vol 263 (3) ◽  
pp. R664-R669
Author(s):  
M. R. Eichinger ◽  
J. R. Claybaugh
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Loss ◽  
Atrial Natriuretic Factor ◽  
Blood Pressure Reduction ◽  
Plasma Renin ◽  
Experimental Period ◽  
Pressure Reduction ◽  
Arterial Blood ◽  
Inspired Oxygen

We studied hypoxia and hypotensive hemorrhage in conscious female goats. After control, goats continued an experimental period in normoxia or hypoxia [fractional inspired oxygen concentration (FIO2) = 0.10] for 120 min. After 60 min in the experimental period, a hemorrhage (0.5 ml.kg-1.min-1 for 30 min) was initiated (normoxic hemorrhage, NH; hypoxic hemorrhage, HH). Heart rate (HR) increased 51 +/- 18 beats/min with NH after 30 min of hemorrhage. HR increased 40 +/- 10 beats/min after hypoxic gas introduction, with no further increase during HH. Mean arterial blood pressure (MABP) was reduced 23 +/- 7 mmHg 30 min after completion of blood loss with normoxia but was reduced 23 +/- 7 mmHg at 20 min of HH. Arginine vasopressin (AVP) was increased to 2.60 +/- 2.08 and 160.40 +/- 49.74 microU/ml after 10 and 20 min of HH, respectively, and was only increased after 30 min (87.33 +/- 67.18 microU/ml) of NH. Unexpectedly, plasma renin activity (PRA) increased in parallel in both groups and was doubled at 30 min of hemorrhage. Atrial natriuretic factor was reduced to 8.8 +/- 1.6 pg/ml by 10 min of NH and to 11.4 +/- 3.3 pg/ml at 30 min of HH. Thus hypoxia leads to an earlier development of hypotension and increase in AVP with blood loss but may attenuate the PRA response to blood pressure reduction.

Hemodynamics in the vessels of the stomach and intestine in patients with anesthesia, peritonitis, trauma and blood loss

1986 ◽  
Vol 67 (5) ◽  
pp. 336-339
Author(s):  
A. A. Nazipov
Keyword(s):  
Blood Pressure ◽  
Comparative Analysis ◽  
Blood Loss ◽  
Epidural Anesthesia ◽  
Traumatic Shock ◽  
Hemodynamic Parameters ◽  
Intestinal Infarction ◽  
Internal Bleeding ◽  
Different Types

The aim of the present study was a comparative analysis of blood pressure in mesenteric and intraorgan vessels and cardiac hemodynamic parameters in different types of general and epidural anesthesia, peritonitis, traumatic shock, internal bleeding and intestinal infarction.

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