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Biomedical subjects

C C Rout

Publications and source records attributed to C C Rout.

6 recordsLinked to original sources
PubMed1992

Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section.

Twenty parturients undergoing elective Caesarean section were allocated randomly to receive crystalloid preload 20 ml kg-1 over either 20 min or 10 min before spinal anaesthesia. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) occurred in six of the 10 patients in the 20-min preload group and seven of 10 patients in the 10-min preload group (ns). Both groups had a significant (P less than 0.05) increase in central venous pressure during the preload period. The mean central venous pressure in the 10-min group was 11.9 mm Hg (range 6-19 mm Hg), which was significantly greater (P less than 0.05) than that in the 20-min group (mean 7.3 mm Hg, range 2-13 mm Hg). Three patients in the 10-min group had clinically unacceptable increases in central venous pressure. This study has demonstrated that rapid administration of crystalloid preload before spinal anaesthesia did not decrease the incidence or severity of hypotension, and questions the role of crystalloid preload.

Adult↗
PubMed1992

Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia.

Difficult tracheal intubation, often unexpected, has been identified as the commonest contributory factor to anesthetic-related maternal death. The ability to predict such cases preoperatively would be of great value. Preoperative airway assessment and potential risk factors for difficult tracheal intubation were recorded in 1,500 patients undergoing emergency and elective cesarean section under general anesthesia. Airway assessment using a modified Mallampati test recorded oropharyngeal structures visible upon maximal mouth opening. Potential risk factors documented were obesity; short neck; missing, protruding, or single maxillary incisors; receding mandible; facial edema; and swollen tongue. Subsequent to induction of anesthesia, the view at laryngoscopy and difficulty at intubation were graded. There was a significant (P less than 0.001) correlation between the oropharyngeal structures seen and both the veiw at laryngoscopy and difficulty at intubation. Univariate analysis demonstrated a significant association between difficult intubation and short neck (P less than 0.001), obesity (P less than 0.0001), missing maxillary incisors (P less than 0.02), protruding maxillary incisors (P less than 0.001), single maxillary incisor (P less than 0.0001), and receding mandible (P less than 0.003). Neither facial edema (P = 0.414) nor swollen tongue (P = 0.141) were found to be associated with difficult intubation. Multivariate analysis removed obesity and missing and single maxillary incisors as risk factors. Obesity was eliminated because of its strong association with short neck. The probability of experiencing a difficult intubation for various combinations of risk factors was determined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Prophylactic intramuscular ephedrine prior to caesarean section.

Thirty healthy parturients, having given informed consent, were randomly allocated in a double-blind study to receive an intramuscular injection of either 0.9% sodium chloride (control), ephedrine 25 mg, or ephedrine 50 mg, 30 minutes prior to general anaesthesia for caesarean section. Nine patients (90%) in the 50 mg group and five patients (50%) in the 25 mg group demonstrated reactive hypertension of 20% or greater from control. The mean maximum increase in the 50 mg group was 28.2% (range 4.4-38.3%). Maternal pH was significantly lower (P = 0.03) in the ephedrine 50 mg group. Neonatal acid base status was significantly impaired in the ephedrine 50 mg group with umbilical venous pH (P = 0.0001) and umbilical arterial pH (P = 0.001) being significantly lower than the control group. The associated increase in umbilical arterial base deficit suggests a metabolic component due to fetal asphyxia related to decreased uterine blood flow. We conclude that the prophylactic administration of intramuscular ephedrine prior to spinal anaesthesia is associated with an unacceptably high incidence of maternal hypertension, and should the spinal fail and general anaesthesia be required, also results in adverse neonatal biochemical changes. The technique is therefore not to be recommended.

Adult↗
PubMed1990

Effects of alfentanil and fentanyl on induction of anaesthesia in patients with severe pregnancy-induced hypertension.

Forty patients with severe pregnancy-induced hypertension presenting for Caesarean section under general anaesthesia were allocated randomly to receive either fentanyl 2.5 micrograms kg-1 or alfentanil 10 micrograms kg-1 as part of the anaesthetic induction sequence. In all patients, the cardiovascular response to tracheal intubation was measured. Both drugs attenuated the response equally but did not abolish it in all patients. Alfentanil 10 micrograms kg-1 is a suitable alternative to fentanyl 2.5 micrograms kg-1 for patients with pregnancy-induced hypertension.

Adult↗
PubMed1990

Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs.

Twenty-four parturients undergoing elective Caesarean section were allocated randomly to have the legs wrapped with elasticated Esmarch bandages immediately following spinal anaesthesia or to serve as controls. Significant hypotension (systolic arterial pressure less than 100 mm Hg and less than 80% of baseline value) was treated with i.v. ephedrine in 5-mg boluses. Leg wrapped patients had a significantly (P = 0.0033) lower incidence (16.7%) of hypotension than controls (83.3%). Only two patients in the leg wrapped group required ephedrine compared with 10 in the control group. Systolic arterial pressure was significantly (P less than 0.05) less in control subjects at 4, 5 and 6 min following spinal injection. No patient in the leg wrapped group became hypotensive following removal of the elasticated bandages.

Anesthesia, Obstetrical↗