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PubMedDate not supplied

Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension. METHODS: Thirty-two women scheduled for cesarean delivery were divided into 2 groups of patients who received a spinal injection of either 10 mg of isobaric (plain) bupivacaine 0.5% or 5 mg of isobaric bupivacaine with 25 microg fentanyl added. Each measurement of a systolic blood pressure less than 95 mm Hg or a decrease in systolic pressure of greater than 25% from baseline was considered as hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine. RESULTS: Spinal block provided surgical anesthesia in all patients. Peak sensory level was higher (T3 v T4. 5) and motor block more intense in the plain bupivacaine group. The plain bupivacaine patients were more likely to require treatment for hypotension (94% v 31%) and had more persistent hypotension (4.8 v 0.6 hypotensive measurements per patient) than patients in the minidose bupivacaine-fentanyl group. Mean ephedrine requirements were 23.8 mg and 2.8 mg, respectively, for the 2 groups. Patients in the plain bupivacaine group also complained of nausea more frequently than patients in the minidose bupivacaine-fentanyl group (69% v 31%). CONCLUSIONS: Bupivacaine 5 mg + fentanyl 25 microg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.

Adjuvants, Anesthesia↗
PubMed1975

[Spinal anesthesia and its consequences in orthopedic and traumatological operations].

Spinal anesthesia as the regional anesthesia of the lower extremity is a counterpart to the comparably frequently used plexus anesthesia in the arm. The effect of spinal anesthesia on the pulse rate and blood pressure was investigated in 100 cases. Collapse states are less frequent and less marked than would be expected from numerous literature data. Spinal anesthesia ought to become a standard method, not least because of the trouble-free after-care.

Anesthesia, Spinal↗
PubMed1981

Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans.

In order to quantitate the effect of spinal anesthesia on adrenergic tone, plasma levels of norepinephrine (NE) and epinephrine (EPI) were measured by radioenzymatic assay in 24 patients were then compared to those of 10 patients receiving inhalation anesthesia (halothane-nitrous oxide). High thoracic dermatome spinal anesthesia caused suppression of both arterial plasma NE and EPI and a fall of mean arterial pressure (MAP); in contrast, no changes of NE, EPI, or MAP were observed in patients receiving low spinal anesthesia. Overall, there was a relationship between the sensory dermatome anesthesia level and changes of both plasma NE (r = 0.71, P less than 0.001) and EPI (r = 0.52,P less than 0.02). In the inhalation anesthesia group, plasma NE increased during the operation and plasma levels of NE, EPI, growth hormone, and cortisol were elevated during the postoperative recovery period. These neuroendocrine responses to surgical stress were not observed in patients receiving either low or high spinal anesthesia. Thus, the effect of spinal anesthesia on adrenergic tone depends on the cord level of anesthesia and can be quantitated by measurement of plasma catecholamines. The neuroendocrine responses to surgical stress were prevented in patients who received low spinal anesthesia and who had no suppression of efferent adrenergic tone. These findings indicate that neural afferents from the site of tissue injury, which were blocked by low spinal anesthesia, mediated both the adrenergic and the hormonal responses to surgical stress in the inhalation anesthesia group.

Adrenergic Fibers↗
PubMed2000

Arrhythmias during spinal anesthesia for Cesarean section.

PURPOSE: Spinal block has long been considered a safe anesthesia technique for surgery. However, severe bradycardia, cardiac arrest, and other arrhythmias during spinal anesthesia have been reported and the incidence of intraoperative arrhythmias is not well established. In this study the incidence of arrhythmias during spinal anesthesia was determined. METHODS: We studied 254 healthy women undergoing Cesarean section under spinal anesthesia prospectively. Spinal anesthesia with 10 mg bupivacaine mixed with 0.2 mg morphine was performed at the L3-4 interspace. Intraoperative arrhythmias were recorded and verified later by a cardiologist. RESULTS: First degree atrioventricular block developed in nine patients (3.5%), second degree atrioventricular block in nine (3.5%), severe bradycardia (heart rate < 50 beats x min(-1)) in seventeen (6.7%), multiple VPC in three (1.2%). The height and weight of patients with severe bradycardia, multiple VPCs, or atrioventricular block were not different from those of the other patients. However, the age of patients in the potentially dangerous arrhythmias group was greater than that in the other group (P = 0.006). CONCLUSION: The incidence of arrhythmias as well as hypotension during spinal anesthesia for Cesarean section was higher than expected. Although most of these arrhythmias were transient and recovered spontaneously, they might unexpectedly occur and sometimes need immediate and prompt treatment. It is necessary to remain vigilant during spinal anesthesia for Cesarean section and careful monitoring of these patients is warranted, especially in older parturients.

Adolescent↗