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Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?

Yıl 2019, Cilt: 72 Sayı: 3, 328 - 333, 23.01.2020

Süheyla Karadağ Erkoç

Öz

Objectives: Anesthesia for pregnant patients requires attention because it affects two healthy people: the mother and the baby. Both general and regional anesthesia are options, although regional anesthesia is generally favored. Avoiding maternal hypotension is an important issue during regional anesthesia, and lowering the dose of local anesthetic is one method for this complication. This study was designed to assessment whether a low-dose regimen provides surgical anesthesia in obese pregnant patients while avoiding maternal hypotension.

Materials and Methods: After informed consent was received from 130 patients, they were randomized to four groups according to their body mass index and received 10 mg hyperbaric bupivacaine or 7.5 mg hyperbaric bupivacaine+25 mcg fentanyl for spinal anesthesia. Hypotension after spinal anesthesia, need for additional anesthetic, technical difficulty with regional anesthesia, Bromage scale score, surgery time, and postoperative analgesic requirements were recorded. Complications and Apgar scores were also recorded.

Results: General anesthesia was administered only to two patients in group II because of ineffective spinal anesthesia. The hemodynamic parameters did not differ among the groups. The analysis revealed no difference among groups in recovery from motor block (p=0.235), but the groups differed in the duration of postoperative analgesia (p=0.00).

Conclusion: Reducing the local anesthetic dose for obese pregnant patients does not lead to significant differences in hypotension compared with spinal anesthesia in non-obese patients. Adding an opioid may also improve postoperative pain control. Even a low dose of local anesthetic with opioid can maintain surgical anesthesia for cesarean section in obese pregnant patients.

Anahtar Kelimeler

Local Anesthetic Low Dose Spinal Anesthesia Obese Pregnant

Etik Beyan

Ethics Committee Approval: The Institutional Ethics Committee of the Ankara University Ethic Committee (approval number: 46004091-302.14.16) approved the study. Informed Consent: Written informed consent was obtained from all participating patients. Peer-review: Externally peer-review. Authorship Contributions Surgical and Medical Practices: Ç.Y.G., S.K.E., H.A.U., Concept: Ç.Y.G., S.K.E., Design: A.A.Y., Data Collection or Processing: Ç.Y.G., S.K.E., Analysis or Ç.Y.G., B.C.M., Writing: Ç.Y.G., B.C.M., A.A.Y., V.B. Conflict of Interest: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study received no financial support.

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93:568-578.
  • 2. Ben-David B, Miller G, Gavriel R, et al. Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Anesth Pain Med. 2000;25:235-239.
  • 3. Roofthooft E. Anesthesia for the morbidly obese parturient. Curr Opin Anaesthesiol. 2009;22:341-346.
  • 4. Soens MA, Birnbach DJ, Ranasinghe JS, et al. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand. 2008;52:6-19.
  • 5. Brodsky JB, Lemmens HJ. Regional anesthesia and obesity. Obes Surg. 2007;17:1146-1149.
  • 6. Norris MC. Height, weight, and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. Anesth Analg. 1988;67:555-558.
  • 7. Norris MC. Patient variables and the subarachnoid spread of hyperbaric bupivacaine in the term parturient. Anesthesiology. 1990;72:478-482.
  • 8. Lee Y, Balki M, Parkes R, et al. Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women. Rev Bras Anestesiol. 2009;59:674-683.
  • 9. Aiono-Le Tagaloa L, Butwick AJ, Carvalho B. A survey of perioperative and postoperative anesthetic practices for cesarean delivery. Anesthesiol Res Pract. 2009;2009:510642.
  • 10. Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: systematic review and meta-analysis. Br J Anaesth. 2011;107:308-318.
  • 11. Hogan QH, Prost R, Kulier A, et al. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesiology. 1996;84:1341-1349.
  • 12. Taivainen T, Tuominen M, Rosenberg PH. Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace. Br J Anaesth. 1990;64:542-546.
  • 13. Carvalho B, Durbin M, Drover DR, et al. The ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery. Anesthesiology. 2005;103:606-612.
  • 14. Venkata HG, Pasupuleti S, Pabba UG, et al. A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section. Saudi J Anaesth. 2015;9:122-127.
  • 15. Hartwell BL, Aglio LS, Hauch MA, et al. Vertebral column length and spread of hyperbaric subarachnoid bupivacaine in the term parturient. Reg Anesth. 1991;16:17-19.
  • 16. Turhanoglu S, Kaya S, Erdogan H. Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section? J Anesth. 2009;23:353-357.
  • 17. Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Anesth Pain Med. 2000;25:240-245.

Yıl 2019, Cilt: 72 Sayı: 3, 328 - 333, 23.01.2020

Süheyla Karadağ Erkoç

Öz

Proje Numarası

-

Kaynakça

  • 1. Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93:568-578.
  • 2. Ben-David B, Miller G, Gavriel R, et al. Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Anesth Pain Med. 2000;25:235-239.
  • 3. Roofthooft E. Anesthesia for the morbidly obese parturient. Curr Opin Anaesthesiol. 2009;22:341-346.
  • 4. Soens MA, Birnbach DJ, Ranasinghe JS, et al. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand. 2008;52:6-19.
  • 5. Brodsky JB, Lemmens HJ. Regional anesthesia and obesity. Obes Surg. 2007;17:1146-1149.
  • 6. Norris MC. Height, weight, and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. Anesth Analg. 1988;67:555-558.
  • 7. Norris MC. Patient variables and the subarachnoid spread of hyperbaric bupivacaine in the term parturient. Anesthesiology. 1990;72:478-482.
  • 8. Lee Y, Balki M, Parkes R, et al. Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women. Rev Bras Anestesiol. 2009;59:674-683.
  • 9. Aiono-Le Tagaloa L, Butwick AJ, Carvalho B. A survey of perioperative and postoperative anesthetic practices for cesarean delivery. Anesthesiol Res Pract. 2009;2009:510642.
  • 10. Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: systematic review and meta-analysis. Br J Anaesth. 2011;107:308-318.
  • 11. Hogan QH, Prost R, Kulier A, et al. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesiology. 1996;84:1341-1349.
  • 12. Taivainen T, Tuominen M, Rosenberg PH. Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3-4 or L4-5 interspace. Br J Anaesth. 1990;64:542-546.
  • 13. Carvalho B, Durbin M, Drover DR, et al. The ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery. Anesthesiology. 2005;103:606-612.
  • 14. Venkata HG, Pasupuleti S, Pabba UG, et al. A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section. Saudi J Anaesth. 2015;9:122-127.
  • 15. Hartwell BL, Aglio LS, Hauch MA, et al. Vertebral column length and spread of hyperbaric subarachnoid bupivacaine in the term parturient. Reg Anesth. 1991;16:17-19.
  • 16. Turhanoglu S, Kaya S, Erdogan H. Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section? J Anesth. 2009;23:353-357.
  • 17. Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Anesth Pain Med. 2000;25:240-245.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Süheyla Karadağ Erkoç 0000-0001-5086-5916

Proje Numarası -
Yayımlanma Tarihi 23 Ocak 2020
Yayımlandığı Sayı Yıl 2019 Cilt: 72 Sayı: 3

Kaynak Göster

APA Karadağ Erkoç, S. (2020). Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(3), 328-333. https://doi.org/10.4274/atfm.galenos.2019.41636
AMA Karadağ Erkoç S. Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ocak 2020;72(3):328-333. doi:10.4274/atfm.galenos.2019.41636
Chicago Karadağ Erkoç, Süheyla. “Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S With Single-Shot Spinal Anesthesia?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72, sy. 3 (Ocak 2020): 328-33. https://doi.org/10.4274/atfm.galenos.2019.41636.
EndNote Karadağ Erkoç S (01 Ocak 2020) Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 3 328–333.
IEEE S. Karadağ Erkoç, “Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 3, ss. 328–333, 2020, doi: 10.4274/atfm.galenos.2019.41636.
ISNAD Karadağ Erkoç, Süheyla. “Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S With Single-Shot Spinal Anesthesia?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/3 (Ocak 2020), 328-333. https://doi.org/10.4274/atfm.galenos.2019.41636.
JAMA Karadağ Erkoç S. Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72:328–333.
MLA Karadağ Erkoç, Süheyla. “Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S With Single-Shot Spinal Anesthesia?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 3, 2020, ss. 328-33, doi:10.4274/atfm.galenos.2019.41636.
Vancouver Karadağ Erkoç S. Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72(3):328-33.
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