ABSTRACT
Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S
Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar [study group, n=42] or hyperbaric [control group, n=42] for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher's exact test, one-way ANOVA, Mann-Whitney U-test, and student's t test
Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant [40.47% vs. 61.9%, P=0.08]. The duration of hypotension was shorter in the study group [1.6 +/- 7.8 min vs. 7.4 +/- 12.5 min, P=0.004]. The dose of ephedrine was lower in the study group [2.4 +/- 6.6 mg vs. 5.3 +/- 10.7 mg, P=0.006]. The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 [16.66%] of hyperbaric groups [P=0.006]. None of the neonates had Apgar score
Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S
ABSTRACT
The current study is to evaluate cardiovascular effects of anesthetic medications and volatile anesthetics on cardiac stress using cardiac stress index [CSI] and rate pressure product [RPP] and to determine which of them in useful in evaluating cardiac stress after comparing results obtained from each method. Forty patients, 60-80 years old, who were all performed Trans abdominal prostatectomy, were studied. Patients were divided into tm groups; half of patients were placed in group A and the other half in group B. The study was carried out as a blinded study. CCSI was measured and evaluated in group A and RPP changes were studied in group B. The mean CSI were 60.25 +/- 5.57, 63.05 +/- .54, 55.75 +/- 4.78 and 67.65 +/- 4.88 before anesthesia induction, after induction, before surgical incision and in recovery respectively. There was no meaningful difference among these four stages measurements. RPP mean in four above mentioned stages was 10.15 +/- 0.44, 9.9 +/- 0.69, 6.8 +/- 0.36 and 9.2 +/- 0.61 respectively. There was a significant difference between RPP in stages before anesthesia induction and before surgical incision [P< 0.0001]. Considering the obtained results from this study, it can be seen that even in non-cardiac surgery, the stress level is high in patients in preoperative period. This condition was not clear in RPP index case and was not in accordance with CSI, which means CSI has been able to illustrate existing stress level better and efficiently