[Vaginal birth after cesarean sections]

It is believed that vaginal delivery is associated with less maternal mortality than cesarean section. On the other hand, repeated cesarean sections are said to be associated with more risks threatening both the mother and the infant. Besides, it is believed that during the next pregnancies, there are many risks involved, such as Placenta Previa, Placenta acreta and even hysterectomy. This article is about a woman who experienced successful vaginal deliveries giving birth to healthy newborns in spite of her numerous cesarean sections she had already experienced

[Studying some of the hemodynamic effects of adding epinephrine to lidocaine for spinal Anesthesia]

Increasing use of regional anesthesia instead of general anesthesia may be the most important factor in decreasing anesthetic difficulties [e.g. difficult intubations, aspiration pneumonia, and analgesic side effect] in caesarean section. Quality of regional anesthesia is improved by adding morphine, fentanyl and sufentanil. The function of Epinephrine is dose-dependent. For instance, in small dosage, it has stimulating effects on Beta1 and Beta2 causing venous stasis to minimize. However, in large doses, Epinephrine's Alfa adrenergic is dominant. This study aimed at investigating the potential hemodynamic effects of adding Epinephrine to lidocaine during spinal anesthesia on expecting mothers who are candidates of caesarean section. This study was a prospective, randomized, double-blind, controlled trial on 100 pregnant women who were candidates for caesarean section with ASA class I, II in the year of 1387. The subjects of the study were divided into two groups, [1] and [2] on the basis of the randomized digital table as follows: Group 1:80 mg lidocaine 5% +2 micro gram sufentanil Group2: 80 mg lidocaine 5% +2 micro gram sufentanyl + 0.2 mg [0.2cc] Epinephrine. Both groups received the drugs intrathecally. Vital signs such as systolic and diastolic blood pressure, pulse rate and SPO2 were recorded both before the anesthesia and thereafter every 5 minutes until the end of the operation. The measuring procedure continued during and after the recovery stage. Besides, the side effects and the drugs needed were recorded. According to the findings in this study, there weren't any significant differences between the two groups in terms of age, weight, ASA, NPO timing and the previous surgery. There weren't any significant differences between the two groups of the study in terms of systolic and diastolic blood pressure, either. However, some hypotension was noted in Adrenaline group. Also, there weren't any significant differences in PR but some bradycardia was seen in Adrenaline group, too. There weren't any significant differences in SPO2 and side effects [nausea, vomiting, dysphagia, respiratory disorder, shivering] between the two groups. Adding Epinephrine to Lidocaine 5% increased the duration of spinal aesthesia in caesarean section whereas no significant difference was observed in terms of hemodynamic and side effects. Nevertheless, regarding the emergence of hypotension and bradycardia observed in the Adrenaline group, no matter how rare, close control of hemodynamic in this group is essential

[ comparative study on spinal fentanyl and sufentanil plus 5% lidocaine at the onset of pain and analgesia after caesarean sections]

The administration of either intrathecal or epidural opioid can provide deep neuroaxial anesthesia without significant changes in sensory or motor functions. This technique may reduce both mortality and morbidity, in comparison with systemic opioids. It seems, then, that using opioids [e.g. Fentanyl or Sufentanil] along with anesthetics [Lidocaine] in spinal anesthesia may also provide better pain control both during and after caesarean sections. This study was a prospective, randomized, double-blind and controlled trial on 86 pregnant women, ASA I-II, who were scheduled for elective caesarean section under the subarachnoid block in the year of 2008. The patients were divided into two groups [1 and 2] on the basis of a randomized digital table according to their taking sufentanil or fentanyl. In both groups, the local anesthetic used was hyperbaric lidocaine 5% [80 mg] with a total volume of 2.2 ml. of the solution. Then, the onset of pain and the need for analgesia after the caesarean section were evaluated. Both groups received drugs intrathecally as follows: Group 1: 20micro g Fentanyl, 80 mg lidocaine%5, 0.2 mg Epinephrine. Group 2:2 micro g Sufentanil, 80 mg lidocaine%5, 0.2 mg Epinephrine. In addition, Visual Analogous Scale [VAS: 0-10] was used to assess the intensity of pain and the patient's sedation both in the recovery room and in the ward every one hour for 6 hours. The side effects and the need for drugs were recorded. As the findings of the study suggest, the onset of pain after cesarean section was more significant in the Sufentanil group than the Fentanyl group [P=0.046]. In this study, the Sufentanil group's pain began about twenty minutes later than that of the Fentanyl group. Although the patients in the Sufentanil group appeared to need analgesic about twenty-six minutes later than those in the Fentanyl group, there was not any significant difference between these two groups of the study [P=0.003]. As for Neonate's APGAR and the other side effects, there weren't any significant differences between the two groups, either. Fentanyl and Sufentanil plus intrathecal Lidocaine provided a good pain control for elective caesarean section; however, no significant difference was noted in terms of side effects. As a whole, Fentanyl and Sufentanil plus 5% Lidocaine can intrathecally induce sufficient analgesia after cesarean sections. More specifically, spinal anesthesia with lidocaine 5% and 2 micro g of Sufentanil may bring about sufficient analgesia after the operation and is recommended for induced anesthesia in operations