Anesthetic management of elderly women scheduled for vaginal hysterectomy

Our study was designed to suggest a safe regional anesthetic technique for elderly women undergoing vaginal hysterectomy suitable for the. duration of surgery, without the need for general anesthesia. Twenty patients scheduled for elective vaginal hysterectomy were randomly divided into two groups, spinal group [SG] and combined spinal epidural group [CSEG], with mean age [60.5 +/- 9.4, 63.2 +/- 3.6], respectively. In SG 2.5 mL hyperbaric bupivacaine 0.5% were injected into the subarachnoid space through 25-gauge spinal needle, in CSEG, 2.5mL hyperbaric bupivacaine 0.5% were injected into the subarachnoid space through 25-gauge spinal needle and bupivacaine 0.5% was injected epiduraly through an epidural catheter, with a total volume not exceeding 12:15mL. The maximal sensory level achieved in CSEG, was significantly higher than that in SG. [median T3.6, maximum T3, minimum T4] versus [median T5.5, maximum T5, minimum T6] P < 0.05, Time [minuets] taken for the block to recede to T10 was significantly longer in CSEG compared with SG. [151.6 +/- 7.486] versus [119.2 +/- 10.25] p < 0.05. Maximum decrease in systolic blood pressure [%] was significantly higher in CSEG compared with SG, [22.4 +/- 5.9] versus [16.9 +/- 5] P < 0.05. The combined spinal epidural anesthesia provided a significantly higher level of sensory blockade and longer time for the block to recede to T10, compared with spinal anesthesia, which make CSE anesthesia the preferred technique to avoid the need for general anesthesia in elderly women undergoing vaginal hysterectomy

Comparison of colloid versus crystalloid preload for prevention of hypotension during spinal anesthesia for elective cesarean section in women with positive supine stress test

If parturient prone to develop caval compression in the supine position were identified before delivery; this might be a method of predicting hypotension during cesarean section under spinal anesthesia. Colloid preloading is thought to be superior to crystalloid in reducing the risk for spinal anesthetic induced hypotension. It is postulated that parturients preoperalively susceptible to the supine position would benefit the most from colloid preloading. The aim of this study is to compare colloid versus crystalloid preload for prevenilon of hypotension during spinal anesthesia for elective cesarean section in women with positive supine stress test [SST]. Forty healthy women, with term singleton normal pregnandes presenling for elective cesarean section under spinal anesthesia were included in the study. All patients were positivefir supine stress test [SST], they were divided into 2 equal groups [20 palients each], crystalloid preload group [group I] and colloid preload group [group II]. IViaternal hypotension, nausea, vomiting or dizziness and ephedrine requirements were recorded during the study. Induction-to-uterotomy interval, uterotomy-to-delivery interval and inlraoperative blood loss, were also recorded. Moreover, Apgar score and umbilical artery add-base status at delivery were measured. Our results showed that in patients received crystalloid preload [group I] the frequendes of occurrence of decreased systolic blood pressure below 100 mmHg or 20% from baseline, occurrence of vomiting, nausea or dizziness were 14[70%], 7[35%], 9[45%], and 7[35%], respectively, while, in palients received colloid preload [group II] were 6[30%], 1[5%], 2[10%], and 1[5%], respectively. So, patients received crystalloid preload showed a higher frequency of hypotension, vomiting, nausea and dizziness compared to colloid group [P<0.05], and also a greater need for ephedrine, mean[+SD] was 21[11.4] in group I compared to 7.25.3]mg in group II[P<0.05]. Pregnant women with a positive preoperative supine stress test constitute a subset at increased risk for clinically significant hypotension during cesarean delivery under spinal anesthesia. These women seem more likely to benefit from prophylaclic colloid solution preload