ABSTRACT
Objective To identity the risk factors for supine hypotension syndrome (SHS) after spinal anesthesia in parturients.Methods A total of 204 parturients,scheduled for elective cesarean section,were divided into either control group or SHS group depending on whether or not SHS (systolic blood pressure [SBP] in the upper extremity decreased by ＞ 30 mmHg or decreased to ＜ 80 mmHg) developed after spinal anesthesia.The baseline patient characteristics such as age,body height and weight,gestational weeks and biparietal diameter were recorded.Supine stress test (SST) was performed.Heart rate,blood pressure in upper and lower extremities,perfusion index,pleth variability index and intravesical pressure were recorded when patients were in supine position and in left lateral position before spinal anesthesia.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for SHS.Results Among the 204 patients,99 cases developed SHS after spinal anesthesia,and the incidence was 48.5％.Logistic regression analysis showed that maternal body weight,biparietal diameter,the difference in SBP between upper and lower extremities in supine position,the difference in SBP in upper extremities caused by changing position and positive SST were risk factors for SHS after spinal anesthesia (P＜0.05 or 0.01).Conclusion Maternal body weight,biparietal diameter,the difference in SBP between the upper and lower extremities in supine position,the difference in SBP in upper extremities caused by changing position and positive SST are risk factors for SHS after spinal anesthesia in parturients.
ABSTRACT
Objective To observe the displacement of endotracheal tube during laparoscopic surgery,explore whether pneumoperitoneum and body position are associate with the displacement. Methods A total of 120 female patients were included in this study,60 cases underwent gynecological lapa-roseopic operation as group A,and 60 cases had laparoscopic cholecystectomy as group B.Intrabdominal pressure was maintained in 13 mm Hg during the operation.The length of trachea(Lac),the length from carina to the tip of an endotracheal tube(Lab),the length from glottis to the tip of an endotracheal tube (Lbc)and the cuff pressure (Pc)were measured after endotracheal intubation (T1 ),insufflation in the su-pine position (T2 ),insufflation in the Trendelenburg or reverse Trendelenburg position (T3 ),30 minutes after insufflation in the Trendelenburg or reverse Trendelenburg position (T4 ),deflation in the Trendelen-burg or reverse Trendelenburg position (T5 ),deflation in the supine position (T6 ).Results In both groups,Lac and Lab at T2-T4 were significantly shorter than those at T1 (P<0.05),but they were back to the original level at T5 ,T6 .Pc were higher at T2-T4 (P<0.05).Lac,Lab and Lbc didn’t show significant difference between the two groups at T1-T6 .At T2 and T3 ,in group B endotracheal tube distorting occurred in 2 patients and tube into right bronchus occurred in 3 patients,while tube into right bronchus occurred in 3 patients in group A.Conclusion Pneumoperitoneum can cause endotracheal tube displacement to-ward to carina.Body position unlikely to change endotracheal tube position.The displacement was blocking by cuff could cause distorting of the tube.