Lower incidence of hypotension following spinal anesthesia with 6% hydroxyethyl starch preload compared to 9% saline solution in caesarean delivery

Hypotension is a common complication following spinal anesthesia for cesarean delivery. Techniques to prevent hypotension include preloading intravenous fluid. To compare the effect of two preloading regimens: 6% hydroxyethyl starch [HES] and 9‰ saline solution, to prevent hypotension after spinal anesthesia in cesarean delivery. 105 patients undergoing intrathecal anesthesia for elective cesarean delivery were randomized and allocated to receive a preload of 500 ml HES 130/0.4 [HES Group] or a preload of 1500 ml 9‰ saline solution [CR group]. Blood pressure and heart rate were recorded at baseline and after spinal anesthesia [every minute for the first 10 min, every 3 min for the next 10 min, and then every 5 min for the last 20 min]. The primary outcome was to compare the incidence of hypotension [defined as a 20% reduction in systolic arterial pressure from baseline] between the two preloading regimens. Vasopressor requirements [i.v. bolus of 6 mg ephedrine] were also compared. The incidence of hypotension was 87% in the CR group and 69% in the HES group [p= 0.028]. Ephedrine requirement, incidence of nausea, and/or vomiting and neonatal outcome did not significantly differ between the two groups. The incidence of hypotension was lower after preloading of 500 mL of HES 130/0.4 than preloading with 1500 mL of 9‰ saline solution

Ultrasound does not shorten the duration of procedure but provides a faster sensory and motor block onset in comparison to nerve stimulator in infraclavicular brachial plexus block / 대한마취과학회지

BACKGROUND: Infraclaviculr Brachial plexus (ICBP) block is useful for upper extremity surgery. The aim of this study was to compare the ultrasound (US) technique with the nerve stimulation (NS) technique in their success rates and times to perform ICBP block. METHODS: 60 patients undergoing surgery of the upper limb were randomly allocated into two groups (n = 30 per group). Group 1; US, and Group 2; NS. Procedure time (including time for initial ultrasound examination), the success rate and the onset time of sensory and motor blockade were assessed. RESULTS: The time needed to perform the ICBP block is similar in both groups (220 seconds +/- 130 in US group versus 281 +/- 134 seconds in NS group; P = 0.74). The success rate of all the nerve blocks in the US group was 100%. The success rate in the NS group was 73.3%, 76.7%, 76.7% and 100% for radial, ulnar, medial, and musculocutaneous nerve, respectively. A significantly faster onset of sensory block for the radial, ulnar, median, musculocutaneous, and the four nerves considered together were observed. The onset of motor block for the radial, ulnar, and medial nerves was faster in the US group. However, the onset of motor block for the musculocutaneous nerve and the four nerves considered together was comparable between the two groups. CONCLUSIONS: The ultrasound-guided infraclavicular brachial plexus block is a significantly efficacious method with faster onset but similar procedure time compared to the nerve stimulation technique.

[Effects of 15 mcg intrathecal clonidine added to bupivacaine and sufentanil for labor analgesia]

For the combined spinal epidural analgesia for labour, 30 mcg of subarachnoid clonidine has proved its effectiveness to extend the analgesia, but increased severe hemodynamic effects. To assess the effectiveness and the safety of 15 mcg intra thecal clonidine for labour analgesia. Four months, prospective, randomised, simple blind Study, including ASA I or II women, with mono foetal pregnancy. Patients were randomised in 2 groups: SB Group received intra thecal isobaric bupivacaine 2.5 mg and sufentanil 5 mcg and SBC Group received 15 mcg clonidine added to the same doses of bupivaca‹ne and sufentanil. Epidural analgesia was used when VAS is more than 30. Studied parameters were: delay of installation, duration of analgesia, VAS score, hemodynamic parameters and the incidence of maternal and neonatal side effects. Sixty pregnant women were included [27 in SBC Group and 33 in SB group]. The duration of initial analgesia was significantly longer in the SBC group [145 +/- 43 min] compared with the SB group [98 +/- 28 min]. The delay of analgesia, sensory level and motor block level were similar. There was neither significant increase of the low incidence of blood pressure nor of the ephedrine consumption. The abnormalities of fetal heart rate, the mode of delivery and the incidence of side effects were also similar. The addition of 15 mcg intra thecal clonidine to the bupivacaine and the sufentanil during combined spinal epidural analgesia for obstetrical labour results in extended significantly duration of analgesia without increasing side effects