[Comparison of 8 mg and 10 mg hyperbaric bupivacaine during spinal anesthesia for cesarean section in Japanese parturients].

BACKGROUND: Hypotension after spinal anesthesia for cesarean section is common and may result in serious complications despite the use of uterine displacement and volume preloading. Adequate amount of hyperbaric bupivacaine for Japanese parturients whose frames are generally smaller than those of Caucasian counterparts have not yet been examined. We compared the analgesic efficacy and the incidence of hypotension with 8 mg versus 10 mg hyperbaric bupivacaine during spinal anesthesia for cesarean section in Japanese parturients. METHODS: Thirty six parturients were randomly divided into two groups, one receiving 8 mg (n = 19) and the other receiving 10 mg (n = 17) hyperbaric bupivacaine. Sensory block level and the incidence of hypotension were evaluated from the time of injection to delivery. Hypotension was defined as a decrease in systolic blood pressure below 100 mmHg and to less than 80% of the baseline value. RESULTS: 15 minutes after spinal injection, the difference in sensory block level was not significant. Ten minutes after the spinal anesthesia, in 79% of 8 mg group and in 88% of 10 mg group, sensory block level reached T 4. Hypotension occurred in 19 parturients (7 in 8 mg group and 12 in 10 mg group). The incidence of hypotension was significantly lower in 8 mg group (37%) than in 10 mg group (71%). There were no significant differences either in neonatal Apgar scores or umbilical blood gas pH. CONCLUSIONS: Injection of 8 mg hyperbaric bupivacaine is preferable than 10 mg in spinal anesthesia for cesarean section to obtain adequate analgesic efficacy and to avoid maternal hypotension.

[Vocal cord palsy after the use of a laryngeal mask airway].

A 58-year-old woman underwent oophorectomy for an ovarian tumor. Anesthesia was maintained with epidural block, and propofol and fentanyl anesthesia using a laryngeal mask airway. After the operation, she complained of hoarseness and difficulty in swallowing. Right vocal cord palsy was found by a ENT surgeon. The condition returned to normal two months after the operation. We have to have in mind that vocal cord palsy may occur even if we use a laryngeal mask airway. At least we have to pay attention to intra-cuff pressures and the position of the laryngeal mask airway.

[Anesthetic factors that influence pH of neonatal umbilical artery from mothers in severe gestosis during cesarean section under sevoflurane anesthesia].

Twenty-two patients complicated with severe gestosis underwent cesarean section. General anesthesia was induced with intravenous thiopental and suxamethonium and maintained with sevoflurane below 1.5% with 40-50% oxygen and 50-60% nitrous oxide. Mean artery pressure at and after the induction as well as at the delivery, expired maternal sevoflurane concentrations at the delivery and neonate birth weight were measured for statistical analyses in relation with neonates pH of umbilical artery. Mean artery pressure at the delivery and neonates birth weight influence neonates pH of umbilical artery.