Online ISSN: 2515-8260

Keywords : Spinal Anesthesia


HEMODYNAMIC STABILITY DURING LAPAROSCOPIC APPENDECTOMY UNDER SPINAL ANAESTHESIA IN COMPARISON TO GENERAL ANAESTHESIA

Dr. VeerendraPatil, Dr. NagarajMalladad Dr. Madhusudhan BV

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1494-1497

Laparoscopy has revolutionised surgery and management of the patient with marked decrease in morbidity and post-operative complications. Initially, these procedures were done using only General Anaesthesia. However, now with the introduction of Spinal anaesthesia and after learning its advantages, surgeons are slowly beginning to gravitate towards this mode of anaesthesia. Sixty three patients who were admitted in the hospital for appendicitis participated in this Randomized controlled trial conducted in a tertiary care hospital in India. Thirty three patients were randomly included in Group A (undergoing laparoscopic surgery under Spinal Anaesthesia) and thirty patients in Group B (undergoing laparoscopic surgery under General Anaesthesia). The mean values of Systolic and diastolic pressure was found to be significantly higher in patients who were administered General anaesthesia and no change in the respiratory functions was observed following administration of either Spinal or General anaesthesia. Laparoscopic surgery under Spinal anaesthesia is a viable and safe alternative as compared to General anaesthesia. The recovery rates and the satisfaction reported by patients is also better. Spinal anaesthesia also helps in maintaining better haemodynamic stabilization.

Cardiovascular Effects Associated with Use of Prophylactic Intravenous Ondansetron in Patients undergoing Orthopedic Surgeries under Spinal Anesthesia

SlemanIfhimaSleman,Mohamed Anwar Refki, Kamelia Ahmed Gamal Eldin Abaza, Mohamed Ibrahim Elsayed

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 4238-4249

Background:Spinal anesthesia is a common choice for patients undergoing orthopedic
surgeries.ondansetron was found to attenuate the incidence of SIH and bradycardia during
spinal anesthesia.
Aim of the study:This work was done to compare between the effects of prophylactic
intravenous of two different doses of ondansetron (4 mg) and (8 mg) in attenuating hypotension
in patients undergoing orthopedic surgeries under spinal anesthesia.
Patients and methods:This study wasa prospective comparative randomized controlled clinical
trial that have been carried out in Zagazig University Hospitals and included 66 patients, their
ages ranged from 21 to 60 years old patients for only unilateral orthopedic surgeries under
spinal anesthesia, duration of surgery less than 2 hours in the study.Patients were randomly
divided into three equal groups, 22 patients for each group, Group "O1" received IV
ondansetron (4mg) diluted in 10 ml saline, group "O2" received IV ondansetron (8mg) diluted
in 10 ml saline, and group C (control) received only 10 ml IV saline alone. Medications were
administrated 5 min before starting the subarachnoid block by an anesthesiologist blinded to
them, they were assessed for their cardiovascular effects including blood pressure, heart rate
(HR) before, throughout and after operation.
Results:There was difference between the prophylactic intra venous of the two different doses
of ondansetron in attenuating hypotension in patients undergoing orthopedic surgeries, under
spinal anesthesia compared with the control group. Mean Blood Pressure (MBP) and HR were
significantly, lower among the control group from 5 min tell the 10 minutes compared to (O1)
and (O2) groups.
Conclusion:
In patient undergoing orthopedic surgeries under spinal anesthesia, prophylactic intravenous
administration of 4mg ondansetron or 8mg ondansetron 5min before induction of spinal
anesthesia to reduce the severity of spinal-induced hypotension and bradycardia well
significantly.

Comparison Of Two Methods Of Administration Of Phenylephrine For The Prevention And Treatment Of Hypotension In Caesarean Section Under Spinal Anaesthesia

Harishbabu Ravulapalli; Laxman N; Rajitha Anga; Busetty Prithviraj; Mushahida .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 3, Pages 4823-4833

Background & Aim: Phenylephrine induces maternal bradycardia in 50% of mothers when used for prevention and treatment of spinal anaesthesia-induced hypotension during caesarean delivery. Rapid fluid administration immediately after initiation of the spinal block (co-loading) may have a vasopressor sparing effect. Even though phenylephrine infusion was active as a vasopressor, there was a fall in heart rate occasionally as a reflex action, but it was not statistically significant. There was no incidence of bradycardia or change in rhythm. Aim of the study is to assess the efficacy of prophylactic and therapeutic phenylephrine when administered by different methods as a vasopressor.
Method: 60 mothers scheduled for elective caesarean section were recruited in this randomized controlled trial. The primigravida included in the study were divided into two groups; group 1 (n = 30) received intravenous prophylactic phenylephrine infusion at 100 micrograms/min for 3 minutes immediately after subarachnoid block and group 2(n = 30) received phenylephrine as boluses of 100 microgram for the treatment of hypotension following subarachnoid block. Vital signs (blood pressure, heart rate, and arterial oxygen saturation) were recorded throughout the surgery. Maternal and neonatal perioperative complications were also controlled and recorded.
Results: There was an insignificant difference in demographic data between the groups. In Group I, only 6.7% incidence of hypotension episodes, whereas in Group II, 96.7% incidence of hypotension episodes were seen, indicating phenylephrine infusion was more effective in preventing hypotension episodes. In both, the groups had similar pre-induction systolic blood pressure, but the mean systolic blood pressure was higher in the infusion group and was statistically significant. In both groups DBP was higher in the infusion group and was statistically significant. Mean arterial pressure pre-induction was similar in both the groups, but mean arterial pressure was higher in the infusion group and was statistically significant. Phenylephrine does much higher in Group I (infusion group) when compared to Group II (bolus group), which was statistically significant (P-value <0.001).No significant side effects were observed in the study (nausea, vomiting). There was no significant difference between the two groups in APGAR score.Conclusion: Administration of prophylactic phenylephrine infusion is more effective as vasopressor compared to therapeutic Boluses in elective caesarean section done under subarachnoid block. Prophylactic phenylephrine infusion was associated with lower heart rates occasionally when compared to bolus doses. There is no significant reduction in APGAR scores at 1st and 5th min in both groups. Prophylactic infusion of phenylephrine can effectively decrease spinal anesthesia related hypotension without any significant complication for mother or her fetus.

Isobaric Levobupivacaine 0.5% Versus Isobaric Levobupivacaine 0.5% With 3mcg Dexmeditomidine In Spinal Anaesthesia- A Comparative Study

Dr. Gopi Kumhar; Dr. Annu Mayank

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 8, Pages 3661-3665

Background: Levobupivacaine is a long acting, amide-type local anaesthetic
that is the S(−) \3- isomer of the racemate bupivacaine. In general, in vitro, in vivo and
human volunteer studies of nerve block indicate that levobupivacaine is as potent as
bupivacaine and produces similar sensory and motor block. Dexmedetomidine is used as
an adjuvant in spinal anesthesia and is associated with prolonged motor and sensory block,
hemodynamic stability, and less requirement of rescue analgesia in 24 h as a result it
facilitates reduction in dose of local anesthetic. Aim of the study: To compare isobaric
levobupivacaine 0.5% versus isobaric levobupivacaine 0.5% with 3 mcg Dexmeditomidine
in spinal anaesthesia. Materials and methods: The present study was conducted in the
Department of Anesthesiology of the medical institution. For the study, we selected a total
of 50 patients in the age group of 20-65 years of physical status American Society of
Anesthesiologists (ASA) Classes I and II admitted for surgeries requiring spinal
anesthesia. An informed written consent was obtained from all the participants after
explaining them the protocol of the study. The patients were randomly grouped into two
groups, Group 1 and Group 2. Group 1 patients received 3 ml (15 mg) of 0.5% isobaric
levobupivacaine + 0.3 ml normal saline, whereas Group 2 patients received 3 ml (15 mg) of
0.5% isobaric levobupivacaine + 0.3 ml (3 μg) dexmedetomidine. Results: It was observed
that the number of male patients in group 1 and 2 was 12 and 14, respectively. The number
of female patients in group 1 and 2 was 13 and 11, respectively. The mean age of patients
in group 1 was 46.28 years and in group 2 was 47.12 years. It was observed that the mean
duration of sensory block in Group 2 was significantly higher than Group 1. The mean
duration of motor block in both the groups was similar and was statistically nonsignificant.
Conclusion: Within the limitations of the present study, it can be concluded
that the duration of sensory block increases with addition of 3 mcg of dexmedetomidine
with Levobupivacaine as compared to plain Levobupivacaine. The results were found to be
statistically significant.