Abstract
Objective: In this study our main goal is to evaluate the clinical characteristics of pregnant women who undergo elective cesarean section under subarachnoid block.
Method: This randomized Controlled trial (RCT) study was carried out at Obstetric Operation Theatre under supervision of Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU from 12 months. A total of 90 parturient admitted for elective caesarean section in Obstetrics and Gynaecology Department of BSMMU were included in the study divided into two groups. Where Group P was the phenylephrine group and Group E was the ephedrine group. Each group had sample size of 45.
Results: During the study, in group P, 64.4% belong to 21-30 years age group, 26.7% belong to 31-39 years age group and only 8.9% belong to ≤20years age group. Whereas in group E quite similar results were found where 73.3% belong to 21-30 years age group, 22.2% belong to 31-39 years age group and only 4.4% belong to ≤20years age group. Mean heart rate was higher in group E than group P. Heart rate was very highly statistically significant at 3 minutes, 6 minutes, 9 minutes, 12minutes before delivery, 5 minutes, 10 minutes, 15 minutes, 20 minutes, 25 minutes, 30 minutes, 35 minutes after delivery. Mean systolic blood pressure was significantly higher in group P than group E. systolic blood pressure was statistically significant at baseline, 3 minutes, 6 minutes, 9 minutes, 12 minutes before delivery and at 20 minutes, 25 minutes, 30 minutes, 35 minutes, 40 minutes, 45 minutes after delivery. But it was statistically not significant at 15 minutes before delivery and 5 minutes, 10 minutes, 15 minutes and 50 minutes after delivery.
Conclusion: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia involving the lower extremities and surgeries below the umbilicus. Further studies are needed for better outcome.
Keywords: Elective cesarean section, Subarachnoid block (SAB), anaesthetic technique.
References
- Ayorinde, B., Buczkowski, P., Brown, J., Shah, J. and Buggy, D. (2001). ‘Evaluation of pre-emptive intramuscular phenylephrine and ephedrine for reduction of spinal anaesthesia-induced hypotension during Caesarean section’. British Journal of Anaesthesia, 86(3), pp.372-76.
- Aziz, N., Bangash, R., Khan, P. (2013). ‘Comparison between ephedrine and phenylephrine in the prevention of post spinal hypotension during elective cesarean section’. J Med Sci, 21(1), pp.27-30.
- Bhagat, H., Malhotra, K., Ghiilayal, SK., Srivastava, PC. (2004). ‘Evaluation of preloading and vasoconstrictors as a combined prophylaxis for hypotension during subarachnoid anesthesia’. Indian J Anaesth, 48, pp.299-303.
- Brooker, R., Butterworth, J., Kitzman, D., Berman, J., Kashtan, H. and McKinley, A. (1997). Treatment of Hypotension after Hyperbaric Tetracaine Spinal Anesthesia. Anesthesiology, 86(4), pp.797-805.
- Cooper, D., Carpenter, M., Mowbray, P., Desira, W., Ryall, D. and Kokri, M. (2002) 'Fetal and Maternal Effects of Phenylephrine and Ephedrine during Spinal Anesthesia for Cesarean Delivery'. Anesthesiology, 97(6), pp.1582-90.
- Cooper, D., Sharma, S., Orakkan, P. and Gurung, S. (2010). Retrospective study of association between choice of vasopressor given during spinal anaesthesia for high-risk caesarean delivery and fetal pH. International Journal of Obstetric Anesthesia, 19(1), pp.44-49.
- Cyna, A., Andrew, M., Emmett, R., Middleton, P. and Simmons, S. (2006). Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database of Systematic Reviews.
- Das, S., Mandal, M., Basu, S., Mukhopadhyay, S. and Mandal, S. (2011). A comparative study of infusions of phenylephrine, ephedrine and phenylephrine plus ephedrine on maternal haemodynamics in elective caesarean section. Indian Journal of Anaesthesia, 55(6), pp.578-83
- Datta, S., Alper, M., Ohtheimer, G. And Weiss, J. (1982) 'Method of Ephedrine Administration and Nausea and Hypotension during Spinal Anesthesia for Cesarean Section'. Anesthesiology, 56(1), pp.68-69.
- Datta, S. (1995). The Obstetric anesthesia handbook, 2nd edition, Mosby Year Book, pp.29.
- Dyer, RA., Farina, Z., Joubert, IA., Du, Toit P., Meyer, M., Torr, G. et al. (2004). ‘Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section’. Anaesth Intensive Care, 32(3) pp.351-7.
Corresponding Author
Pooja Bhari
MD Phase B Anaesthesia Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
DOI: https://dx.doi.org/10.18535/jmscr/v8i9.22
