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Clinic Study of Different Anesthetic Methods for Caesarean Section

Author: ChenTianRong
Tutor: ZhaoHengLan
School: Jilin University
Course: Anesthesiology
Keywords: ropivacaine combined spinal-epidural anesthesia epidural anesthesia stress response caesarean section
CLC: R614
Type: Master's thesis
Year: 2006
Downloads: 154
Quote: 2
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Abstract

The predominant recent literature on the combined spinal-epidural technique involves its use in obstetrics. A 2004 UK surveyshowed that the use of the combined spinal-epidural technique isincreasing. This is because combined spinal-epidural provides fasteronset of analgesia and good muscle relaxation and increases maternalsatisfaction. Meanwhile, epidural catheter could prolong the time ofintrathecal local anesthetic action and use in postoperation analgesia.Ropivacaine is a new long-acting local anaesthetic with a chemicalformula similar to that of other amino amides in clinical use. In vitrostudies have demonstrated that ropivacaine is a potent blocker of Aand C fibres. It has been reported to be less toxic than that ofbupivacaine. It’s a satisfactory local anesthetic for obstetric anesthesia.We observed that 0.75% ropivacaine 2ml injecting into intrathecalspace with combined spinal-epidural anesthesia was how to changehemodynamics and stress responses for caesarean section. We assayedfetal blood gas values. Combined spinal-epidural compared withtraditional epidural have advantages and drawbacks. 30 women physical ASAⅠ-Ⅱwere assigned randomly into twogroups: Group CSEA (combined spinal-epidural anesthesia) andGroup CEA (continuous epidural anesthesia). MAP, HR and SPO2were measured before anesthesia, skin incision, obtaining fetal and atthe end of the surgery respectively. Sensory block was measured withpinprick and time of obtaining T12, T10, T8 were recorded. And werecorded highest anesthetic level. Pain scores were evaluated bypatients. Blood sugar and corticosteroid were measured beforeanesthesia, skin incision and obtaining fetal. After obtaining fetal,umbilical vein blood was sampled from neonate and assayed for bloodgas. If hypotension occurred (≥30% baseline value), we recordedincidence of the hypotension and rescued with ephedrine10-15mg. Inthe operation, we observed patient side effects of drugs such asnausea, vomiting, post anesthesia headache and hypotension. All datawere showed with x ±S and analyzed using the t test, chi-square,level of significance P<0.05. Results: there was no difference at age,height and weight between two groups. The incidence of hypotensionin Group CSEA was higher than that in Group CEA. Time ofobtaining T12, T10, T8 in Group CSEA were shorter than that inGroup CEA (P<0.05), There was markedly difference between twogroups. In the other aspects of relieving pain,Group CSEA wassuperior to Group CEA. There was no difference in blood sugarbetween two groups. But corticosteroid had markedly change. It issuggested that combined spinal-epidural with 0.75% ropivacaineprovides a safer and faster onset of analgesia method.Conclusion: previous studies demonstrated that parturient is moresensitivity than not-parturient for local anesthetic, especiallybupivacaine. But it is found that ropivacaine hasn’t increased cardiactoxic. Cardiac toxic of ropivacaine is lower than bupivacaine. Someliterature demonstrated that ropivacaine is fewer never damage inclinic concentration and dosage. So, ropivacaine is safer anestheticthan bupivacaine in obstetrics anesthesia. But onset time of epiduralanesthesia is slow. It is due to epidural block mechanism. Mechanismhas three. Firstly, it has effect through paravertebral block. Secondly, itblocks spinal cord through arachnoids pile in roots. Lately, it diffusesinto subarachnoid space through epidural membrane. It is showed thatcombined spinal-epidural is better than sole epidural anesthesia.In a word, using combined spinal-epidural technique isincreasing. It uses little local anesthetic and has slight hemodynamicschanges. Meanwhile, it has lower incidence for post anesthesiaheadache. Hypotension in operation which is rescued withephedrine10mg-15mg hasn’t bad affection for neonate. Combinedspinal-epidural and sole epidural act on nerves or spinal column whichlocalized in operation area. It greatly reduces stress responses withoperation damage. In the article, index of stress responses such bloodsugar hasn’t significant increment, but corticosteroid has significantchange in the group CSEA.Summary: 0.75% ropivacaine2 ml with combined spinal-epiduralanesthesia is better method undergoing caesarean section which onsettime is shorter .It has equilibrium hemodynamics using ephedrine andrapid injecting fluid. It hasn’t bad affection on neonate .It is suggestedthat combined spinal-epidural anesthesia is a safe method forcaesarean section. The technique can be used widespread in clinicprocedure.

Clinic Study of Different Anesthetic Methods for Caesarean Section

Abstract

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