BSCPB offers analgesic efficacy in the early postoperative period for up to 24 h after thyroid surgery, with reduced length of hospital stay, but without any beneficial effect on PONV.
We are unsure of the basis of Dr Dutta's contention that we 'overly credit correlative association of . . . anxiety . . . with post-spinal systolic arterial pressure' or that we 'probably missed the actual scientific basis' for cause and effect. As this was only an observational study, we actually do not claim to provide causative data, but merely report the association.Spinal anaesthesia was conducted exactly as described in Methods. We agree that patient positioning has an effect on hypotension after spinal anaesthesia. All patients had urinary catheterization after spinal anaesthesia (anxious and non-anxious alike), so this is unlikely to have had any impact on the association of anxiety with spinal hypotension. No patients had vaginal examinations to assess cervical dilatation status/fetal-head descent after spinal anaesthesia, as these patients were all undergoing elective Caesarean delivery.Dr Dutta argues that spinal hypotension may have been a random event induced by 'anti-hyperbaricity' rather than 'preoperative patient anxiety'. The 'antihyperbaricity effect of fentanyl' is indeed not mentioned much in the literature; we could not find a single reference in Medline or Google corresponding to that word in any spelling-neither in relation to spinal fentanyl nor in relation to cerebrospinal fluid aspiration. However, as all patients underwent the same anaesthesia protocol, we fail to see how this addresses the observed association of anxiety with spinal-induced hypotension.We hope that these comments will be helpful.1 Orbach-Zinger S, Ginosar Y, Elliston J, et al. Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery. Br
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