Does combined spinal-epidural analgesia with subarachnoid sufentanil increase the incidence of emergency cesarean delivery?

Albright, George A.; Forster, Richard M.

doi:10.1016/s1098-7339(97)80025-9

Cited by 64 publications

(24 citation statements)

References 8 publications

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“…There was no cesarean delivery performed within 1 h of induction of analgesia. Likewise, Albright and Forster [33], in a series of 1240 CSEs, reported no emergency cesarean delivery within 90 min of induction of analgesia. The incidence of emergency cesarean delivery for fetal distress did not differ when using CSE or standard epidural analgesia.…”

Section: Fetal/neonatal Effectsmentioning

confidence: 96%

Recent advances in obstetric anesthesia

Farragher

Datta

2003

Journal of Anesthesia

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The low-dose technique of combined spinal/epidural analgesia is to be welcomed in obstetrics. Its merits include rapid onset of analgesia, with the flexibility of an epidural technique, and high maternal satisfaction. It is a safe and effective technique. Pulse oximetry should be employed when using intrathecal opioids. Commercially available combined-needle devices may make this technique more attractive to users. The role of spinal anesthesia for emergency cesarean section in severe preeclampsia has been reevaluated recently. We consider it a feasible option for those severely preeclamptic women requiring urgent cesarean section who do not have an epidural catheter in place. The choice of anesthetic technique for this patient population should be made on clinical judgment and not on anticipated hemodynamic changes. Spinal anaesthesia for cesarean section is associated with hypotension; however, certain interventions may reduce the incidence and severity of the hypotension. An increase in cardiac output appears to be key in attenuating the hypotensive response to spinal anesthesia. Colloids have exhibited most success in this regard. At our institution, we do not delay spinal anesthesia for urgent cesarean section in order to administer a predetermined volume of fluid; in such cases, we simultaneously administer a fluid preload and spinal anesthesia. Recent studies regarding the use of cell savers for blood conservation in obstetrics are based on small numbers of patients. These studies show great promise, particularly with the modern emphasis on avoiding blood transfusion, which can be massive in this usually young patient population.

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Section: Fetal/neonatal Effectsmentioning

confidence: 96%

Recent advances in obstetric anesthesia

Farragher

Datta

2003

Journal of Anesthesia

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“…A etiologia da bradicardia fetal é incerta, mas parece estar relacionada com a rápida cessação da dor das contrações uterinas, o que reduz a concentração plasmática materna de β-endorfinas 10 e epinefrina 11 . Um rápido desequilíbrio plasmático entre epinefrina/norepinefrina pode resultar em hipertonia uterina e/ou espasmo arterial e conseqüente diminuição da oferta sangüínea uteroplacentária 12 . Essa bradicardia, quando intensa, acarreta indicação de cesariana de emergência.…”

Section: Discussionunclassified

“…The etiology of fetal bradycardia is not well known, but it seems to be related to the fast reduction of the pain caused by uterine contractions, which reduces maternal plasma concentration of β-endorphins 10 and epinephrine 11 . A sudden plasma imbalance of epinephrine/norepinephrine may result in uterine hypotonus and/or arterial spasm and the consequent decrease in uterine-placental blood flow 12 . When this bradycardia is severe, it is an indication for cesarean section.…”

Section: Discussionmentioning

confidence: 99%

Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua

Côrtes¹,

Sanchez²,

Oliveira³

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:O alívio da dor no trabalho de parto tem recebido atenção constante visando ao bem-estar materno, diminuindo o estresse causado pela dor e reduzindo as conseqüên-cias deste sobre o concepto. Inúmeras técnicas podem ser utilizadas para analgesia de parto. Este trabalho teve como objetivo comparar a técnica peridural contínua com a combinada, ambas com o uso de bupivacaína a 0,25% em excesso enantiomérico 50% e fentanil como agentes. MÉTODO:Participaram do estudo 40 parturientes em trabalho de parto com dilatação cervical entre 4 e 5 cm que foram distribuídas em dois grupos iguais de forma aleatória. O Grupo I recebeu anestesia peridural contínua. O Grupo II recebeu anestesia combinada. Foram avaliados: medidas antropométricas, idade gestacional, dilatação cervical, tempo entre o bloqueio e a ausência de dor por meio da escala analógica visual, possibilidade de deambulação, tempo entre o início da analgesia e a dilatação cervical completa, duração do período expulsivo, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. Possíveis complicações, como depressão respiratória, hipotensão arterial materna, prurido, náu-seas e vômitos, também foram observadas. Para a comparação das médias utilizou-se o teste t de Student e para a paridade e tipo de parto utilizou-se o teste do Qui-quadrado. RESULTADOS:Não houve diferença estatística significativa entre os dois grupos em relação ao tempo entre o início da analgesia e a dilatação cervical completa, bem como em relação ao tempo da duração do período expulsivo, incidência de cesariana relacionada com a analgesia, parâmetros hemodinâmicos maternos e vitalidade do recém-nascido. CONCLUSÕES:Ambas as técnicas se mostraram eficazes e seguras para a analgesia do trabalho de parto, embora a técnica combinada tenha proporcionado um rápido e imediato alívio da dor.Estudos clínicos com maior número de casos são necessários para avaliar diferença na incidência de cesarianas.Unitermos: ANALGESIA, Obstétrica: parto; ANESTÉSICOS, Local: bupivacaína 0,25% em excesso enantiomérico de 50%; ANALGÉSI-COS, Opióides: fentanil; TÉCNICAS ANESTÉSICAS, Regional: peridural contínua, combinada raquiperidural. SUMMARY BACKGROUND AND OBJECTIVES:Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. METHODS:Forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. Group I received continuous epidural anesthesia. Group II received combined anesthesia. The following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between ...

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“…However, nonreassuring fetal bradycardia is not more common with intrathecal opioids than after traditional epidurals, 19 and the rate of emergency cesarean delivery does not increase. 20 It is notable that fetal bradycardia after CSE is more frequent than after meperidine analgesia. 21 The presumable mechanism of the bradycardia is uterine hypertonicity, which is due to significant decrease in epinephrine concentration in the mother.…”

Section: Discussionmentioning

confidence: 99%