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Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during cesarean section: a randomized controlled trial

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Chinese Medical Journal 2021年第7期134卷 792-799页

作者： Qian-Qian Fan Yong-Hui Wang Jing-Wen Fu Hai-Long Dong Man-Ping Yang Duo-Duo Liu Xiao-Fan Jiang Zhi-Xin Wu Li-Ze Xiong Zhi-Hong Lu Department of Anesthesiology and Perioperative Medicine Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Gynecology and Obstetrics Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Neurosurgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi 710032China Department of Anesthesiology and Translational Research Institute of Brain and Brain-like Intelligence Shanghai Fourth People’s Hospital Affiliated to Tongji University School of MedicineShanghai 200081China.

Background:Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section.This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.Methods:In this double-blinded,randomized controlled clinical trial,parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion(0.05μg·kg^(-1)·min^(-1))just before spinal anesthesia continuing for 30 min or ephedrine bolus(0.15 mg/kg)just before spinal anesthesia.A rescue bolus(5μg norepinephrine for the norepinephrine group,and 5 mg ephedrine for the ephedrine group)was administered whenever hypotension occurred.Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration.Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block,and neonatal cerebral oxygenation 10 min after birth.Results:In total,190 patients were enrolled;of these patients,177 were included in the final analysis.Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group(29.5%vs.44.9%,odds ratio[OR]:0.51,95%confidence interval[CI]:0.28-0.95,P=0.034).Moreover,the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group(OR:0.22,95%CI:0.11-0.44,Pcesarean section with spinal anesthesia,norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia,and exhibited potential neonatal benefits.

关键词： Hypotension Spinal anesthesia Norepinephrine Ephedrine cesarean section

Effects of colloid preload on the incidence of hypotension in spinal anesthesia for cesarean section:a systematic review and meta-analysis

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Chinese Medical Journal 2021年第9期134卷 1043-1051页

作者： Rui-Song Gong Xiao_Wen Liu Wei-Xia Li Jing Zhao Department of Anesthesia China-Japan Friendship HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijingChina Department of Anesthesia China-Japan Friendship HospitalBeijingChina

Background:Hypotension is a common complication caused by spinal anesthesia(SA),which may have adverse impacts on the condition of the parturient and fetus.Liquid infusion was found to be relatively effective for reducing the incidence of hypotension.However,the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial.This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.Methods:Related keywords were searched on PubMed,EMBASE,and Cochrane Library from inception dates to May 2020.Studies included were evaluated for eligibility and quality.The primary outcome was the intra-operative incidence of hypotension and severe hypotension.The secondary outcomes included the lowest intra-operative systolic blood pressure,the maximal intra-operative heart rate,the intra-operative needs of ephedrine and phenylephrine,the incidence of maternal nausea and/or vomiting,and neonatal outcomes(umbilical artery pH and Apgar scores).Apart from the above,RevMan 5.3 was used for the data analysis.Results:Altogether nine randomized controlled trials were included in the meta-analysis.There were no significant differences in the incidence of intra-operative hypotension,severe hypotension,or neonatal outcomes between the colloid preload group and control group,except for the umbilical artery pH.Conclusion:This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

关键词： Colloid Preload Spinal anesthesia cesarean section

Uterine incision dehiscence 3 mo after cesarean section causing massive bleeding:A case report

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World Journal of Clinical Cases 2020年第11期8卷 2392-2398页

作者： Yao Zhang Ning-Ye Ma Xiao-Ao Pang Department of Obstetrics and Gynecology Shengjing Hospital of China Medical UniversityShenyang 110001Liaoning ProvinceChina

BACKGROUND The traditional definition of late postpartum hemorrhage is a massive uterine hemorrhage from 24 h after delivery to the puerperal period.Here,we report a case of late postpartum hemorrhage that occurred 3 mo after cesarean section and endangered the patient's life.The cause of the case we are reporting was poor incision healing.By reporting this case,we hope to make doctors aware that late postpartum hemorrhage due to poor incision healing may happen as late as 3 mo after cesarean section.CASE SUMMARY A 31-year-old woman complained of acute,severe vaginal bleeding for 1 h;the patient had a history of cesarean section 3 mo prior.After receiving antiinflammatory treatment,fluid supplementation,blood transfusion,oxytocin administration,and hemostatic treatment,the vaginal bleeding ceased,and the patient’s clinical status improved.Unfortunately,she experienced recurrent massive vaginal bleeding,and uterine contractile agents did not decrease the persistent bleeding.To save the patient’s life,she was admitted for emergency laparotomy.At exploratory laparotomy,dehiscence and necrosis of the previous cesarean section scar were noted;the dehiscence penetrated through the entire thickness of the uterine muscle wall and extended to the left uterine artery.Ultimately,we performed a total hysterectomy.CONCLUSION Late postpartum hemorrhage due to poor incision healing after cesarean section may occur in the 3 mo after cesarean section or even later.Therefore,obstetricians-gynecologists should monitor for this potential complication in all patients post–cesarean section.Such hemorrhages can be severe enough to endanger the patient's life.

关键词： cesarean section Late postpartum hemorrhage Pathogeny Prevention Treatment Wound healing Case report

Effect of cesarean section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

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Current Medical Science 2018年第4期38卷 618-625页

作者： Chang XU Qiang FU Hong-bing TAO Xiao-jun LIN Man-li WANG Shu-xu XIA Hao-ling XIONG Department of Health Administration School of Medicine and Health Management Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 China Department of Epidemiology and Biostatistics College for Public Health and Social Justice Saint Louis University Saint Louis 63104 USA

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nul

关键词： postpartum hemorrhage cesarean section parity indications

Effects on newborns of applying bupivacaine combined with different doses of fentanyl for cesarean section

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World Journal of Clinical Cases 2021年第23期9卷 6698-6704页

作者： Yun Wang Wen-Xun Liu Xiao-Hong Zhou Min Yang Xin Liu Yuan Zhang Ke-Rong Hai Qing-Shan Ye The First Hospital of Northwest Minzu University(Department of Anesthesiology People's Hospital of Ningxia Hui Autonomous Region)Yinchuan 750002Ningxia Hui Autonomous RegionChina Department of Anesthesiology The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshi 445000Hubei ProvinceChina

BACKGROUND The choice of anesthesia for cesarean section is very important.AIM To compare the effects of applying bupivacaine combined with different doses of fentanyl on newborns after cesarean section.METHODS We randomly divided one hundred and twenty patients undergoing cesarean section into the following 4 groups:group B(bupivacaine group),group BF10(bupivacaine combined with 10μg fentanyl),group BF30(bupivacaine combined with 30μg fentanyl)and group BF50(bupivacaine combined with 50μg fentanyl).The heart rate,mean arterial pressure,block plane fixation time and sensory block time were recorded.Umbilical artery blood was then collected immediately after fetal delivery for blood gas analysis and qualitative detection of fentanyl.Additionally,data on the neonatal 1-min and 5-min Apgar scores,results of umbilical artery blood gas analysis and qualitative detection of fentanyl in umbilical artery blood were recorded.RESULTS Although the mean arterial pressure decreased in all four groups at 3 min after anesthesia,the percentage of the decrease was less than 20%of the baseline.In addition,there were no significant differences in the 1-min or 5-min Apgar scores or the umbilical artery blood gas analysis among the four groups(P>0.05).Moreover,the concentration of fentanyl in umbilical artery blood was qualitatively detected using an ELISA kit,and the results in the four groups were negative.CONCLUSION Bupivacaine combined with fentanyl spinal anesthesia is effective in cesarean section.

关键词： Bupivacaine Fentanyl Spinal anesthesia cesarean section Newborn

Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial

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International Journal of Nursing Sciences 2019年第3期6卷 252-258页

作者： Wafaa Taha Ebrahim Elgzar Hanan Ebrahim Said Heba Abdelfatah Ebrahim Department of Obstetrics and Gynecology Nursing Faculty of Nursing University of Damanhour Egypt Department of Obstetrics and Woman Health Nursing Faculty of Nursing University of Benha Egypt

Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.

关键词： cesarean section Hemodynamics Hypotension Leg Neonatal Stockings,compression

Psychotic due to bath salts and methamphetamines:emergency cesarean section under general anesthesia

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The Journal of Biomedical Research 2018年第4期32卷 311-313页

作者： Nina Schloemerkemper Department of Anesthesiology and Pain Medicine University of California Davis

The use of ＂bath salts＂ or other new psychoactive substances,otherwise known as ＂legal highs＂,is increasing.Illicit drug use during pregnancy is not uncommon.Nevertheless,literature reporting bath salts and their effect on pregnancy is scant.Besides,there seems to be no literature about bath salts and conduct of general anesthesia.This case report describes a general anesthetic for the surgical delivery of an infant to a woman under the acute influence of bath salts and methamphetamines.

关键词： bath salts psychoactive substance legal high designer drug methamphetamine general anesthesia cesarean section

Study on Modification of the Misgav Ladach Method for cesarean section

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2001年第1期21卷 75-77页

作者：李敏邹丽朱剑文 Department of Obstetrics and Gynecology Xiehe Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan

cases of pregnant women scheduled for delivery by cesarean section were randomly assigned to 59 cases in modification group with modified Misgav Ladach technique, 57 cases in Misgav Ladach group with Misgav Ladach technique and 56 cases in Pfannenstiel group with Pfannenstiel technique from May to Dec. 1999. The modified points included: transversely incising the fascia 2 to 3 cm, then dividing it bluntly; without opening and dissociating the visceral peritoneum; two layers suturing of low transverse uterine incision; closing the skin by continuous suturing. Results showed the average delivery time in the modification group was (3.6±2.6) min and (5.7±2.9) min in the Misgav Ladach group ( P 0.05). Average blood loss was (128±35) ml in modification group compared with (212±147) ml in the Pfannenstiel group ( P <0.05). It was concluded that the modified Misgav Ladach technique not only preserved all advantages of Misgav Ladach method, but also had additional advantages, such as faster in delivering the fetus, less damage, easier mastering for obstetricians.

关键词： cesarean section peritoneum/surgery surgical method

Enhanced Recovery after cesarean section (CS) versus Conventional Care in a Lower Middle-Income Country: A Randomized Controlled Trial

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Open Journal of Nursing 2022年第12期12卷 831-841页

作者： Atef Darwish Manal Mustafa Entrsar Youness Bushra Al-Harazi Department of Obstetrics and Gynecology Faculty of Medicine Assiut University Assiut Egypt Department of Obstetrics and Gynecological Nursing Faculty of Nursing Assiut University Assiut Egypt Department of Obstetrics and Gynecological Nursing Faculty of Medicine and Health Sciences-Nursing Department Sana’a University Sanaa Yemen

Background: Enhanced recovery after surgery (ERAS) has been tested in a wide variety of surgeries with promising outcomes. However, there is a need for a standardized, evidence-informed approach to both the development of new ERAS Society guidelines, and the adaptation and revision of existing guidelines. Developing countries have limited resources and deserve every effort to improve economic status. Aim of the Study: to evaluate perinatal maternal outcomes of ERAS? versus routine care protocols in women undergoing elective cesarean section (CS) in a lower middle-income country with limited resources ranked as a third most country performing CS worldwide using a multidisciplinary team (MDT) management. Design: A prospective randomized Controlled Trial. Setting: Outpatient department (OPD) and labor ward at the Woman’s Health hospital, Assiut University, Egypt. Participants: Healthy pregnant women planned for elective CS (300 women) were randomly divided into a study group offered ERAS protocol and a control group offered regular care. Results: Repeat CS was the main indication of elective CS in both groups without significant difference (89 cases (59.3%) and 75 cases (50%) in both groups respectively). Other indications included cephalopelvic disproportion in 17 cases (11%) and 19 cases (12.6%), placenta previa in 28 (18.6%) and 34 (22.6%) cases, DM in 11 (7%) and 19 (12.6%) cases, and others in 5 (0.3%) and 3 (2%) cases in both groups respectively. The study group took much less time to eat and walk. It had significantly lower pain levels and postoperative problems, as well as much greater women’s satisfaction and a shorter hospital stay (p = 0.001). Conclusions: Collaboration of nursing, obstetricians and anesthesiologists is the cornerstone for a successful ERAS for CS. Significant better perinatal maternal outcomes encourage expansion of ERAS in lower middle-income countries with limited resources.

关键词： Nursing cesarean section Enhanced Recovery