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Combined spinal – epidural anesthesia for cesarian section


Author: Stasiuc Violeta
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2008
Scientific adviser: Victor Cojocaru
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:

Status

The thesis was presented on the 23 October, 2008
Approved by NCAA on the 23 October, 2008

Abstract

Adobe PDF document0.50 Mb / in romanian

Thesis

CZU 618.5-089.888.61h

Adobe PDF document 1.76 Mb / in romanian
123 pages


Keywords

combined spinal-epidural anaesthesia, caesarean section, tocodynamometria, Apgar score, neonatal acid-base status, lidocain

Summary

Current study discusses otcomes of different techniques of regional anesthesia in 102 cesarian section cases performed in 2005 – 2007 at the Republican Research Institute of Mother and Child.

The goal of the study was to study characteristics, evaluate results of the combined spinal-epidural anesthesia (CSEA) versus epidural anesthesia (EA) or spinal anesthesia (SA) in the routine C-section cases. The results of the study suggest that CSEA is effective method for obtaining optimal pain control during and after the surgery. Use of relatively small amount of the local anesthetic delivered in subarachnoidal space decreases the frequency of the “high” block, and the possibility to extend the area of the regional block using epidural boluses decreases the frequency of the “low“ block in 8,6 and 4,3 times respectevly, comparing with standart SA technique. Hypotension was more common in SA group – 13 (40,6±8,7%) cases versus 6 (17,6±6,5%) cases in CSEA group. Because CSEA was performed in more controlled manner it resulted in more hemodynamic stability. Unstable hemodinamics can provoke disturbances in the utero-placental blood flow and promote hypoxic state in the fetus. The frequency of the fetal arrhythmia was 2,4 times less in CSEA then in EA group and marked acidosis (pH < 7,2) in newborn was 1,9 times less then in SA group. Mean Apgar score at the first minute of neonatal life was 8,06±0,41 in CSEA group versus 7,75±0,49 in EA group. Decrease in diastolic blood pressure in the newborns from the EA was due to the relatively large dose of local anesthetic. Pharmokinetic studies performed have shown that the moment of fetal extraction corresponds to the timepoint of maximal lidocaine concentration in the mother’s plasma.

That’s why anaesthetic concentration and mother’s hemodinamic profile play important role in the clinical presentation of newborn. The benificial effect of the CSEA technique on abovementioned variables, such as fetal heart rate, Apgar score, acid-base balance and lidocaine concentration in the newborn suggests it’s advantage over traditional EA or SA techn