The relationship between symphysis-fundal height and intravenous ephedrine dose in spinal anesthesia for elective cesarean section

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Background/aim

Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia.

Materials and methods

This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded.

Results

Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects.

Conclusion

SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.

Correlation of Symphysiofundal Height and Abdominal Girth with the Incidence of Hypotension in Cesarean Section Under Spinal Anesthesia using Bupivacaine with Fentanyl as Adjuvant: A Clinical Study

Background and Aims:

A decreased lumbosacral subarachnoid space volume is a major factor in cephalad intrathecal spread of local anesthetic in term parturients due to compressive effect of the gravid uterus. The aim of this study was to assess the relationship of symphysiofundal height (SFH) and abdominal girth (AG) with the incidence of hypotension and the highest level of sensory blockade.

Settings and Design:

This study was a prospective observational study.

Materials and Methods:

Ninety parturients under the American Society of Anesthesiologists physical status class II within the age range of 20–30 years, weighing between 60 and 65 kg, and height between 150 and 155 cm were studied, and the SFH and AG of all parturients had been measured just before spinal anesthesia. Hyperbaric bupivacaine 9 mg with 12.5 μg intrathecal fentanyl was administered for subarachnoid block. The incidence of hypotension and the highest level of sensory block were assessed.

Statistical Analysis:

Correlation analysis (Spearman's rank test) was applied to analyze the data, and P < 0.05 was considered to be statistically significant.

Results:

The incidence of hypotension was higher with increasing SFH (16.9% with SFH of 30–35 cm, 78.37% with SFH of 36–40 cm; correlation coefficient ρ =0.338) and with increasing AG (5.3% with AG between 85 and 89 cm, 35.7% with AG 90–94 cm, 62.8% with AG 95–99 cm; ρ =0.341), and both were statistically significant (P < 0.001). There was a statistically significant correlation between increasing SFH and maximum sensory block achieved (ρ =0.157, P < 0.001). There was increased level of sensory blockade with increased AG but was not statistically significant (ρ =0.011, P = 0.32).

Conclusion:

In term parturients undergoing cesarean section under spinal anesthesia, the SFH has a significant positive correlation with the incidence of hypotension and ascent of spinal anesthesia. AG also has a positive correlation with the incidence of hypotension but is not significant with the ascent of spinal anesthesia.

Correlation between Weight of the Baby and the Level of Sensory Blockade in Spinal Anaesthesia for Caesarean Section: An Observational Study

Background

The spread of local anaesthetics during spinal anaesthesia is affected by various factors and can be unpredictable especially in parturients undergoing caesarean section. Factors like abdominal girth, symphysis fundal height etc have to studied to know their impact on level of sensory blockade. We hypothesized a study to find any correlation between weight of the baby and the level of sensory blockade.

Methods

46 parturients posted for elective caesarean section belonging to American Society of Anaesthesiologists (ASA) physical status 1 and 2 were included in the study. Maternal height and weight were noted down before entering operation theatre. All patients were instituted subarachnoid block with 2 cc of 0.5% of hyperbaric bupivacaine in sitting position. Level of sensory blockade was assessed with pin prick along midline of the patient every min till 5^th minute and 5 minutes till 15^th minute. The birth weight of baby was recorded soon after delivery.

Results

The weight of the baby and height of the mother were correlated with the sensory blockade of T4. The number of babies weighing more than 3.5 kgs were 3 in our study out of which 2 babies were associated with maximum sensory blockade at 15^th minute. It amounts to 66.7% when compared with 14.7% in babies weighing 2.5 to 3.5 kgs which is suggestive of significance ('P' value of 0.093).

Conclusion

There is no statistically significant correlation between weight of the baby and the level of sensory blockade.