Ali Hassan Mohamed, Ismail Ahmed Abdelaziz
Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Cairo, Egypt.
Anesth Essays Res. 2019 Oct-Dec;13(4):663-668. doi: 10.4103/aer.AER_131_19. Epub 2019 Dec 16.
The spinal anesthesia in a cesarean section is still presenting a challenge to the anesthetist in the form of either severe hypotension from large bupivacaine dose or insufficient satisfactory anesthesia level conditions as a result of small bupivacaine dose. In this study, we tried to solve this challenge by increasing the dose of bupivacaine to achieve a proper spinal level accompanied by prolonged sitting up to avoid hypotension.
We included 53 patients in this study whom were randomly divided into two groups, namely Group B and Group C. In Group B (25 patients), each patient received 3 mL of bupivacaine and left 5 min sitting up, whereas in Group C (28 patients), each patient received 2.5 mL of bupivacaine and was asked to lie supine immediately. Both groups were tested for hypotension, ephedrine dose, and sensory block level.
The present study showed a statistically significant lower dose of ephedrine which was given in Group B (7.2 ± 15.684 mg in Group B versus 27.86 ± 12.04 mg in Group C with < 0.05). The proper anesthesia level was achieved equally in both groups.
Large dose 15 mg of bupivacaine with the prolonged sitting position will lead to fewer incidences of hypotension and proper anesthesia block.
剖宫产术中的脊髓麻醉对于麻醉医生而言仍是一项挑战，表现为大剂量布比卡因导致严重低血压，或小剂量布比卡因导致麻醉水平不充分。在本研究中，我们试图通过增加布比卡因剂量以达到合适的脊髓麻醉平面，并延长坐立时间以避免低血压，从而解决这一挑战。
本研究纳入53例患者，随机分为两组，即B组和C组。B组（25例患者）中，每位患者接受3 mL布比卡因，并保持坐立5分钟；而C组（28例患者）中，每位患者接受2.5 mL布比卡因，并立即平卧。两组均检测低血压情况、麻黄碱用量及感觉阻滞平面。
本研究显示，B组给予的麻黄碱剂量在统计学上显著更低（B组为7.2±15.684 mg，C组为27.86±12.04 mg，P<0.05）。两组均同等程度地达到了合适的麻醉平面。
15 mg大剂量布比卡因并延长坐立位可减少低血压的发生率，并获得合适的麻醉阻滞效果。
