Tehran University Medical Journal

Background: Spinal anesthesia can be associated with hemodynamic changes and some other complications. The aim of this study was to evaluate the effect of adding fentanyl to lidocaine on the spinal anesthesia time and its complications for cesarean section.

Methods: Sixty pregnant women with gestational age of 37- 42 weeks and ASA physical status I and II undergoing elective cesarean section under spinal anesthesia were enrolled in a randomized double blinded clinical trial. They were randomly allocated to receive spinal anesthesia with lidocaine-normal saline (LS: 75 mg lidocaine 5% with 0.3 ml normal saline) lidocaine-fentanyl (LF) group (75 mg lidocaine 5% with 50 μg fentanyl). The duration of initiation of sensory block to achieve T4 level, time to return of sensory level to T12, time to first analgesic request, ephedrine requirement, nausea and vomiting during and after the surgery, pruritus, respirator depression, headache and apgar score of the new born  at 1st and 5th minutes were assessed.

Results: There was no significant difference between time to achieve T4 level, ephedrine dose, post operative nausea and vomiting (PONV), pruritus and headache in study groups. Time to return of sensory level to T12 was significantly longer in LF group (152.6±14.7 vs. 66.2±11.2 min, P=0.0009). Time to first analgesic request was also longer in LF group (164.2±20.8 vs. 68.1±11.3 min, P=0.0009). The incidence of nausea and vomiting during surgery was significantly more in LF group (20% vs. 0%, P=0.023). No case of respiratory depression was observed in groups.The 1st and 5th minute's apgar score were comparable between groups and were between 7 and 10.

Conclusions: Addition of fentanyl to intrathecal lidocaine in patients undergoing elective cesarean section results in increasing of the block duration and time to first analgesic request without significant maternal or neonatal side-effects, without effect on 1st and 5th minutes apgar score  with increasing the incidence of during surgery nausea and vomiting.

Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.

Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.

Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

Background: Patients who require surgery on the lower extremities are considered to be a high risk group from the point of anesthesia. This study was performed to compare sitting and lateral positions in spinal anesthesia method with hyperbaric bupivacaine 0.5% for hemodynamic status and analgesic period in patients under vascular surgery of the lower limbs in Imam-Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences in 2009.

Methods: In this study 40 patients were divided into two groups of 20 to undergo spinal anesthesia with 3 ml of hyperbaric bupivacaine 0.5% injected into the subarachnoid space in sitting or lateral positions. The anesthesia was performed at T10 level and the hemodynamic status and analgesic periods were compared in the two groups.

Results: The changes in mean arterial blood pressure and systolic and diastolic blood pressures were different between the two groups (P<0.05). Except in the first and thirtieth minutes, the changes in heart rate (HR) were significantly different throughout the study between the two groups (P<0.04) and they were higher in sitting position. The duration of analgesia was significantly longer in lateral position (P<0.04) and the use of fluid was significantly larger in the sitting group (P<0.05).

Conclusion: According to the obtained results, the changes in hemodynamic variables were significantly lower in the group in lateral versus sitting position in patients undergoing spinal anesthesia with bupivacaine for vascular surgery of the lower limb.

Background: Surgery and pain increases cortisol levels with inducing hormonal responses. By reducing stress, adverse effects of cortisol can be controlled and accelerated the healing process. Religious practices like listening to Quran have important roles in reducing anxiety. Moreover, the level of cortisol hormone of the blood is one of the best indicators of the stress level. The aim of this study was to investigating the effect of listening to Quran on the plasma cortisol level of the umbilical cord in cesarean with spinal anesthesia.

Methods: A clinical trial study was designed and conducted on sixty primigravid mothers who were hospitalized to deliver their first baby by elective caesarian operation, 30 of them were selected as intervention group and 30 of them were selected as control group. For the subjects of the intervention group, the personal information questionnaires were completed and their vital signs were recorded. Also, their blood was sampled for measuring cortisol level. Then they listened to Quran. After spinal anesthesia, vital signs were recorded and the blood of umbilical cord was sampled for measuring the cortisol level. For the subjects of the control group, all the steps were done except listening to Quran. Two groups were statistically homogenous in the variables of age, gestational age, systolic blood pressure and diastolic blood pressure, pulse rate and cortisol levels before the intervention. The mean and SD cortisol in intervention group before and after listening to the Quran were 39.08±10.71 versus 41.10±5.05.

Results: The reduction of cortisol level of the intervention group (who listened to Quran) was significantly greater than of the control group P=0.035. Systolic blood pressure of the intervention group in the operating ward had statistically significant reduction relation to the systolic blood pressure before operation P=0.043. However systolic blood pressure of the control group in the operating ward had not statistically significant reduction relation to the systolic blood pressure before operation P=0.357. Listening to Quran has no effect on diastolic blood pressure and pulse rate.

Conclusion: Listening to Quran before caesarean affects the change of plasma cortisol level and the systolic blood pressure.