Body Mass Index and Clinical Outcomes During Cesarean Section Under Spinal Anesthesia
Marcio Luiz Benevides,
Anne Karoline Coutinho Borges,
Luiz Fernando Galesso Seror,
Danilo Augusto Oliani Giroto,
Aleandra Simoes Furtado,
Amanda Costa Pinto,
Marco Antonio Marquioreto Benevides
Issue:
Volume 10, Issue 2, December 2022
Pages:
44-51
Received:
26 June 2022
Accepted:
15 July 2022
Published:
20 July 2022
DOI:
10.11648/j.ijacm.20221002.11
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Abstract: Introduction: Obese pregnant women, especially morbidly obese, are at greater risk of undergoing a cesarean section (CS). Clinical outcomes have been associated with an increase in body mass index (BMI). Objective: The objective of the study was to evaluate the sensory block level, the perioperative times, the incidence of maternal hypotension, the Apgar score, and the birth weight between the BMI strata of pregnant women undergoing CS. Method: In this prospective cohort study were included women with singleton pregnancies undergoing spinal anesthesia for elective CS. The pregnant women were classified according to BMI at delivery: normal (18.5–25 kg.m-2), overweight (25–29.9 kg.m-2), obese (30–39.9 kg.m-2), and morbidly obese (≥ 40 kg.m-2). The primary outcome was the total operative time. Results: Among 540 patients analyzed, 252 (46.7%) were obese and 54 (10%) were morbidly obese. The sensory block level (> T4) was higher in morbidly obese patients (18.5%) compared to patients with normal BMI (4%) and overweight (7.5%), p < 0.05. The median and interquartile range of the spinal-to-incision interval was longer in morbidly obese patients [13 (10–16.2) minutes] compared with normal BMI [10 (8–12) minutes] and overweight [10 (9.5–14) minutes], p < 0.000; and obese [11 (10–15) minutes], p < 0.00. Also, it was longer in obese patients compared with normal BMI, p < 0.00. The mean and standard deviation (SD) of the total operative time was longer in morbidly obese patients (70.2 ± 21 minutes) compared to those with normal BMI (59.7 ± 12 minutes) and overweight (61.3 ± 17 minutes), p < 0.00; and in obese (65.4 ± 18 minutes) compared with normal BMI, p < 0.05. The incidence of maternal hypotension was higher in morbidly obese patients (79.6%) compared with normal BMI (58.7%) and overweight (61%), p < 0.05; and in obese patients (71.8%) compared with normal BMI and overweight, p < 0.05. The birth weight of morbidly obese patients (3,553 ± 623 g) was higher than in patients with normal BMI (3,020 ± 626 g) and overweight (3,187 ± 587 g), p < 0.000; and in obese patients compared with normal BMI and overweight, p < 0.00. The incision-to-delivery interval, Apgar score < 7 at 5 minutes were similar in the different BMI strata. Conclusion: The increase in BMI is associated with longer perioperative times, higher sensory block level, higher incidence of maternal hypotension, and higher birth weight.
Abstract: Introduction: Obese pregnant women, especially morbidly obese, are at greater risk of undergoing a cesarean section (CS). Clinical outcomes have been associated with an increase in body mass index (BMI). Objective: The objective of the study was to evaluate the sensory block level, the perioperative times, the incidence of maternal hypotension, the...
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Research Progress on Catheter-Related Bladder Discomfort After General Anesthesia
Wencai Jiang,
Xu Zeng,
Xinyu Zhou,
Xianjie Zhang
Issue:
Volume 10, Issue 2, December 2022
Pages:
52-56
Received:
1 November 2022
Accepted:
23 November 2022
Published:
30 November 2022
DOI:
10.11648/j.ijacm.20221002.12
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Abstract: Urinary catheterization is a common intervention for patients undergoing general anesthesia, especially for major surgeries. It plays an important role in the perioperative period in assessing renal function, avoiding renal impairment, and improving patient prognosis. However, for patients receiving urinary catheterization, catheter-associated bladder discomfort (CRBD) is a common complication after general anesthesia, accounting for a significant proportion. In mild cases, it may reduce the comfort of patients during the perioperative period; In severe cases, it may affect patient recovery, increase the hospitalization period, increase the medical burden, and decrease patient satisfaction. However, However, CRBD is often ignored by medical staff in clinical work. Prevention and treatment of CRBD are important for patients undergoing urinary catheterization under general anesthesia to accelerate rapid recovery. At present, there is still a lack of consensus on the prevention and treatment of CRBD. In recent years, scholars at home and abroad have conducted many studies on CRBD and provided many prevention and treatment measures, including pharmacological interventions, nerve blocks, and psychological interventions, which have provided more evidence for clinical work. The article mainly review the prevention and treatment of CRBD from the aspects of risk factors, mechanism, and intervention methods, and provides a reference for the prevention and treatment of CRBD under general anesthesia.
Abstract: Urinary catheterization is a common intervention for patients undergoing general anesthesia, especially for major surgeries. It plays an important role in the perioperative period in assessing renal function, avoiding renal impairment, and improving patient prognosis. However, for patients receiving urinary catheterization, catheter-associated blad...
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Continuous Adductor Canal Block (ACB) Versus ACB with Peri-Articular Injection and ACB with IPACK for Postoperative Analgesia in Total Knee Arthroplasty
Rabab Mohamed Mohamed,
Jehan Mohammad Darwish Hamed
Issue:
Volume 10, Issue 2, December 2022
Pages:
57-64
Received:
5 November 2022
Accepted:
7 December 2022
Published:
27 December 2022
DOI:
10.11648/j.ijacm.20221002.13
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Abstract: Background: Acute postoperative pain after total knee arthroplasty (TKA) is so severe that patients are entitled to analgesia that avoids the detrimental effects of pain on several body systems. Objectives: This study compared the post-operative analgesic impact of continuous adductor canal block to that of adductor canal block with peri-articular injection (PAI) and adductor canal block (ACB) with infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) in TKA. Patients and Methods: This prospective randomized trial included 60 adult cases with severe knee osteoarthritis scheduled for elective TKA. Patients were randomly divided into three equal groups: group I received ACB and a continuous adductor canal block (CACB), group II received ACB and PAI, group III received ACB and IPACK. Results: Significant increase in NRS values was detected in CACB patients at 2h post operative (p=0.001) while a significant decrease in NRS in PAI group patients at 6h and 12 h post operative (All P values < 0.05) respectively. Motion ability was recorded through the use of Time Up and Go test (TUG) showed the shortest records in PAI block group than CACB and IPACK groups, p=0.001 at 12h post operative. At 24 h post operative, the IPACK group showed the shortest time records than PAI and CACB patients (p value < 0.05). Conclusion: In TKA, PAI has higher quadriceps muscle power and lower TUG and length hospital stay compared to ACB with IPACK and continuous ACB. ACB with PAI and ACB with IPACK are associated with better analgesia (prolonged action and lower morphine consumption) compared to continuous ACB.
Abstract: Background: Acute postoperative pain after total knee arthroplasty (TKA) is so severe that patients are entitled to analgesia that avoids the detrimental effects of pain on several body systems. Objectives: This study compared the post-operative analgesic impact of continuous adductor canal block to that of adductor canal block with peri-articular ...
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