Journal List > Ewha Med J > v.35(2) > 1058552

TOOLS
Kang, Bang, Shin, Kweon, Kim, Lee, Cho, and Lee: Effect of Injection Speed of Local Anesthetic on Hypotension during Spinal Anesthesia for Cesarean Section
Original Article
The Ewha Medical Journal

The Ewha Medical Journal 2012; 35(2): 83-88.

Published online: 30 September 2012

DOI: https://doi.org/10.12771/emj.2012.35.2.83

Effect of Injection Speed of Local Anesthetic on Hypotension during Spinal Anesthesia for Cesarean Section

Yong In Kang, Eun Chi Bang, Dong-Wook Shin, Dae Eun Kweon, Su Yeon Kim, Hyun Sook Lee, Kyung Sook Cho, Su Yeon Lee

Department of Anesthesia and Pain Medicine, Gangnam Medical Center, CHA University, Seoul, Korea.

Corresponding author: Yong In Kang, Department of Anesthesia and Pain Medicine, Gangnam Medical Center, CHA University, 566 Nonhyeon-ro, Gangnam-gu, Seoul 135-913, Korea. Tel: 82-2-3468-3080, Fax: 82-2-558-1119, anein09@hanmail.net

Received 5 June 2012       Accepted 2 July 2012

Copyright © 2012. Ewha Womans University School of Medicine

Abstract

Objectives

Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block.

Methods

Bupivacaine (0.5%) 9 mg with fentanyl 10 µg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine.

Results

Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed.

Conclusion

Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.

Keywords: Anesthesia, Cesarean section, Hypotension, Speed, Spinal injection

Figures and Tables

Table 1
Patient characteristics
emj-35-83-i001

There are no significant differences between two groups. The values are presented as mean±SD.

Table 2
Data between two groups
emj-35-83-i002

There are no significant differences between two groups. Values are presented as mean±SD.

Table 3
Ephedrine data
emj-35-83-i003

There are significant difference between two groups in the first ephedrine injection time but no differences in the number of use and amount of ephedrine. Values are presented as mean±SD. *P<0.05 between two groups.

Table 4
Hemodynamic data in two groups
emj-35-83-i004

There are no significant differences between two groups in SBP, DBP and HR. Values are presented as mean±SD. SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate.

References

1. The Korean Society of Anesthesiologists. Anesthesia. 2002. Seoul: Koonja Inc..
2. Simon L, Boulay G, Ziane AF, Noblesse E, Mathiot JL, Toubas MF, et al. Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section. Int J Obstet Anesth. 2000. 9:10–14.
3. Ebner H, Barcohana J, Bartoshuk AK. Influence of postspinal hypotension on the fetal electrocardiogram. Am J Obstet Gynecol. 1960. 80:569–572.
4. Corke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH. Spinal anaesthesia for Caesarean section: the influence of hypotension on neonatal outcome. Anaesthesia. 1982. 37:658–662.
5. Miller RD. Miller's anesthesia. 2005. 6th ed. San Francisco: Elsevier Inc..
6. Bucx MJ, Kroon JW, Stienstra R. Effect of speed of injection on the maximum sensory level for spinal anesthesia using plain bupivacaine 0.5% at room temperature. Reg Anesth. 1993. 18:103–105.
7. Stienstra R, Gielen M, Kroon JW, Van Poorten F. The influence of temperature and speed of injection on the distribution of a solution containing bupivacaine and methylene blue in a spinal canal model. Reg Anesth. 1990. 15:6–11.
8. Van Gessel EF, Praplan J, Fuchs T, Forster A, Gamulin Z. Influence of injection speed on the subarachnoid distribution of isobaric bupivacaine 0.5%. Anesth Analg. 1993. 77:483–487.
9. Prakash S, Bhartiya V, Pramanik V, Pahilajani J, Gogia AR, Singh R. The effect of injection speed on the spinal block characteristics of hyperbaric bupivacaine 0.5% in the elderly. J Anesth. 2010. 24:877–881.
10. Atchison SR, Wedel DJ, Wilson PR. Effect of injection rate on level and duration of hypobaric spinal anesthesia. Anesth Analg. 1989. 69:496–500.
11. Horlocker TT, Wedel DJ, Wilson PR. Effect of injection rate on sensory level and duration of hypobaric bupivacaine spinal anesthesia for total hip arthroplasty. Anesth Analg. 1994. 79:773–777.
12. Holman SJ, Robinson RA, Beardsley D, Stewart SF, Klein L, Stevens RA. Hyperbaric dye solution distribution characteristics after pencil-point needle injection in a spinal cord model. Anesthesiology. 1997. 86:966–973.
13. Bourke DL, Sprung J, Harrison C, Thomas P. High injection speed overwhelms other maneuvers for controlling the spread of spinal anesthesia. Anesth Analg. 1995. 81:427–428.
14. Tuominen M, Pitkänen M, Rosenberg PH. Effect of speed of injection of 0.5% plain bupivacaine on the spread of spinal anaesthesia. Br J Anaesth. 1992. 69:148–149.
15. Davis H, King WR. Densities of cerebrospinal fluid of human beings. Anesthesiology. 1954. 15:666–672.
16. Brown DT, Wildsmith JA, Covino BG, Scott DB. Effect of baricity on spinal anaesthesia with amethocaine. Br J Anaesth. 1980. 52:589–596.
17. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg. 1985. 64:715–730.
18. Neigh JL, Kane PB, Smith TC. Effects of speed and direction of injection on the level and duration of spinal anesthesia. Anesth Analg. 1970. 49:912–918.
19. The Korean Society of Obstetric Anesthesiologists. Obstetric anesthesia. 2009. Seoul: Koonja Inc..
20. Cho HS, Son YS, Chung KD, Lee WH, Park JM, Chung JH, et al. The effect of injection speed of local anesthetic on success rate of unilateral spinal anesthesia. Korean J Anesthesiol. 2005. 49:793–797.
21. Bouchnak M, Belhadj N, Chaaoua T, Azaiez W, Hamdi M, Maghrebi H. Spinal anaesthesia for Caesarean section: dose injection speed have an effect on the incidence of hypotension? Ann Fr Anesth Reanim. 2006. 25:17–19.
TOOLS
Similar articles