- Email: [email protected]
159
52
Posters
•
Obstetrics
120. Remifentanil by patient controlled analgesia compared with epidural analgesia for pain relief in labour M.E. Rabie, H.H. Negmi, A.M. Moustafa, H. Al Oufi [email protected] Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, KSA Background: Epidural analgesia has been established as the gold standard for labour analgesia. However, clinical contraindications and personnel or institutional limitations preclude some parturients from receiving an epidural. Remifentanil has been suggested as an ideal opioid for patient controlled analgesia (PCA) in labour. In our study we compared the use of PCA remifentanil to epidural analgesia in labour as regard pain relief, safety of the mother and the fetus, side effects, and overall parturient’s satisfaction. Methods: After ethical committee approval and informed written consent 30 healthy pregnant women ASA I or II, with no obstetric complications or contraindication to remifentanil or epidural analgesia were included in the study randomly allocated into one of two equal groups, in (Group EP) epidural infusion of bupivacain 1% plus 2ug/ml of fentanyl was given and in (Group R) the women received PCA remifentanil with a bolus of 0.4 ug kg-1 over 20 seconds and a lockout period of 1 min as an analgesia for labour. Results: There was significant decrease in (VAS) of pain in both groups with significantly more decrease in (Group EP). There was no significant difference between both groups as regard arterial blood pressure, heart rate, oxygen saturation, nausea, and overall patient’s satisfaction. Sedation scores were significantly higher in (Group R), there were no serious bradycardia, hypotension, or desaturation, and all the parturients were easily arousable. There were no fetal heart rate changes that required interference. The median 1 & 5 minutes Apgar scores were 9 in both groups, and the mean umbilical cord gases, & lactate levels were within normal limits with no difference between both groups. Conclusion: Our study demonstrated that epidural infusion gives better analgesia for labour than PCA remifentanil and That PCA remifentanil is a good, safe, and well tolerated alternative method of analgesia for labour.
159. To preload or coload? uscom evaluation of the timing of colloid expansion on preventing spinal hypotension at cesarean delivery W.H.L. Teoh, A.T.H. Sia, M.H. Loh [email protected] Dept of Women’s Anesthesia, KK Women’s & Children’s Hospital, Singapore Background & Aim: Common strategies to offset the hypotension associated with spinal anesthesia are lateral uterine displacement, intravenous fluid loading, and vasopressor therapy. Recent literature indicates fluid preloading is ineffective due to rapid redistribution. A “coload” may be better, maximizing intravascular volume expansion during vasodilatation from the sympathetic blockade; with colloids more effective than crystalloids. We aimed to evaluate the effects of a 15ml/kg (Hesteril 6%) colloid preload versus coload, on the prevention of spinal anesthesia- induced hypotension. We also assessed maternal cardiac output non-invasively with the Ultrasonic Cardiac Output Monitor (USCOM). Methods: We recruited 40 ASA I and II parturients who gave written informed consent. Patients were randomized to Group P (preload of 15 ml/kg Hesteril 6% prior to spinal) or Group C (coload, given when CSF identified). Fluids were administered at the maximal rate using a pressurized giving set and 16G IV. BP, HR, CO, stroke volume (SV) readings were taken at baseline, q1min x10mins, thereafter at 2.5min intervals for another 10mins after induction of spinal anesthesia. 50 mcg Phenylephrine boluses were given to maintain BP 90-100% baseline. Apgar scores and umbilical cord blood gas results were recorded. Results: Baseline demographics were comparable. Grp P received a mean of 1100(200) vs.1085(199) mls colloid in Grp C, infused over 7.8(2.4)min and 9.1(3.3)mins respectively. The CO and SV was significantly different (increased) in the preload group(p⫽0.011) in the 5 mins after the spinal However, there was no significant difference in hypotension, BP (p⫽0.727), pre-delivery phenylephrine use (353(260) Grp P vs 265(266)mcg Grp C, p⫽0.299), or umbilical artery and vein pH, CO2, O2, base excess between groups. Conclusion: A 15ml/kg colloid preload significantly increases maternal cardiac output after spinal anesthesia for cesarean delivery, but is not significantly different from an identical coload in preventing BP changes and hypotension.
Posters
•
Obstetrics
120. Remifentanil by patient controlled analgesia compared with epidural analgesia for pain relief in labour M.E. Rabie, H.H. Negmi, A.M. Moustafa, H. Al Oufi [email protected] Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, KSA Background: Epidural analgesia has been established as the gold standard for labour analgesia. However, clinical contraindications and personnel or institutional limitations preclude some parturients from receiving an epidural. Remifentanil has been suggested as an ideal opioid for patient controlled analgesia (PCA) in labour. In our study we compared the use of PCA remifentanil to epidural analgesia in labour as regard pain relief, safety of the mother and the fetus, side effects, and overall parturient’s satisfaction. Methods: After ethical committee approval and informed written consent 30 healthy pregnant women ASA I or II, with no obstetric complications or contraindication to remifentanil or epidural analgesia were included in the study randomly allocated into one of two equal groups, in (Group EP) epidural infusion of bupivacain 1% plus 2ug/ml of fentanyl was given and in (Group R) the women received PCA remifentanil with a bolus of 0.4 ug kg-1 over 20 seconds and a lockout period of 1 min as an analgesia for labour. Results: There was significant decrease in (VAS) of pain in both groups with significantly more decrease in (Group EP). There was no significant difference between both groups as regard arterial blood pressure, heart rate, oxygen saturation, nausea, and overall patient’s satisfaction. Sedation scores were significantly higher in (Group R), there were no serious bradycardia, hypotension, or desaturation, and all the parturients were easily arousable. There were no fetal heart rate changes that required interference. The median 1 & 5 minutes Apgar scores were 9 in both groups, and the mean umbilical cord gases, & lactate levels were within normal limits with no difference between both groups. Conclusion: Our study demonstrated that epidural infusion gives better analgesia for labour than PCA remifentanil and That PCA remifentanil is a good, safe, and well tolerated alternative method of analgesia for labour.
159. To preload or coload? uscom evaluation of the timing of colloid expansion on preventing spinal hypotension at cesarean delivery W.H.L. Teoh, A.T.H. Sia, M.H. Loh [email protected] Dept of Women’s Anesthesia, KK Women’s & Children’s Hospital, Singapore Background & Aim: Common strategies to offset the hypotension associated with spinal anesthesia are lateral uterine displacement, intravenous fluid loading, and vasopressor therapy. Recent literature indicates fluid preloading is ineffective due to rapid redistribution. A “coload” may be better, maximizing intravascular volume expansion during vasodilatation from the sympathetic blockade; with colloids more effective than crystalloids. We aimed to evaluate the effects of a 15ml/kg (Hesteril 6%) colloid preload versus coload, on the prevention of spinal anesthesia- induced hypotension. We also assessed maternal cardiac output non-invasively with the Ultrasonic Cardiac Output Monitor (USCOM). Methods: We recruited 40 ASA I and II parturients who gave written informed consent. Patients were randomized to Group P (preload of 15 ml/kg Hesteril 6% prior to spinal) or Group C (coload, given when CSF identified). Fluids were administered at the maximal rate using a pressurized giving set and 16G IV. BP, HR, CO, stroke volume (SV) readings were taken at baseline, q1min x10mins, thereafter at 2.5min intervals for another 10mins after induction of spinal anesthesia. 50 mcg Phenylephrine boluses were given to maintain BP 90-100% baseline. Apgar scores and umbilical cord blood gas results were recorded. Results: Baseline demographics were comparable. Grp P received a mean of 1100(200) vs.1085(199) mls colloid in Grp C, infused over 7.8(2.4)min and 9.1(3.3)mins respectively. The CO and SV was significantly different (increased) in the preload group(p⫽0.011) in the 5 mins after the spinal However, there was no significant difference in hypotension, BP (p⫽0.727), pre-delivery phenylephrine use (353(260) Grp P vs 265(266)mcg Grp C, p⫽0.299), or umbilical artery and vein pH, CO2, O2, base excess between groups. Conclusion: A 15ml/kg colloid preload significantly increases maternal cardiac output after spinal anesthesia for cesarean delivery, but is not significantly different from an identical coload in preventing BP changes and hypotension.