Anyone have any issues with a spinal block that went to high.

[blackduckies]

Fleur, that was pretty much the conversation I had, epi is not preferrable, to a spinal...mine was'nt a bad reaction that some people need to be incubated...and it can be a long lasting effect up to 24 hours (all I could think was oh my Lord just kill me now!!!) (maybe they need to sit through a bit of their own medicine and know what it feels like to be in that situation before they start calling it a minor reaction???) and best of all a spinal won't kill you whereas a general can and is dangerous for the baby. I don't know call me crazy, that was'nt all that helpful???

Heaven, I thought if I go into labour I might have the epi, so there is no possiblity of that happening again I have had local injected in around the wound to get me through, I think this would be preferrable to a high block.

Minny I am sure his intentions are good, and I guess thtas what he would hope to avoid, feeling returnign during surgery or soon after..but..I would rather chance that.

Infinity, this might not be who I get (i hope not anyway) and if I do I don't plan on letting him do it to me, they can look up my records and give me what i had last time, I'II take my chances. After he made me panic I did'nt really hear a lot of what he said but I think there was somethign about a lot of aneasthetist give 9 units but he likes to give more to make sure the block works and gives enough pain relief, if most agree 9 works why not him? I have a pre-op appointment next week so will be discussing this a lot further and won't be signing anything until I'm sure..They should be able to tell me who did it last time and with any luck I might be able to have him again (same hospital) he was also excllent in surgery very reasurring and caring, some just seem to be doing a job.

Thanks Pandora, don't worry about asking her..I have thought a bit about it and just won't be letting him give me more than last time if it comes to it, the block from under my breast to my hips was spot on I was able to feed easily and had sensation and it was nice to move my legs and be able to push up etc. Mybe he is thinking if I can move my legs I might use them??? especially if I'm scared???

i guess i take it a day at a time and hopefully i get the chance to labour and it all falls into place? if not go to my booked CS with lots of requests in place.

[skeetaboat]

Hey BD's, do you want to have a VBAC? Because if you want to have one, you can. It's your birth and it's up to you hun.

If you do go ahead with the cesarean, something to remember is that they can't give you a spinal/epidural without your consent, in which case the only alternative is general anaesthetic (which I wouldn't highly recommend, but it's your birth and your choice). Docs tend to use scare tactics because they prefer to stick with stock standard hospital policy, but choice of anaesthesia is actually up to you. If you want a lower block you can request that. If you start feeling the op they can knock you out a bit with lower doses of drugs that don't require intubation (fentanyl from memory). These can also be given in very low doses to help you relax after the spinal has been given. Again, they will probably be reluctant to do this, but if you want you could ask to have this as an option at your pre-op appt if you're very stressed about a block going too high on the day. Sometiems you have to push for what you want. They will probably tell you that it's dangerous and that's why they don't do it but actually there are a number of studies demonstrating that in low doses this is safe for mother and baby.

Here's a bit of info that might be of use about general versus spinal for C/S. Again, I wouldn't recommend general because it makes you groggy and you have to spend longer in recovery and wait longer for the first BF, but it's your decision to make hun.

Regional versus general anaesthesia for caesarean section

Bosede B Afolabi1, Afolabi FE Lesi2, Nkihu A Merah3

1Department of Obstetrics and Gynaecology, University of Lagos, Lagos, Nigeria. 2Department of Paediatrics and Child Health, College of Medicine of the University of Lagos, Lagos, Nigeria. 3Department of Anaesthesia, University of Lagos, Lagos, Nigeria

Contact address: Bosede B Afolabi, Department of Obstetrics and Gynaecology, University of Lagos, College of Medicine, PMB 12003, Idi-Araba, Lagos, Nigeria. bosedeafolabi2003@yahoo.com.

Editorial group: Cochrane Pregnancy and Childbirth Group.
Publication status and date: Edited (no change to conclusions), published in Issue 1, 2010.
Review content assessed as up-to-date: 14 August 2006.

Citation: Afolabi BB, Lesi AFE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004350. DOI: 10.1002/14651858.CD004350.pub2.

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Abstract


Background
Regional and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious.


Objectives
To compare the effects of regional anaesthesia (RA) with those of GA on the outcomes of CS.


Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to December 2005), and EMBASE (1980 to December 2005).

We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 1 October 2009 and added the results to the awaiting classification section.


Selection criteria
Randomised and quasi-randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication.


Data collection and analysis
Two authors independently assessed trials for inclusion, data extraction and trial quality.


Main results
Sixteen studies (1586 women) were included in this review.

Women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit (weighted mean difference (WMD) 1.70, 95% confidence interval (CI) 0.47 to 2.93, one trial, 231 women) and (WMD 3.10, 95% CI 1.73 to 4.47, one trial, 209 women). Compared to GA, women having either an epidural anaesthesia or spinal had a lower estimated maternal blood loss (WMD -126.98 millilitres, 95% CI -225.06 to -28.90, two trials, 256 women) and (WMD -84.79 millilitres, 95% CI -126.96 to -42.63, two trials, 279 women). More women preferred to have GA for subsequent procedures when compared with epidural (odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, one trial, 223 women) or spinal (OR 0.44, 95% CI 0.24 to 0.81, 221 women). The incidence of nausea was also less for this group of women compared with epidural (OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women) or spinal (OR 23.22, 95% CI 8.69 to 62.03, 209 women).

No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at one and five minutes and need for neonatal resuscitation with oxygen.


Authors' conclusions
There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.

[Note: The nine citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]


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Plain language summary

Regional versus general anaesthesia for caesarean section
Regional compared with general anaesthesia for caesarean section.

Caesarean section is when a baby is born through an incision in the mother's abdomen and uterine wall. This requires effective anaesthesia which can be regional (epidural or spinal) or a general anaesthetic. With regional epidural anaesthesia, the anaesthetic is infused into the space around the mother's spinal column, whilst with regional spinal anaesthesia, the drug is injected as a single dose into the mother's spinal column. With the two types of regional anaesthesia, the mother is awake for the birth but numbed from the waist down. With general anaesthesia, the mother is unconscious for the birth with the anaesthetic affecting her whole body. As well as women having a view as to whether they might wish to be awake or asleep for the caesarean birth, it is important to know the balance of the benefits and adverse effects of these different types of anaesthesia. The review of trials sought to assess these benefits and harms, and identified sixteen randomised controlled trials involving 1586 women. There were some differences which favoured general anaesthesia, for example, less nausea and vomiting. There were also some differences which favoured regional anaesthesia, for example, less blood loss and less shivering. The evidence on the differences in pain was difficult to evaluate. There were not enough participants to assess the very rare outcome of mortality for the mother, which may be an important aspect. None of the trials addressed important outcomes for women like recovery times, effects on breastfeeding, effects on the mother-child relationship and length of time before mother feels well enough to care for her baby. As there is insufficient evidence on benefits and adverse effects, women are most likely to choose anaesthesia for caesarean section, depending on whether they wish to be awake or asleep for the birth.

[blackduckies]

Thanks Skeetboat, I am hopefully going to try for a VBAC I am due 29th March I booked a CS for the 6th April JIC I am not keen to go much further overdue than that and the OB only does CS 1 day a week so his next appointment is 13th April, which is too far over for my liking I have had 1 labour start 20 days overdue she was quite sick, even though she had been monitered and showed lots of movements and another 2 weeks over with a badly calcified palcenta..so I'm not coming this far to take the chance, especially when the odds are pretty high it will end in a repeat CS, this would be
VBA3C attempt.
The info is helpful, sometimes its easy to forgot that they can't do anything without your consent..they seem to put you in a postion that you feel you have to agree or you are'nt supported.

[Miss H]

I had a spinal for DD1 but I can't remember from where I was numb although I didn't have any issues with the block. However, due to knowing what I was going through with the second, I was very anxious and had a TERRIBLE experience with the CS. I had a spinal block which came under my breasts and my legs were out too. But I won't go into the rest of what happended but I do blame it for my PND and PNA. So I will be getting a GA should I be lucky enough to have another bub. All I'm saying is choose what is going to make you feel comfortable as if you don't you might end up having a panic attack on the table which is what happended to me. Good luck and I hope all goes well for you.

[skeetaboat]

Goodluck BDs, I hope you get your VBAC and the spinal doesn't even become an issue, but if not, I hope it all goes well for you and end up with whatever is right for you and carers who respect the horrible experience you had previously. xx

[blackduckies]

I certainly can understand the panic /anxiety surrounding the surgery and ongoing afterwards I have felt the fight or flight response and if I could jump off the table would be outta there.. it is also ongoing while I am in hospital..part of it is missing the kids and DH and the other part is the lack of contol you have over anything you do. a major reason why i want to acheive my VBAC, thanks for your support, its good to know others understand.

[Jennifer13]

The spinal I had for DD, after first attempt I still had feeling down one side (ob checked with instrument, thank goodness), so the anaesthetist re-did it above the next veterbrae. I'm not sure mine even went as high as my breasts, although it absolutely covered the c/s site.

So I don't get why they couldn't give it to you as low as possible and check that feeling is blocked where it needs to be? They can always go higher if they need to. Especially since your records would surely say where the last spinal was placed. The anaesthetist could try a bit lower first. Why on earth would he think he'd need to go higher?? Lower and you might avoid the breathing issues altogether. I'd ask more questions. You don't need to consent to something that is going to cause you problems without being abo****ely sure it's the right thing to do. If you aren't in labour, there's not likely to be any rush to get the spinal done ASAP.

Hopefully this is not even an issue for you and your VBAC is successful!

[skeetaboat]

Well said Jennifer!

I just wanted to add some more on having a CS with a spinal/epidural AND anxiety relief, for the people experiencing anxiety so strong that it's causing panic attacks. It can be a better alternative to having a general, because you can still be awake for your bubs being born without having to face having a panic attack on the table. It's also less risky.

Document title
Nitrous oxide anxiolysis for elective cesarean section
Auteur(s) / Author(s)
VALLEJO Manuel C. (1) ; PHELPS Amy L. (1) ; KAUL Bupesh (1) ; RAMANATHAN Sivam (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Department of Anesthesia, Magee-Womens Hospital, University of Pittsburgh School of Medicine and Dental Medicine, Pittsburgh, PA 15213, ETATS-UNIS

Résumé / Abstract
Study Objective: To determine if inhaled 40% nitrous oxide (N2O) via facemask is an effective anxiolytic in women undergoing elective cesarean section under spinal anesthesia. Study Design: Prospective, randomized, double-blinded study. Setting: Tertiary-care women's hospital. Patients: Sixty American Society of Anesthesiologists physical status 1 and II patients scheduled for elective cesarean section under spinal anesthesia. Interventions: Patients were randomized to 2 groups to receive either 100% O2 via facemask or 40% N2O in O2 via facemask. Measurements: Vital signs (blood pressure, heart rate, and oxygen saturation) and measured variables (visual analog scale [VAS] anxiety, VAS pain, and sedation scores) were obtained at specific periods during the procedure (preoperatively, entering the operating room, spinal injection, skin incision, uterine incision, delivery, and at the conclusion of the surgical procedure). In addition, surgical time and delivery time, mean dose and percentage of patients requiring ephedrine or phenylephrine boluses, the emesis rate, and Apgar scores were measured. Main Results: No differences were noted with respect to maternal mean blood pressure, heart rate, pulse-oximeter oxygen saturation, and sedation or VAS pain scores during the measured periods. No differences were noted in surgical and delivery times, mean dose, or percentage of patients who required ephedrine or phenylephrine to maintain maternal blood pressure, the emesis rate, or 1- and 5-minute Apgar scores. Mean anxiety scores for the N2O group were significantly lower at the time of spinal injection, skin incision, and uterine incision. Multivariate analysis of variance for high-anxiety patients (>50 VAS) revealed significantly lower VAS scores in the N2O group, compared with the O2 group again at spinal injection, skin incision, and uterine incision. Conclusions: Inhaled 40% N2O via facemask provides effective anxiolysis in women undergoing elective cesarean section under spinal anesthesia in patients with high anxiety (≥50 VAS) at the time of soinal iniection. skin incision, and uterine incision.
Revue / Journal Title
Journal of clinical anesthesia ISSN 0952-8180
Source / Source
2005, vol. 17, no7, pp. 543-548 [6 page(s) (article)] (19 ref.)
Langue / Language
Anglais

Editeur / Publisher
Elsevier, New York, NY, ETATS-UNIS (1988) (Revue)

Canadian Journal of Anesthesia Volume 53, Number 1 / January, 2006

NEONATAL EFFECTS OF MATERNAL ANALGESIA AND
SEDATION WITH FENTANYL AND MIDAZOLAM
M. A. Froelich, T. Euliano, D. Caton
University of Florida, Gainesville, FL
Introduction: The study of drugs used during pregnancy is one of
the most neglected areas in the field of clinical pharmacology and
drug research. Analgesia and sedation, routinely used as adjunct
medication for regional anesthesia, is rarely used in the pregnant
patient because of concerns about adverse neonatal effect. We
studied neonatal and maternal effects of intravenous fentanyl and
midazolam prior to spinal anesthesia for elective Cesarean section.
We postulate that an intravenous bolus of midazolam and fentanyl
does not affect neonatal well-being.
Methods: After institutional approval, sixty healthy women
scheduled for elective Cesarean delivery where enrolled from
April 2001 until December 2003. Women were randomly assigned
to either receive a combination of 1 mcg/kg IV fentanyl and 0.02
mg/kg IV midazolam or an equal volume of intravenous (IV)
saline at the time of their skin prep for spinal anesthesia. Both
investigator and patient were blinded to the study drug. Patients
underwent spinal anesthesia with 12 mg hyperbaric bupivacaine,
10 mcg fentanyl and 300 mcg preservative-free bupivacaine. We
collected maternal and umbilical levels of fentanyl and midazolam
and maternal catecholamine levels (epinephrine and
norepinephrine). Fentanyl and midazolam levels were analyzed
using high performance lipid chromatography (HPLC). The
following neonatal data were recorded: Apgar scores, continuous
neonatal pulse oximetry for 3 hours and Scanlon neurobehavioral
scores (NACS). This study had more than 95% power (expected
difference of means and standard deviation: 1 Apgar score unit).
Results: Women in both groups were of similar height, weight and
age. Neonates of women who received fentanyl and midazolam did
not show different Apgar or NACS scores. Umbilical arterial and
venous levels of fentanyl and midazolam were below the limit of
quantification (less than 50 ng/mL) and neonates in either group
did not show significant oxygen desaturations during the first three
hours of life. Mothers in both groups were able to recall their birth.
Conclusion: Maternal analgosedation with fentanyl (1 mcg/kg) and
midazolam (0.02 mg/kg) prior to spinal anesthesia for elective
Cesarean section is without adverse neonatal effects.

[Fleur]

BD, I thought the exact same thing, if it's them lying on the table feeling like that, it might not be so minor!

I would be talking to them again, or maybe someone else, especially given what you have said

I think there was somethign about a lot of aneasthetist give 9 units but he likes to give more to make sure the block works and gives enough pain relief, if most agree 9 works why not him?

- that is interesting & if it was me I would be wanting to hear more about this.

Good luck hun I hope it all goes teh way you want & your anaesthesia isn't even an issue, I will be looking forward to your BA in any case

[blackduckies]

Thanks so much girls, sometimes it is hard to think clearly when there is so much emotion involved (which with me there clearly is) all I can see is this EDD coming up and going by and the CS booked date is staring me in the face, there is part of me that wants to do a runner, and another part that says if I get there lets just get it done and meet this baby.
I think I am a bit scared that she will have something wrong, we already know she has a non functioning kidney and there has been talk of a syndrome??( most likely not, becasue she only has one problem but still can't be ruled out until after the birth)...I don't think I realized how much it played on my mind until now!!!!

[Mildez]

Hope it all goes very smoothly.
I have only seen one block too high and it was a woman who was birthing vaginally and had an epidural. It went up to the lungs and we had to call the anethetist whom had to stay for the duration of the block with the resus trolley ready to go. She had alot of respiratory depression but wasn't intubated. It took hours for the block to wear off where the risk was gone for a respiratory arrest.
I have not seen a problem with a spinal in theatre only the one woman. When it happens (only seen it once in 6years) its pretty scary.