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

[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.

[blackduckies]

Wow the way the guy explained it to me was that you would'nt have that risk with an epi??? It only happened with a spinal... good to know you have only seen it once in 6 years though, I did wonder how common it might be, just the fact it has happened to me before worries me but in theroy it should'nt happen to me again (as she pats her back and reassures herself, not helping though!!!)