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.
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