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Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
By contrast, medication injected into the intrathecal space has a quick onset of 2–5 minutes. Block height is determined primarily by the baricity (density relative to cerebrospinal fluid [CSF]) of the drug and, to some extent, the total volume of the drug.
Spine
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Drug factorsBaricity: is one of the main determinants. Administration of hyperbaric local anaesthetic to patients in the lateral decubitus position will result in a preferential anaesthetic effect on the dependent side, with hyperbaric solutions ‘sinking’ and hypobaric solutions ‘floating’. Hyperbaric solutions also produce a more reliable block with a more predictable maximal block height than isobaric solutions. It is also assumed that isobaric solutions give a prolonged sacral sensory and motor block.Dose: most studies show that it is the dose rather than the volume of local anaesthetic injected into the subarachnoid space that determines block spread.Temperature: increased temperature of the drug decreases its density rendering it more hypobaric.
High Spinal Block
Published in Kate McCombe, Lara Wijayasiri, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 2, 2017
Kate McCombe, Lara Wijayasiri, Paul Hatton, David Bogod
Local anaesthetic: dosage, volume and baricityPatient positionPatient characteristics, e.g. height, intra-abdominal pressureInjection technique, e.g. speed of injection, barbotage (i.e. repeated injection and aspiration of the fluid)
Special maternal care bundle to attenuate post-spinal hypotension in cesarean section: A randomized controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2023
Abdelrhman Alshawadfy, Shaimaa A. Dahshan, Ahmed A. Ellilly, Ahmed M. Elewa
Hypotension following spinal block in pregnant women may be attributable to a reduction in the systemic vascular resistance because of arterial vasodilation secondary to a minor degree of venodilation [33]. Thoracolumbar sympathetic fiber is blocked by spinal block, which causes a significant vasodilatation [34]. Vasodilation lowers venous return and lowers arterial blood pressure, both of which worsen hypotension. An old theory suggested that the solution that was previously injected at ambient temperature may become warmed as it travels through the needle. Variations in the rate of injection may alter the baricity and, consequently, the spread of the local anesthetic solution, since temperature affects the baricity of the solution [35].
Magnesium Sulfate Mediates Morphine Administration Reduction in Varicocelectomy Surgery
Published in Journal of Investigative Surgery, 2018
Sedigheh Nadri, Hormoz Mahmoudvand, Mahmoud Reza Moradkhani
In a research conducted by Ozalevli et al. [20], Mg group was found to delayed response for sensory and motor block, observing an identical delay in onset of spinal anesthesia when adding intrathecal Mg to fentanyl and isobaric bupivacaine. They proposed that the difference in pH and baricity of the solution having Mg add to the delayed onset. Arcioni et al., [21], observed that there was a prolonged duration of motor and sensory block likewise the period taken for postoperative analgesia, but less than the MgD group.