Muhammad Azam, Naila Asad, Tanvir Akhtar Butt.
Combined spinal epidural anesthesia with volume extension technique: Comparison of 3 different doses of Intrathecal Hyperbaric Bupivicaine on Hemodynamics in elective cesarean section.
Pak J Med Health Sci Jan ;12(3):942-5.

Aim: To compare three low doses of intrathecal hyperbaric bupivacain on maternal haemodynamic variables in CSEA with volume extension technique. Study Design: Randomized Controlled Trial. Place and Duration of Study: Department of Anesthesia at Gynaecology and Obstetrics operation Theater Lady Aitchison Hospital Lahore affiliated with King Edward University Lahore from June 2015 to Feb 2016. Methodology: 145 parturiant undergoing elective cesarean section divided into three groups using hyperbaric bupivacain 4.5mg (group A) , 5.5 mg (group B) , 6mg (Group C) intrathecally followed by EVE 10ml normal saline. Hemodynamic variables like systolic / diastolic, mean blood pressure and heart rate were studied in individual group and compare to each other group. Results : The mean age of cases in group-A was 26.69 +/- 4.19 years, in group-B was 28.49 +/- 4.37 years and mean age in group-C was 27.33 +/- 4.12 years. The mean age in all groups was statistically same. In our study incidence of maternal hemodynamic instability using CSEA – EVE in group A (4.5mg) was significantly lower than group B (5.5) & C(6mg) at different time intervals 3,6,9,12, 15 min. At 3 minute hypotension was seen in 24.4% patients in group A as compared to group B and C (p =0.04). Conclusion : CSEA – EVE technique with low dose intrathecal hyperbaric bupivacaine (4.5mg) for cesarean section is more beneficial in maintaining maternal hemodynamic stability in (ASA I-II patients) than spinal and epidural anesthesia alone.

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