Dataset Information

Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide during cesarean section under spinal anesthesia: a randomized controlled trial.

ABSTRACT:

Background

Abrupt bradycardia and hemodynamic instability during spinal anesthesia for cesarean section are not uncommon and are considered as one of the primary causes of intraoperative nausea and vomiting (IONV). We hypothesized that prophylactic use of hyoscine butyl-bromide (HBB) could improve hemodynamics and reduce IONV in parturients undergoing cesarean section.

Methods

A randomized, double-blind placebo-controlled trial was carried out in a tertiary university hospital, patients scheduled for elective cesarean section were equally randomized to receive either IV HBB 20 mg in 1 ml (Hyoscine group) or the same volume of 0.9% saline (Control group), one minute after spinal anesthesia. The primary endpoint was the incidence of intraoperative bradycardia (HR < 50 beats min^-1). Secondary endpoints included changes in mean arterial blood pressure (MAP), the incidence of Intraoperative and Postoperative nausea or vomiting (IONV & PONV), the fetal heart rate and, Apgar score.

Results

Of the 160 subjects randomized, 80 received HBB and 80 received placebo. There was a significant reduction in the incidence of the primary endpoint of intraoperative bradycardia (HR < 50 beats min^-1) in the Hyoscine group (0% vs 10%; OR = 0.05, 95% CI = [0.003, 0.93]; P = 0.004) compared with placebo. MAP showed an insignificant difference between groups over time. HBB significantly decreased incidences of IONV and PONV (p = 0.002 & 0.004) respectively.

Conclusions

In parturients undergoing cesarean section under spinal anesthesia, pretreatment with intravenous HBB was a safe measure for both the mother and the baby to reduce the risk of severe intraoperative bradycardia, but not hypotension. Furthermore, it was associated with less incidence of both IONV and PONV.

Trial registration

https://clinicaltrials.gov/ct2/show/NCT04069078.

SUBMITTER: Abbas MS

PROVIDER: S-EPMC9027476 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide during cesarean section under spinal anesthesia: a randomized controlled trial.

Abbas Mostafa Samy MS Hassan Shimaa Abbas SA Abbas Ahmed Mohamed AM Thabet Amr Mohamed AM Thabet Ahmed Mostafa AM Mahdy Magdy Mohammed MM

BMC anesthesiology 20220421 1

<h4>Background</h4>Abrupt bradycardia and hemodynamic instability during spinal anesthesia for cesarean section are not uncommon and are considered as one of the primary causes of intraoperative nausea and vomiting (IONV). We hypothesized that prophylactic use of hyoscine butyl-bromide (HBB) could improve hemodynamics and reduce IONV in parturients undergoing cesarean section.<h4>Methods</h4>A randomized, double-blind placebo-controlled trial was carried out in a tertiary university hospital, pa ...[more]

PMID: 35448942

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Project description:Background Spinal anesthesia is an anesthesia technique suitable for cesarean section to avoid respiratory complications. However, the management of spinal anesthesia is very important because spinal anesthesia may fail and the patient may be exposed to pain and discomfort. Objective To assess the type, management, and related factors of failure of spinal anesthesia at cesarean section. Methods Multicenter prospective cohort study was conducted at a public hospital in Addis Ababa on 794 mothers who met the criteria for cesarean section under spinal anesthesia. Data collection methods were adopted, including chart reviews and observations of spinal anesthesia procedures. The data collected was entered in Epi info version 7 and analyzed in SPSS version 20. Independent variables with dependent variables were analyzed using logistic regression. A p-value of 0.05 for & it; was considered a statistically significant test cutoff. Result Of 121 failed spinal anesthesia 35 were complete and 86 were partial failed spinal anesthesia from those complete failed spinal anesthesia were managed by repeating spinal and converting to general anesthesia and partial failed spinal anesthesia were managed by the supplementary drug. Experience of the anesthetist <1 (AOR = 4.12, 95% CI, 2.47–6.90), patient position (AOR = 14.43,95%CL, 2.65–78.61), number of attempts>1 (AOR = 9.26, 95% CI, 5.69–15.01), bloody CSF (AOR = 6.37, 95%CI, 2.90–13.96), BMI ≥30kgm2 (AOR = 2.03, 95%CI, 1.12–3.68) and dose of bupivacaine <10 mg (AOR = 2.72, 95% CI, 1.33–5.53) were found to be statistically significant associated with failed spinal anesthesia. Conclusion and recommendation Experience of anesthetists (<1 year), obesity, bupivacaine dose <10 mg, bloody appearance of CSF, number of attempts> 1 were associated factors for failed spinal anesthesia in cesarean section. Our failed spinal management is not the same among hospitals and does not follow recommended failed spinal management. Up-skilling of anesthesia professionals should be considered on identified associated factors of failed spinal anesthesia and management of failed spinal anesthesia should be based on the recommended guidelines. Highlights • Failed spinal anesthesia may lead to maternal discomfort.• In our study failed spinal managements were not along with recommended guidelines.• Experience of the anesthetist, bloody CSF others were associated factors for FSA.

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Dataset Information

Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide during cesarean section under spinal anesthesia: a randomized controlled trial.

Background

Methods

Results

Conclusions

Trial registration

Publications

Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide during cesarean section under spinal anesthesia: a randomized controlled trial.

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