The Prophylactic Administration of Intravenous Paracetamol for Control of Shivering During and After Cesarean Section Under Spinal Anesthesia

Background: Shivering refers to a series of repetitive involuntary movements of the skeletal muscles commonly occurring during spinal anesthesia. Regional anesthesia (both spinal and Epidural) reduces vasoconstriction and shivering threshold to 6 degrees Celsius above the surface of the block. The aim of this study was to determine the effect of prophylactic administration of intravenous paracetamol in controlling shivering during and after cesarean section under spinal anesthesia. Methods: In a double-blind randomized clinical trial in the Department of Anesthesiology of Tabriz on patients undergoing cesarean section with spinal anesthesia, the effect of prophylactic administration of paracetamol IV in controlling shivering during and after cesarean section under spinal anesthesia was evaluated. Results: The mean gestational age of patients was 37.94±1.07 weeks in paracetamol group and 37.58±2.07 weeks in the control group (p=0.278). The mean shivering scores of patients in paracetamol group were 0.72±0.80 in the operating room and 1.32±1.05 in recovery room (P<0.001). The mean shivering scores of patients in control group were 1.16±1.07 in the operating room and 2.28±1.45 in recovery room (P<0.001). The mean increase of shivering score in patients was 0.60±0.98 in paracetamol group and 1.12±1.46 in the control group. The mean increase of shivering score in patients in paracetamol group was significantly less than the control group (p=0.041). Conclusion: In the present study, the prophylactic use of intravenous acetaminophen reduced the rate of increase of shivering in patients after spinal anesthesia. Postoperative complications in patients in paracetamol group was less than the control group, however, this difference was not statistically significant.

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The Preventive Effects of two Different Doses of Dexmedetomidine on Shivering in Cesarean Section under Spinal Anesthesia

10.53350/pjmhs211572352 ◽

2021 ◽

Vol 15 (7) ◽

pp. 2352-2357

Author(s):

Behzad Nazemroaya ◽

Samira Heydari

Keyword(s):

Side Effects ◽

Cesarean Section ◽

Pregnant Women ◽

Spinal Anesthesia ◽

Normal Saline ◽

Target Population ◽

Control Group ◽

Medical Sciences ◽

Double Blind ◽

Different Doses

Introduction: One of the side effects caused by spinal anesthesia is seizures of impaired body temperature regulation, which in addition to causing concern for the mother, can lead to problems such as cardiovascular and respiratory disorders. This has led to the choice of the appropriate drug to reduce shivering, with the least neonatal and maternal side effects in cesarean section. The main purpose of this study was to compare the prophylactic effect of intravenous dexmedetomidine at two different doses for cesarean section induced shivering under spinal anesthesia. Methods: This article is a double blind randomized clinical trial study performed in Isfahan University of Medical Sciences (Alzahra and Shahid Beheshti). The target population of the study was pregnant women with indication of cesarean section. In this study 60 pregnant women were divided into three groups. In the first group patients were injected with 2.5 mg / kg dexmedetomidine, in the second group patients with 5 mg / kg dexmedetomidine and in the third group with similar volume, normal saline was injected and the shivering intensity in patients with the use of Grassi and Mahajan criteria was evaluated. Finally, the collected data were analyzed using SPSS software and Kruskal-Wallis One-Way ANOVA tests. Results: According to the statistical analysis of the data, after cesarean section with spinal anesthesia, shivering intensity in the 5mg / kg dexmedetomidine group was lower than in the 2.5mg group and less than the control group. Normal saline was given as prophylaxis. Conclusion: Intravenous dexmedetomidine, especially at a dose of 5 μg / kg, has a significant effect on reducing postoperative shivering by cesarean section with spinal anesthesia. Keywords: Dexmedetomidine, Shivering, Cesarean section, Spinal anesthesia

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A Clinical Trial on the Effects of Different Regimens of Phenylephrine on Maternal Hemodynamic After Spinal Anesthesia for Cesarean Section

Anesthesiology and Pain Medicine ◽

10.5812/aapm.58048 ◽

2020 ◽

Vol 10 (4) ◽

Author(s):

Mahshid Nikooseresht ◽

Mohammad Ali Seifrabiei ◽

Pouran Hajian ◽

Shadab Khamooshi

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Saline Control ◽

Control Group ◽

Significant Difference ◽

The Mean ◽

Phenylephrine Infusion

Background: Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. Objectives: The present study aims to investigate the effects of different regimens of phenylephrine on blood pressure of candidates for the cesarean section. Methods: In this double-blind, randomized clinical trial, a total of 120 candidates of elective cesarean delivery under spinal anesthesia was randomly categorized into three groups. Groups 1, 2, and 3 received bolus and prophylactic saline (control group), prophylactic bolus phenylephrine (100 µg), and prophylactic phenylephrine infusion (50 µg/min), respectively. The incidence of hypotension, maternal hemodynamics, hypertension, rescue phenylephrine dose, nausea, and vomit were compared between the groups. Results: In all the three groups, the incidence of nausea and vomit, bradycardia, hypertension, and neonatal Apgar score were not statistically different (P > 0.05). However, the adjuvant phenylephrine dose requirement was remarkably different. Moreover, the mean systolic blood pressure differed significantly in the second and 7th minutes after the spinal block (P < 0.05). 35% in the first group, 15% in the second group, and 2.5% in the third group had hypotension (P = 0.001). Apart from the first measurement after spinal anesthesia, the mean heart rate showed no significant difference between the groups. Conclusions: The use of prophylactic phenylephrine infusion is recommended to control the optimal blood pressure in parturients undergoing cesarean section after spinal anesthesia.

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Comparison of the Prophylactic Effect of Propofol, Dexamethasone and Ondansetron on Post-Operative Nausea and Vomiting in Elective Cesarean Section Under Spinal Anesthesia

ACTA MEDICA IRANICA ◽

10.18502/acta.v59i12.8059 ◽

2021 ◽

Author(s):

Ebrahim Hassani ◽

Nazli Karami ◽

Asma Hassani ◽

Leila Hassani ◽

Veghar Ashraf

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Control Group ◽

Double Blind ◽

Short Period ◽

Post Operative Nausea ◽

Group D

Nausea, and vomiting are common complications in women undergoing cesarean section with spinal anesthesia. This study aimed to compare the propofol, dexamethasone, and ondansetron effects on nausea and vomiting. In this double-blind, randomized clinical trial study, 120 women aged 15 to 35 years candidates for cesarean section under spinal anesthesia were enrolled. Patients were randomly divided into four groups (three-drug groups and control group). Patients received 0.05 mg/kg ondansetron (group O), 0.1 mg/kg dexamethasone (group D), 0.2 mg/kg propofol (group P) and normal saline in controls (group C). Nausea and vomiting in recovery and 6 hours after surgery compared between groups. In recovery and 6 hours after surgery, both nausea and vomiting were the highest in group C while they were lowest in group O. the frequency of nausea was 11(36.7%) in both recovery and 6 hours after surgery, and the frequency of vomiting was 12(40%) and 10(33.3%) in the recovery and 6 hours after surgery respectively. Among three drug groups, nausea and vomiting were higher in group D in both the recovery room and 6 hours after surgery. The frequency of vomiting was 10 (33.3%) and 5 (16.7%) in recovery and 6 hours after surgery in group D, respectively. These differences were statistically significant between the four groups (P<0.05). The preventive effect of dexamethasone is not very useful in both periods. Therefore, it can be recommended that in the short period after surgery, propofol has a beneficial effect in preventing postoperative nausea and vomiting.

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Investigation of the Effect of Operating Room Environment and Cesarean Section Orientation on Physiological Parameters (BP, heart rate, respiration) in Mothers of Candidate for Cesarean Section in Shiraz, a Clinical Trial Study

Current Women s Health Reviews ◽

10.2174/1573404817666210405145748 ◽

2021 ◽

Vol 17 ◽

Author(s):

Jamshid Eslami ◽

Neda Hatami ◽

Aazadeh Amiri ◽

Marzieh Akbarzadeh

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Heart Rate ◽

Cesarean Section ◽

Pregnant Women ◽

Operating Room ◽

Intervention Group ◽

Physiological Parameters ◽

Control Group ◽

The Mean

Background: : Changes in physiological parameters in pregnant women are important factors in mothers who are candidates for cesarean section. Objective:: The aim of present study was to investigate the effect of operating room and cesarean section orientation on the physiological parameters (BP, heart rate, respiration) of pregnant women undergoing cesarean section. Materials and Methods:: This clinical trial study was performed on 80 pregnant women referring to cesarean section in hospitals affiliated to Shiraz University of Medical Sciences in 2019. The samples were randomly divided into two control (n = 40) and intervention groups (n = 40). The intervention group participated in 4 sessions of training classes. The control group used routine hospital trainings. The parameters were measured before and after the intervention in two groups. Data were analyzed using SPSS software (version 21), independent t-test and analysis of covariance. Results: The mean of post-training blood pressure in the intervention group 82.78(7.86) and in the control group 84.08 (7.44) was not statistically significant (p < .487). After intervention, the mean of heart rate in the intervention group 82.15 (8.10) and in the control group 83.43 (8.54) was statistically significant (p <0.0001). After intervention, the mean of respiratory rate in the intervention group was 94.28 (0.96) and in the control group was 75.96 (1.08) (P <0.0001). Conclusions: Although the patient's operating room and cesarean section orientation did not affect mothers' mean blood pressure; it reduced the mean of their heart rate and respiratory rate. It is important for medical staff to play an important role in identifying important strategies in managing the anxiety of pregnant women in order to improve their physiological indicators.

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Effect of Maternal Pethidine on Breast Feeding Behavior of Infants in Cesarean Section by Spinal Anesthesia: A Randomized Controlled Trial

Archives of Iranian Medicine ◽

10.34172/aim.2021.84 ◽

2021 ◽

Vol 24 (8) ◽

pp. 591-598

Author(s):

Majid Dejbakht ◽

Zohreh Montaseri ◽

Jalal Saem ◽

Mehrdad Rezaei ◽

Marzieh Akbarzadeh

Keyword(s):

Cesarean Section ◽

Feeding Behavior ◽

Spinal Anesthesia ◽

Breast Feeding ◽

Controlled Trial ◽

Rapid Assessment ◽

Test Group ◽

Control Group ◽

Double Blind ◽

Significant Difference

Background: Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of infants born via cesarean section with spinal anesthesia. Methods: In this randomized double-blind clinical trial, we evaluated 116 infants born via cesarean section in Gerash Amiralmomenin hospital (Southern Iran) in 2017. The subjects were selected through purposive sampling and randomly by permuted block randomization and assigned to intervention and control groups. The test group received 100 mg of pethidine as intravenous infusion and the control group received only routine cares. Infants’ breast feeding behavior in both groups was recorded within 48 hours of hospitalization, using the standard tool for rapid assessment of infant feeding behavior, which consists of 4 main components of breastfeeding, including readiness to feed, rooting, latching, and sucking with a score range of 0 to 3 for each component evaluated at 1, 6, 12, 24, 36, and 48 hours postnatally. Data were analyzed using independent t tests and chi-square test. Results: The highest score of breast-feeding behavior pertained to sucking reflexes in the control group and the lowest score to breast feeding readiness in the pethidine group. Readiness for feeding in the control group (2.09±0.53) was significantly higher than the pethidine group (1.81±0.61) (95% CI: 0.0552, 0.5092 and P=0.015). Sucking reflex (95% CI: -0.1461, 0.2208 and P=0.687), latching (95% CI: -0.3012, 0.0345 and P=0.118) and rooting reflexes (95% CI: -0.1685, 0.2342 and P=0.747) were almost equal in the control group (2.54±0.49, 2.52±0.38, 2.5±0.48, respectively) and pethidine groups (2.51±0.43, 2.65±0.45, 2.46±0.53, respectively). The total score of feeding behavior in the control group (9.66±1.04) was higher than that of the pethidine group (9.44 ±.69) (95% CI: -0.2032, 0.6412 and P=0.306). There was no significant difference between the infants’ feeding frequency (95% CI: -0.269, 1.930 and P=0.137) and duration of feeding (95% CI: -3.2067, 0.4597 and P=0.14). Conclusion: Evaluation of infants in the first 48 hours after birth showed that those babies whose mothers received pethidine were less willing to start breast-feeding. However, other components of breast-feeding behaviors were similar.

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The effect of positive end-expiratory pressure during anesthesia on arterial oxygen saturation after surgery in patient undergoing cesarean section

European Journal of Translational Myology ◽

10.4081/ejtm.2018.7191 ◽

2018 ◽

Vol 28 (1) ◽

Author(s):

Mahmood Ganjifard ◽

Masoumeh Samii ◽

Samaneh Kouzegaran ◽

Amir Sabertanha

Keyword(s):

Heart Rate ◽

Cesarean Section ◽

Oxygen Saturation ◽

Recovery Room ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Control Group ◽

Positive End Expiratory Pressure ◽

Double Blind ◽

Arterial Blood

One of the major complications of general anesthesia in the recovery room is arterial oxygen desaturation and hypoxemia. Positive end-expiratory pressure (PEEP) can improve arterial oxygen saturation by increasing FRC. This study aims to evaluate the effects of applying PEEP on arterial oxygen saturation and hemodynamic parameters in the patient undergoing cesarean section in VALIASR hospital. In this double blind clinical trial we randomly allocated 120 patients of class1 and 2 ASA scheduled to undergoing cesarean section into 3 group (in 40).Different levels of PEEP (0, 5 and 10 CmH2o) were applied to each group while zero PEEP was established as control. All other variables (anesthesia and surgery techniques) were the same for all patients SPO2, noninvasive mean arterial pressure and heart rate were measured before, during and after surgery (Recovery room). The comparison of noninvasive arterial blood pressure and heart rate during and after surgery did not show significant differences but mean o2 saturation in group B (5 cmH2o PEEP) and C (10 cm H2o PEEP) in PACU was higher than control group (98.30±0.93 and 98.50±0.90 as opposed to97.12±1.15 respectively) P0<001. In light of results applying PEEP is effective in preventing desaturation after surgery and improving respiratory indexes without the significant hemodynamic changes, the result of using five cmH2o PEEP is more efficient and satisfying.

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Comparison of the effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia

Current Clinical Pharmacology ◽

10.2174/1574884715666200302122800 ◽

2020 ◽

Vol 15 ◽

Author(s):

Arash karimi ◽

Jahanbakhsh Nejadi ◽

Mahnaz Shamseh ◽

Nooshin Ronasi ◽

Mehdi Birjandi

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Postoperative Nausea ◽

Demographic Data ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Double Blind ◽

Group A ◽

Group B

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.

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Effect of the Modified Surgeon Assisted Bilateral Transversus Abdominis Plane Block on Time Required for First Analgesic Dose after Cesarean Section under Spinal Anesthesia: Randomized placebo-control

Women Health Care and Issues ◽

10.31579/2642-9756/055 ◽

2021 ◽

Vol 4 (3) ◽

pp. 01-05

Author(s):

Ahmed Mamdouh

Keyword(s):

Placebo Group ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Interquartile Range ◽

Transversus Abdominis ◽

Secondary Outcome ◽

Control Group ◽

Placebo Control ◽

Study Group ◽

Tap Block

Background: The transverses abdominis plane block (TAP block) is one of the widely used regional analgesic techniques in cesarean section. There are different variations of the procedure. The aim of the present study was to evaluate the analgesic effect of the modified surgeon assisted bilateral TAP block in patients undergoing cesarean section Patients&Methods: Sixty patients undergoing cesarean section under spinal anesthesia were randomized into two groups to receive either TAP block with 40 ml of bupivacaine 0.25%(study group) or 40 ml normal saline as placebo after obtaining informed consent. All patients will receive intravenous diclofencac75mg every 12 hrs postoperatively. Postoperatively, there was an assessment every 2hrs during the first 24hrs by the visual analogue pain scale (VAPS). Time to the first analgesic request will be measured as primary outcome and all patients will receive opioid on demand or VAPS > 4 with 25mg pethidine intramuscularly. Moreover, total opioid requirement in 24hrs will be measured as secondary outcome along with postoperative complications as nausea, vomiting and abdominal distention. Complications related to the TAP procedure will be also assessed. Results: The median (interquartile range) time to the first analgesic request in the first 24hrs postoperatively was significantly shorter in the placebo group compared to the study group; 4h (4, 6) and 24h (10, 24) with p value < 0.001. Postoperative opioid requirement was significantly higher in the control group (30/30{100%}) than the study group (13/30{43.3%}). The median (interquartile range) number of opioid doses was significantly higher in the placebo group compared with the study group; 2(2, 2) and 0(0, 1) respectively. At all points in the study, pain scores both were lower in the study group (p < 0.0001). Conclusion: The modified surgeon assisted bilateral TAP block is relatively new, safe and cost effective technique which provides adequate postoperative analgesia allowing for better maternal ambulation and better postoperative recovery. Trial registration: Clinicaltrial.gov registration number: NCT04623632

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The Effectiveness of Group Acceptance and Commitment Therapy and Cognitive Therapy on Alexithymia and Marital Boredom, Case study: Women Affected by Marital Infidelity in Mashhad, Iran

Journal of Community Health Research ◽

10.18502/jchr.v10i4.8337 ◽

2022 ◽

Author(s):

Maryam Sadeghi ◽

Naeimeh Moheb ◽

Marziyeh Alivandi Vafa

Keyword(s):

Cognitive Therapy ◽

Analysis Of Covariance ◽

Control Group ◽

Double Blind Study ◽

University Counseling Center ◽

Double Blind ◽

University Counseling ◽

Acceptance And Commitment ◽

Marital Infidelity ◽

The Mean

Introduction: The aim of current paper was to compare the effectiveness of acceptance and commitment group therapy (ACT) and group cognitive therapy (GCT) on Alexithymia and marital boredom (MB) among women affected by marital infidelity in Mashhad. Method: This clinical trial was a double- blind study with a pretest-posttest design in which two intervention groups and one control group were investigated. The study performed on women who realized their spouse infidelity and referred to Azad University Counseling Center in Mashhad in 2018. The sample consisted of 30 women who were selected by purposive sampling and were randomly assigned to two intervention groups and a control group (n=10 per group). The intervention groups were put under ACT training (twelve 90-minute sessions) and GCT training (twelve 90-minute sessions), but the control group did not receive any intervention. Data was obtained by the Toronto Alexithymia Scale-20 and Pines Marital Boredom Scale and was analyzed by multivariate analysis of covariance with SPSS (version 22) software. Results: The results showed a significant reduction in the mean score of MB in the ACT group, also there was a significant reduction in the mean score of Alexithymia in the GCT group (P <0.05). So comparing both therapies, ACT was more influential on reducing marital boredom whereas GCT was more effective on reducing alexithymia. Conclusion: Although both intervention methods were effective on Alexithymia and Marital Boredom in women affected by marital infidelity, it was demonstrated that ACT and GCT have more effect on Marital Boredom and Alexithymia, respectively.

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Effects of imidacloprid and thiamethoxam on the development and reproduction of the soybean aphid Aphis glycines

PLoS ONE ◽

10.1371/journal.pone.0250311 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0250311

Author(s):

Aonan Zhang ◽

Lin Zhu ◽

Zhenghao Shi ◽

Tianying Liu ◽

Lanlan Han ◽

...

Keyword(s):

Treatment Group ◽

Reproductive Rate ◽

Soybean Aphid ◽

Aphis Glycines ◽

Intrinsic Rate Of Increase ◽

Control Group ◽

Net Reproductive Rate ◽

Treatment Groups ◽

Rate Of Increase ◽

The Mean

The soybean aphid Aphis glycines Matsumura (Hemiptera: Aphididae) is a primary pest of soybeans and poses a serious threat to soybean production. Our studies were conducted to understand the effects of different concentrations of insecticides (imidacloprid and thiamethoxam) on A. glycines and provided critical information for its effective management. Here, we found that the mean generation time and adult and total pre-nymphiposition periods of the LC50 imidacloprid- and thiamethoxam-treatment groups were significantly longer than those of the control group, although the adult pre-nymphiposition period in LC30 imidacloprid and thiamethoxam treatment groups was significantly shorter than that of the control group. Additionally, the mean fecundity per female adult, net reproductive rate, intrinsic rate of increase, and finite rate of increase of the LC30 imidacloprid-treatment group were significantly lower than those of the control group and higher than those of the LC50 imidacloprid-treatment group (P < 0.05). Moreover, both insecticides exerted stress effects on A. glycines, and specimens treated with the two insecticides at the LC50 showed a significant decrease in their growth rates relative to those treated with the insecticides at LC30. These results provide a reference for exploring the effects of imidacloprid and thiamethoxam on A. glycines population dynamics in the field and offer insight to agricultural producers on the potential of low-lethal concentrations of insecticides to stimulate insect reproduction during insecticide application.

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