Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study.

BACKGROUND: Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. METHODS: This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. RESULTS: Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5-2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. CONCLUSIONS: This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.

The effect of various pressure of pneumatic uterine bracket by using saccule sterine external stent on incidence of supine hypotensive syndrome.

OBJECTIVES: The saccule uterine external stent with a pneumatic uterine bracket reportedly prevents the incidence of supine hypotension syndrome (SHS) during cesarean section under combined spinal - epidural anesthesia (CSEA). However, the preventive effect is affected by the pressure within pneumatic uterine bracket. This study aims to explore the optimal pressure. MATERIAL AND METHODS: One hundred forty-eight pregnant women were selected and randomly divided into three groups: Group A (the control group, n = 49), Group B (n = 49), and Group C (n = 50). The pressure within pneumatic uterine bracket was set at 240 mmHg, 260mmHg, and 280mmHg, respectively, during cesarean section under CSEA for participants in groups A, B and C. The intraoperative comfort rate and incidence of SHS were recorded. RESULTS: No significant difference in the anesthetic efficacy was observed among the three groups (p > 0.05). However, there was a significant difference in the occurrence of SHS, with a reduction of 30 mmHg in blood pressure. The incidence of SHS belong the three groups showed significant differences (36.73% in Group A, 18.37% in Group B and 18.00% in Group C, p < 0.05). In addition, significant differences (p < 0.05) in the intraoperative comfort rate were also found among the three groups, with the comfort rate of 69.39% in group A, 91.84% in group B and 90.00% in Group C. CONCLUSIONS: The optimal pressure within pneumatic uterine bracket for preventing SHS hypotension is about 260 mmHg. These findings might contribute to the prevention of SHS.

The effect of maternal position on venous return for pregnant women during MRI.

Magnetic resonance imaging (MRI) in pregnancy is commonly undertaken in the left lateral tilt (LLT) position to prevent inferior vena cava (IVC) compression and supine hypotensive events, although this may be suboptimal for image quality. The supine position may also have an adverse effect on fetal well-being. The spinal venous plexus may provide an alternative pathway for venous return in the presence of IVC compression. This study assesses morphology and blood flow of the IVC and spinal venous plexus for pregnant women in LLT and supine positions to ascertain the effect of maternal position on venous return during MRI. Eighty-two pregnant women underwent phase contrast MRI (PC-MRI) of the IVC and spinal venous plexus in the supine position; 25 were also imaged in the LLT position. Differences in life monitoring, IVC, spinal venous plexus and total venous return between the two positions were assessed. A linear regression assessed the relationship between flow in the IVC and the spinal venous plexus in the supine position. Increasing gestational age and the right-sided position of the uterus on IVC and spinal venous plexus venous return were also evaluated. Hypotension symptoms were similar in supine (10%) and LLT (8%) positioning. Supine positioning decreased IVC height (p < 0.004) and flow (p = 0.045) but flow in the spinal venous plexus increased (p < 0.001) compared with the LLT position. Total venous return showed no difference (p = 0.989) between the two positions. Additional measurements of flow in the aorta also showed no significant difference between the two groups (p = 0.866). Reduced IVC flow in the supine position was associated with increasing gestational age (p = 0.004) and degree of right-sided uterine position (p = 0.004). Women in the left lateral decubitus position who then rotated supine had greater flow in the IVC (p = 0.008) and spinal venous plexus (p = 0.029) than those who started supine. For the majority of women, the spinal venous plexus acts as a complementary venous return system for pregnant women in the supine position, maintaining vascular homeostasis. Further study is needed to assess the effects on the health of the fetus.

Value of ultrasonic inferior vena cava parameters in predicting cesarean section subarachnoid obstruction and supine hypotension syndrome / 中国医师杂志

Objective:To explore the clinical value of ultrasonic inferior vena cava parameters in predicting supine hypotension syndrome after subarachnoid block.Methods:80 cases of cesarean section under subarachnoid block in singleton pregnancy treated in Beijing Maternity Hospital from August 2019 to March 2020 were selected retrospectively. According to the occurrence of supine hypotension syndrome after anesthesia, they were divided into two groups (group A had supine hypotension syndrome and group B did not), with 40 cases in each group. The changes of related parameters of inferior vena cava in supine position and left 30 ° lying position were compared between the two groups. The correlation between the maximum end expiratory diameter (IVCe), the minimum end inspiratory diameter (IVCi) and the collapse index (IVC-CI) of inferior vena cava and the changes of systolic blood pressure in supine hypotension syndrome were analyzed, and the value of IVCe, IVCi and IVC-CI in predicting supine hypotension syndrome were compared.Results:Under the condition of supine position and left 30 ° lying position, the levels of IVCe and IVCi in group A were significantly lower than those in group B ( P<0.05), and the levels of IVC-CI were higher than those in group B ( P<0.05). Spearman analysis showed that the levels of IVCe and IVCi were positively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome ( P<0.05), and the levels of IVC-CI were negatively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome ( P<0.05). IVC-CI had the highest yoden index and the highest sensitivity in predicting the occurrence of supine hypotension syndrome, and IVCe had the highest specificity in predicting the occurrence of supine hypotension syndrome. Conclusions:Cava collapse index has high sensitivity to predict supine hypotension syndrome, while the maximum end-expiratory diameter of inferior vena cava has high specificity to predict supine hypotension syndrome.

Hemodynamic changes in women with symptoms of supine hypotensive syndrome.

INTRODUCTION: Supine positioning during late pregnancy causes the gravid uterus to compress the inferior vena cava, resulting in dramatic hemodynamic changes. The maintenance of placental perfusion requires maternal circulatory and autonomic adaptations. Women with supine hypotensive syndrome (defined as a drop in systolic blood pressure of anything between 15 and 30 mmHg or an increase in heart rate of 20 bpm, with or without symptoms) may have reduced ability to compensate for the effects of supine positioning. MATERIAL AND METHODS: Twelve women with uncomplicated pregnancies and no symptoms of supine hypotension (normal) and 10 women with uncomplicated pregnancies who reported symptoms of supine hypotension between 34 and 38 weeks' gestation underwent magnetic resonance imaging in the supine and left lateral positions. Phase contrast images were evaluated to measure blood flow through the aorta, inferior vena cava, superior vena cava and azygos vein. RESULTS: Women with symptoms of supine hypotension showed significant reductions in azygos venous flow rate compared with the normal group (-0.15 (-0.30 to -0.01) L/min). Those with symptoms showed no statistically significant compensatory changes in heart rate compared with the normal group (heart rate change 4.5 (-3.1 to 12.1) bpm). Hemodynamic changes in response to positioning were similar across both groups including: a reduction in inferior vena cava blood flow, reduction in cardiac output and an increase in azygos blood flow. CONCLUSIONS: Maternal hemodynamic adaptations were found to be consistent across groups irrespective of whether the women had symptoms of supine hypotension. In both groups a reduction in blood flow through the inferior vena cava occurred in the supine position with a subsequent reduction in cardiac output. Both groups showed a compensatory increase in blood flow through the azygos vein in order to partially compensate for this. Taking into account the effect of maternal position, women with symptoms were found to have reduced azygos flow compared with asymptomatic women. There was a significant increase in heart rate when the women were supine than when they were in the left lateral position.

Application of gradient cushion on prevention of supine hypotension syndrome undergoing cesarean section / 中国实用护理杂志

Objective@#To investigate the application of gradient cushion on prevention of supine hypotension syndrome (SHS) undergoing cesarean section.@*Methods@#450 parturients undergoing cesarean section with spinal and epidural anesthesia, aged 20-45 years, ASA Ⅰ, Ⅱor Ⅲ grades, were randomly assigned into three groups: gradient cushion group (group A), sandbag group (group B) and left-leaning-operating table group (group C), 150 cases in each. The posture intervention was alternated after completion of spinal and epidural anesthesia. Recorded the cases of SHS, and collected systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR) and saturation of pulse oximetry (SpO2) before anesthesia, 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus. And assessed the position comfort with surgical posture comfort scale.@*Results@#The incidence of SHS in group A was 8.0%(12/150), in group B was 20.0% (30/150), and in group C was 21.3% (32/150). The rate of SHS was higher in group A than other groups (χ2 value was 8.970, 10.653, all P<0.01). The score with surgical posture comfort scale was (47.03 ± 3.01), (38.13 ± 4.70), (36.10 ± 4.04), which was higher in group A than group B or group C, and the score with surgical posture comfort scale was higher in group B than group C (t value was 27.413, 30.227, 2.542, P<0.01 or 0.05). SBP and DBP were higher in group A and group B than group C at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, and SBP and DBP were higher in group A than group B at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, HR and RR were higher in group A and group B than group C at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, and HR and RR were higher in group A than group B at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus (t value was -15.842-21.117, P<0.05 or 0.01).@*Conclusion@#After spinal and epidural anesthesia, applying the gradient cushion for adjustment of position would be effective to reduce the occurrence of SHS, simple to handle, decreasing to change the position and increasing to comfort after position in cesarean section.

Predictive effect of the difference of brachial artery peak velocity in different positions on Supine hypo-tension syndrome of parturient after spinal anesthesia / 临床麻醉学杂志

Objective To investigate the effectiveness of predicting the incidence of supine hy-potension syndrome (SHS)after spinal anesthesia measured by ultrasonic measurement of the varia-tion of brachial artery peak velocity in different positions of parturient.Methods Parturient scheduled for elective cesarean section,ASA physical status Ⅰ or Ⅱ,were divided into SHS group and no-SHS group (SBP in the upper extremity decreased by > 30 mm Hg or decreased to < 80 mm Hg)after spinal anesthesia.HR,SBP,DBP of supine position and left lateral position before anesthesia were re-corded,and brachial artery peak velocity were measured by Ultrasonic.The differences of the above indexs before and after the transformation position were calculated.The receiver operating characteris-tic curve (ROC)was plotted by indexs of which P values were less than 0.05,to evaluate the predic-tive effect of each index on SHS after spinal anesthesia.Results Among the 196 patients,89 cases (45.4%)developed SHS after spinal anesthesia.SBP,DBP,peak velocity of brachial artery (Vpmin) and brachial artery peak velocity variation (ΔVp)were different before and after the transformation position (P<0.05).The difference in SHS group was significantly higher than no-SHS group.The areas under ROC curve (AUC)of ΔSBP,ΔDBP,ΔVpmin,ΔΔVp were 0.711 (95%CI 0.575-0.846), 0.573 (95%CI 0.419-0.727),0.948 (95% CI 0.895-0.987),0.864 (95% CI 0.770-0.958),and the cut-off values were 17.5 mm Hg,7.6 mm Hg,17.8 cm/s,and 13.1%.Conclusion The differ-ence of brachial artery peak velocity measured by ultrasonic in different positions of parturient can ef-fectively predict the occurrence of SHS,in which ΔVpmin≥ 17.8 cm/s has better predictive effect.

Clinical observation on ropivacaine and bupivacaine for cesarean section in combined spinal -epidural ;anesthesia / 中国基层医药

Objective To compare the anesthetic effect of ropivacaine and bupivacaine in combined spinal-epidural anesthesia(CSEA)for cesarean section,and their influence on the incidence rate of supine hypotension syndrome(SHS).Methods 200 patients with cesarean section surgery in our hospital from February 2016 to July 2016 were randomly divided into observation group and control group,all of cases were given CSEA.100 patients in the observation group(the group L)were given ropivacaine in spinal anesthesia,the other 100 patients in the control group(the group B)were given bupivacane in spinal anesthesia.Recorded the relevant indicators,compared the incidence rate of SHS,the effect of anesthesia and neonatal score.Results The incidence rate of SHS of the group L was lower than the group B(χ2 =9.261,P0.05).Conclusion The application of ropivacaine in CSEA for cesarean section not only has exact anesthesia effect,but also can effectively prevent SHS without any side effects.