A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery: Time for Initiation of Anesthesia
There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinal-epidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initia...
Gespeichert in:
| Veröffentlicht in: | Anesthesia and analgesia 2014-01, Vol.118 (1), p.168-172 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 172 |
|---|---|
| container_issue | 1 |
| container_start_page | 168 |
| container_title | Anesthesia and analgesia |
| container_volume | 118 |
| creator | Ross, Vernon H. Dean, Laura S. Thomas, John A. Harris, Lynne C. Pan, Peter H. |
| description | There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinal-epidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery.
Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time).
Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m for SSS; 49.9 ± 8.6 kg/m for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116-692] seconds and 180 [75-450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was -80 to +180 seconds. The first operator completed the procedure in |
| doi_str_mv | 10.1213/ANE.0000000000000022 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1490781965</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1490781965</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3019-86ec12045f7602dc7cccedaa468d8bb5b0513930145266bb5b7c1a5dab9623843</originalsourceid><addsrcrecordid>eNpdkcGS1CAQhlOWlju7-gaWxdFLViAJCd7GcdStWl3LmT2nCHQ2KIERiFOzr-eLSZxRS7lA_939Q_Nl2TOCLwklxcvlx_Ul_mdR-iBbkIqyvK548zBbJK3IKef8LDsP4UsKCW7Y4-yMlkXFCGOL7McSfRZWuVHfg0IrZ6N3xvw6jjvhdXAWvYa4B7Cz1GmbcpudtsLk651WkxcGJQO00fbOQL4ZXDzl0RbkYPW3CQLSFn1wvtPKHNBNBwHQJ-Hj5DXYGNCtVeDvXHJAKwjCg7DoDRj9HfzhFdrqEVDvPLqyOmoRdXqS69HSQogDBC2eZI96YQI8Pe0X2e3b9Xb1Pr--eXe1Wl7nssCE5w0DSSguq75mmCpZSylBCVGyRjVdV3W4IgVPpWX6QjYLtSSiUqLjjBZNWVxkL46-O-_mqWI76iDBGGHBTaElJcd1QzirUml5LJXeheChb3dej8IfWoLbGV-b8LX_40ttz083TN0I6k_Tb15_fffORPDhq5n24NsBhInD0a8qeE7TEIk1xvnMnBc_AQZ9qFw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490781965</pqid></control><display><type>article</type><title>A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery: Time for Initiation of Anesthesia</title><source>MEDLINE</source><source>Journals@Ovid LWW Legacy Archive</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Ross, Vernon H. ; Dean, Laura S. ; Thomas, John A. ; Harris, Lynne C. ; Pan, Peter H.</creator><creatorcontrib>Ross, Vernon H. ; Dean, Laura S. ; Thomas, John A. ; Harris, Lynne C. ; Pan, Peter H.</creatorcontrib><description>There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinal-epidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery.
Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time).
Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m for SSS; 49.9 ± 8.6 kg/m for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116-692] seconds and 180 [75-450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was -80 to +180 seconds. The first operator completed the procedure in <10 minutes in 71% of subjects in the SSS group and 95% of those in the CSE group (P = 0.09) and the 95% CI of the difference was -2% to +45%. There were more attempts to successful completion of the procedure in the SSS group (P = 0.007) with its 95% CI of the difference being +1 to +6.
Our results suggest that the CSE technique is noninferior to the SS technique in morbidly obese parturients for time of initiation of subarachnoid anesthesia and may be accomplished with fewer attempts than the SSS technique with experienced residents.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/ANE.0000000000000022</identifier><identifier>PMID: 24356166</identifier><language>eng</language><publisher>United States: International Anesthesia Research Society</publisher><subject>Adult ; Anesthesia, Epidural - methods ; Anesthesia, Spinal - methods ; Cesarean Section - methods ; Female ; Humans ; Injections, Spinal ; Obesity, Morbid - epidemiology ; Obesity, Morbid - surgery ; Pregnancy ; Time Factors ; Young Adult</subject><ispartof>Anesthesia and analgesia, 2014-01, Vol.118 (1), p.168-172</ispartof><rights>International Anesthesia Research Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3019-86ec12045f7602dc7cccedaa468d8bb5b0513930145266bb5b7c1a5dab9623843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00000539-201401000-00019$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,776,780,4595,27901,27902,65206</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24356166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ross, Vernon H.</creatorcontrib><creatorcontrib>Dean, Laura S.</creatorcontrib><creatorcontrib>Thomas, John A.</creatorcontrib><creatorcontrib>Harris, Lynne C.</creatorcontrib><creatorcontrib>Pan, Peter H.</creatorcontrib><title>A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery: Time for Initiation of Anesthesia</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinal-epidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery.
Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time).
Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m for SSS; 49.9 ± 8.6 kg/m for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116-692] seconds and 180 [75-450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was -80 to +180 seconds. The first operator completed the procedure in <10 minutes in 71% of subjects in the SSS group and 95% of those in the CSE group (P = 0.09) and the 95% CI of the difference was -2% to +45%. There were more attempts to successful completion of the procedure in the SSS group (P = 0.007) with its 95% CI of the difference being +1 to +6.
Our results suggest that the CSE technique is noninferior to the SS technique in morbidly obese parturients for time of initiation of subarachnoid anesthesia and may be accomplished with fewer attempts than the SSS technique with experienced residents.</description><subject>Adult</subject><subject>Anesthesia, Epidural - methods</subject><subject>Anesthesia, Spinal - methods</subject><subject>Cesarean Section - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Injections, Spinal</subject><subject>Obesity, Morbid - epidemiology</subject><subject>Obesity, Morbid - surgery</subject><subject>Pregnancy</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkcGS1CAQhlOWlju7-gaWxdFLViAJCd7GcdStWl3LmT2nCHQ2KIERiFOzr-eLSZxRS7lA_939Q_Nl2TOCLwklxcvlx_Ul_mdR-iBbkIqyvK548zBbJK3IKef8LDsP4UsKCW7Y4-yMlkXFCGOL7McSfRZWuVHfg0IrZ6N3xvw6jjvhdXAWvYa4B7Cz1GmbcpudtsLk651WkxcGJQO00fbOQL4ZXDzl0RbkYPW3CQLSFn1wvtPKHNBNBwHQJ-Hj5DXYGNCtVeDvXHJAKwjCg7DoDRj9HfzhFdrqEVDvPLqyOmoRdXqS69HSQogDBC2eZI96YQI8Pe0X2e3b9Xb1Pr--eXe1Wl7nssCE5w0DSSguq75mmCpZSylBCVGyRjVdV3W4IgVPpWX6QjYLtSSiUqLjjBZNWVxkL46-O-_mqWI76iDBGGHBTaElJcd1QzirUml5LJXeheChb3dej8IfWoLbGV-b8LX_40ttz083TN0I6k_Tb15_fffORPDhq5n24NsBhInD0a8qeE7TEIk1xvnMnBc_AQZ9qFw</recordid><startdate>20140101</startdate><enddate>20140101</enddate><creator>Ross, Vernon H.</creator><creator>Dean, Laura S.</creator><creator>Thomas, John A.</creator><creator>Harris, Lynne C.</creator><creator>Pan, Peter H.</creator><general>International Anesthesia Research Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140101</creationdate><title>A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery: Time for Initiation of Anesthesia</title><author>Ross, Vernon H. ; Dean, Laura S. ; Thomas, John A. ; Harris, Lynne C. ; Pan, Peter H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3019-86ec12045f7602dc7cccedaa468d8bb5b0513930145266bb5b7c1a5dab9623843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Anesthesia, Epidural - methods</topic><topic>Anesthesia, Spinal - methods</topic><topic>Cesarean Section - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Injections, Spinal</topic><topic>Obesity, Morbid - epidemiology</topic><topic>Obesity, Morbid - surgery</topic><topic>Pregnancy</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ross, Vernon H.</creatorcontrib><creatorcontrib>Dean, Laura S.</creatorcontrib><creatorcontrib>Thomas, John A.</creatorcontrib><creatorcontrib>Harris, Lynne C.</creatorcontrib><creatorcontrib>Pan, Peter H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ross, Vernon H.</au><au>Dean, Laura S.</au><au>Thomas, John A.</au><au>Harris, Lynne C.</au><au>Pan, Peter H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery: Time for Initiation of Anesthesia</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2014-01-01</date><risdate>2014</risdate><volume>118</volume><issue>1</issue><spage>168</spage><epage>172</epage><pages>168-172</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><abstract>There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinal-epidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery.
Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time).
Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m for SSS; 49.9 ± 8.6 kg/m for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116-692] seconds and 180 [75-450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was -80 to +180 seconds. The first operator completed the procedure in <10 minutes in 71% of subjects in the SSS group and 95% of those in the CSE group (P = 0.09) and the 95% CI of the difference was -2% to +45%. There were more attempts to successful completion of the procedure in the SSS group (P = 0.007) with its 95% CI of the difference being +1 to +6.
Our results suggest that the CSE technique is noninferior to the SS technique in morbidly obese parturients for time of initiation of subarachnoid anesthesia and may be accomplished with fewer attempts than the SSS technique with experienced residents.</abstract><cop>United States</cop><pub>International Anesthesia Research Society</pub><pmid>24356166</pmid><doi>10.1213/ANE.0000000000000022</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-2999 |
| ispartof | Anesthesia and analgesia, 2014-01, Vol.118 (1), p.168-172 |
| issn | 0003-2999 1526-7598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1490781965 |
| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Anesthesia, Epidural - methods Anesthesia, Spinal - methods Cesarean Section - methods Female Humans Injections, Spinal Obesity, Morbid - epidemiology Obesity, Morbid - surgery Pregnancy Time Factors Young Adult |
| title | A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery: Time for Initiation of Anesthesia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T09%3A46%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Randomized%20Controlled%20Comparison%20Between%20Combined%20Spinal-Epidural%20and%20Single-Shot%20Spinal%20Techniques%20in%20Morbidly%20Obese%20Parturients%20Undergoing%20Cesarean%20Delivery:%20Time%20for%20Initiation%20of%20Anesthesia&rft.jtitle=Anesthesia%20and%20analgesia&rft.au=Ross,%20Vernon%20H.&rft.date=2014-01-01&rft.volume=118&rft.issue=1&rft.spage=168&rft.epage=172&rft.pages=168-172&rft.issn=0003-2999&rft.eissn=1526-7598&rft_id=info:doi/10.1213/ANE.0000000000000022&rft_dat=%3Cproquest_cross%3E1490781965%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1490781965&rft_id=info:pmid/24356166&rfr_iscdi=true |