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Hemodynamic Dimension Trend between Non Conversion and Conversion Lumbar Epidural Anesthesia to General Anesthesia Explored using Pulse Oximeter Technology

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Hemodynamic Dimension Trend between Non Conversion and Conversion Lumbar Epidural Anesthesia to General Anesthesia Explored using Pulse Oximeter Technology


Zafri Bin Yusoff | Ir. Dr Ahmad Faizul Bin Shamsudin

https://doi.org/10.31142/ijtsrd21766



Zafri Bin Yusoff | Ir. Dr Ahmad Faizul Bin Shamsudin "Hemodynamic Dimension Trend between Non Conversion and Conversion Lumbar Epidural Anesthesia to General Anesthesia Explored using Pulse Oximeter Technology" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3, April 2019, pp.317-325, URL: https://www.ijtsrd.com/papers/ijtsrd21766.pdf

Background Lumbar epidural anesthesia was considered to be the gold standard in anesthesia practice. It caused some form sympathetic blockade and changed baseline peripheral vascular tone including some dynamic changes. However, failure of epidural anesthesia was a clinical problem together with difficult to predict failure based on clinical parameter and hemodynamic changes Methods Parturient undergoing lower segment caesarean section LSCS surgery under epidural anesthesia enrolled in this mono centric study. Parturient were in the range of age 16 - 45 years old with ASA 1, II and II involved in the study The total of 160 parturient (respondents) planned for elective and emergency lower segment caesarean section LSCS surgery obtained from Yamane formula n = N / (1 + Ne2) calculation with the Universal Convenience Sampling. Clinical observational and interventional methods were applied using a formatted checklist. Visual analogue pain scores VAPS, Bromage scale and perfusion index PI were used as instrument to assess lumbar epidural anesthesia blockade. After the administration of hyperbaric anesthetic drug into epidural space, hemodynamic changes of perfusion index PI were recorded every five minutes. Simultaneously, somatosensory, visual analogue pain scores VAPS, Bromage scale were assessed. Statistical analyses with SPSS version 24 were performed using Independent T – Test, ANOVA and Bivariate analysis for numerical variable. Levene’s Test for equality of variances assumption was used to check for homogeneity of numerical variables. Recommendation Future direction Technology advances should be used as way to predict epidural failure such as Transcutaneous Electrical Nerve Stimulation (TENS). Ultrasound imaging of the spine could be proposed to facilitate identification of the epidural space and predict difficult spine identification, especially in women with abnormal lumbosacral anatomy (scoliosis) and those who were obese. Results The hemodynamic dimension of initial blood pressure did not influence the trend of perfusion index PI for both groups of non-conversion and conversion of lumbar epidural anesthesia. These were elaborated through (Systolic: r = -0.01, p> 0.05), (Diastolic: r = -0.70, p > 0.05). Similarly the initial pulse rate as element of hemodynamic did not influence the trend of perfusion index as r = -0.10, p> 0.05. It was a novelty finding that initial pulse rate influenced the hemodynamic trend of initial blood pressure (Systolic: r = 0.31, p> 0.05), (Diastolic: r = 0.44, p< 0.05). Also, there was a significant changed in the mean perfusion index with the rate of 115.4% increased of perfusion index PI for non-conversion group in 20 minutes duration. The perfusion index PI for non-conversion group increased with the rate of 80.0% in 20 minutes duration. Hemodynamic dimension especially referring to perfusion index PI (p < 0.05) at parameter value of base line 3.99 ± 0.44 contributed to the lumbar epidural anesthesia failure. Our overall lumbar epidural anesthesia failure rate was 3.8% in this study. Conclusions Perfusion index PI considered a reliable and simpler hemodynamic assessment for lumbar epidural anesthesia failure for parturient undergoing lower segment caesarean section LSCS surgery. Perhaps new heuristics in new Transition Policy Anesthesia Analysis TAPA could be developed for addressing more holistic in determination of lumbar epidural anesthesia failure among parturient undergoing lower segment caesarean section LSCS surgery in terms of hemodynamic dimension.

Pulse Oximeter, Perfusion Value Index SpO2, Epidural Failure, Lower Segment Caesarean Section LSCS, Lumbar Epidural Anaesthesia


IJTSRD21766
Volume-3 | Issue-3, April 2019
317-325
IJTSRD | www.ijtsrd.com | E-ISSN 2456-6470
Copyright © 2019 by author(s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0)

International Journal of Trend in Scientific Research and Development - IJTSRD having online ISSN 2456-6470. IJTSRD is a leading Open Access, Peer-Reviewed International Journal which provides rapid publication of your research articles and aims to promote the theory and practice along with knowledge sharing between researchers, developers, engineers, students, and practitioners working in and around the world in many areas like Sciences, Technology, Innovation, Engineering, Agriculture, Management and many more and it is recommended by all Universities, review articles and short communications in all subjects. IJTSRD running an International Journal who are proving quality publication of peer reviewed and refereed international journals from diverse fields that emphasizes new research, development and their applications. IJTSRD provides an online access to exchange your research work, technical notes & surveying results among professionals throughout the world in e-journals. IJTSRD is a fastest growing and dynamic professional organization. The aim of this organization is to provide access not only to world class research resources, but through its professionals aim to bring in a significant transformation in the real of open access journals and online publishing.

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