Hemodynamic Dimension Trend between Non Conversion and Conversion Lumbar Epidural Anesthesia to General Anesthesia Explored using Pulse Oximeter Technology
International Journal of Trend in Scientific Research and Development, 3 (3):
317-325 (April 2019)DOI: https://doi.org/10.31142/ijtsrd21766
Abstract
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. 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, URL: https://www.ijtsrd.com/papers/ijtsrd21766.pdf