Hyperbaric Treatment Plan
Name Rahayanu binti Sarijo
MRN 90255
ID 761114-01-7342
Date of operation : 02/07/2013
36 years old malay lady, G3 P2 at 38 weeks and 2 days of POA . Antenataly had 2 previous scar caesarean sections done in HSI . First was in 2008 for poor progress and the second was for secondary arrest in 2009. She also had background history of threatened abortion during this pregnancy at 8 weeks of POA. This patient initially was planned for elective caesarean section with bilateral tubal ligation on 8/7/2013 , was seen in PAC on 1/7/2013 and fit for op, however she presented the next day with complaint of contraction pain, regular , 2 contractions in 10 minutes.She came in active phase of labour. However there were no show, leaking liquor …show more content…
Hyperbaric solutions tend to spread below the level of the injection, while isobaric solutions are not influenced in this way. It is easier to predict the spread of spinal anaesthesia when using a hyperbaric agent. Isobaric preparations may be made hyperbaric by the addition of dextrose. Hypobaric agents are not generally available.
In my patient we have used plain bupivacaine 0.5% with 0.2 mg morphine. Bupivacaine (Marcaine) is 0.5% hyperbaric (heavy) solution is the best agent to use if it is available. 0.5% plain bupivacaine is also popular. Bupivacaine lasts longer than most other spinal anaesthetics: usually 2-3 hours.Intrathecal morphine is administered to provide profound and prolonged analgesia, and to treat acute postoperative pain
The specific gravity of the local anaesthetic solution can be altered by the addition of dextrose. Concentrations of 7.5% dextrose make the local anaesthetic hyperbaric (heavy) relative to CSF and also reduce the rate at which it diffuses and mixes with the CSF. Isobaric and hyperbaric solutions both produce reliable blocks. The most controllable blocks are probably produced by injecting hyperbaric solutions and then altering the patient’s …show more content…
The sacral autonomic fibres are among the last to recover following a spinal anaesthetic, urinary retention may occur. If fluid pre-loading has been excessive, a painful distended bladder may result and the patient may need to be catherised. Permanent neurological complications are extremely rare. If inadequate sterile precautions are taken bacterial meningitis or an epidural abscess may result although it is thought that most such abscesses are caused by the spread of infection in the blood. Finally, permanent paralysis can occur due to 'anterior spinal artery syndrome'. This is most likely to affect elderly patients who are subjected to prolonged periods of hypotension and may result in permanent paralysis of the lower
MRN 90255
ID 761114-01-7342
Date of operation : 02/07/2013
36 years old malay lady, G3 P2 at 38 weeks and 2 days of POA . Antenataly had 2 previous scar caesarean sections done in HSI . First was in 2008 for poor progress and the second was for secondary arrest in 2009. She also had background history of threatened abortion during this pregnancy at 8 weeks of POA. This patient initially was planned for elective caesarean section with bilateral tubal ligation on 8/7/2013 , was seen in PAC on 1/7/2013 and fit for op, however she presented the next day with complaint of contraction pain, regular , 2 contractions in 10 minutes.She came in active phase of labour. However there were no show, leaking liquor …show more content…
Hyperbaric solutions tend to spread below the level of the injection, while isobaric solutions are not influenced in this way. It is easier to predict the spread of spinal anaesthesia when using a hyperbaric agent. Isobaric preparations may be made hyperbaric by the addition of dextrose. Hypobaric agents are not generally available.
In my patient we have used plain bupivacaine 0.5% with 0.2 mg morphine. Bupivacaine (Marcaine) is 0.5% hyperbaric (heavy) solution is the best agent to use if it is available. 0.5% plain bupivacaine is also popular. Bupivacaine lasts longer than most other spinal anaesthetics: usually 2-3 hours.Intrathecal morphine is administered to provide profound and prolonged analgesia, and to treat acute postoperative pain
The specific gravity of the local anaesthetic solution can be altered by the addition of dextrose. Concentrations of 7.5% dextrose make the local anaesthetic hyperbaric (heavy) relative to CSF and also reduce the rate at which it diffuses and mixes with the CSF. Isobaric and hyperbaric solutions both produce reliable blocks. The most controllable blocks are probably produced by injecting hyperbaric solutions and then altering the patient’s …show more content…
The sacral autonomic fibres are among the last to recover following a spinal anaesthetic, urinary retention may occur. If fluid pre-loading has been excessive, a painful distended bladder may result and the patient may need to be catherised. Permanent neurological complications are extremely rare. If inadequate sterile precautions are taken bacterial meningitis or an epidural abscess may result although it is thought that most such abscesses are caused by the spread of infection in the blood. Finally, permanent paralysis can occur due to 'anterior spinal artery syndrome'. This is most likely to affect elderly patients who are subjected to prolonged periods of hypotension and may result in permanent paralysis of the lower