[Hemodynamic and respiratory conditions of patients with obstetric fistulae operated under spinal anesthesia at the Regional Reference Hospital in Manakara, Madagascar]

Abstract

The objective was to evaluate the hemodynamic and respiratory conditions of patients who had undergone obstetric fistula surgery and to report our experience in the management of these patients. We conducted a descriptive cross-sectional study in the Operating Room and Intensive Care Unit of the Regional Reference Hospital in Manakara from 20 to 30 August 2013. All patients who had undergone obstetric fistula surgery under spinal anesthesia were included in the study. We excluded patients classified as ASA> 2 and those with cardiovascular or respiratory disorders. After pre-anesthetic consultation and preoperative assessments, patients received bupivacaine 12.5 mg with adrenaline 0,5% isobar intrathecal. They were placed in the Trendelenburg position for 5 minutes after the injection of anesthesia and during surgery. Intraoperative sensory level, blood pressure, heart rate, respiratory rate and peripheral capillary oxygen saturation (SpO2) were recorded. 57 patients were retained. The sensory and motor block were excellent in all patients. A metameric level higher than T6 was achieved in 56.36% of patients. Despite a few episodes of hypertension and tachycardia, no patient had respiratory or cardiovascular problems associated with Trendelenburg position. Only sensory level and respiratory rate showed a correlation with Trendelenburg position (p=0,01). This study suggests that Trendelenburg position can be used during spinal anesthesia if an appropriate anesthetic is administered, paying particular attention to changes in position and taking into account the pre-anesthetic examination.

Keywords: Respiratory effects; Trendelenburg; hemodynamic; obstetric fistula spinal anesthesia.

Figure 1

Position des malades durant l'opération (Trendelenburg et Lithotomie)