N-[2-(4-Bromo­benzo­yl)eth­yl]isopropyl­aminium chloride

The crystal structure of the title compound, C12H17BrNO+·Cl−, is stabilized by N—H⋯Cl and C—H⋯O hydrogen bonds, forming a three-dimensional network. The inter­actions framework is completed by C—H⋯π contacts between a methyl­ene group and the benzene ring of a symmetry-related mol­ecule

3-(4-Chloro­benzo­yl)-4-(4-chloro­phen­yl)-1-phenethyl­piperidin-4-ol

In the title compound, C26H25Cl2NO2, the piperidine ring adopts a chair conformation with a cis configuration of the carbonyl and hy­droxy substituents. The dihedral angle between the aromatic rings of the chloro­benzene groups is 24.3 (2)°. The phenyl ring forms dihedral angles of 59.4 (3) and 44.1 (3)° with the benzene rings. In the crystal, mol­ecules are linked by inter­molecular O—H⋯N and C—H⋯O hydrogen bonds and C—H⋯π inter­actions into layers parallel to the bc plane

Effects of isothermic crystalloid coload on maternal hypotension and fetal outcomes during spinal anesthesia for cesarean section: A randomized controlled trial

Objective: Spinal anesthesia induced hypotension (SAIH) is a common occurrence during spinal anesthesia for cesarean section resulting in perturbing effects on maternal and fetal outcomes. Previous studies conducted to attenuate SAIH focused on the timing of intravenous fluid infusion and demonstrated the superiority of coload strategy on traditional preload strategy but neither of them focused on the effect of the temperature of crystalloid infused on SAIH and fetal outcomes. The current study aimed to assess the effect of the temperature of the crystalloid infused with coload strategy on the incidence of SAIH and fetal outcomes. Materials and methods: Seventy-six parturients were enrolled into the study and data of 60 parturients were analyzed. Patients were randomly assigned to receive crystalloid coload at room temperature (Group RT, n = 30) or warmed at 37 °C (Group W, n = 30). The incidence of hypotension, cumulative hypotension episodes, heart rate, core body temperature, ephedrine dose, and fetal outcomes were recorded. Results: There was no significant difference in the incidence of maternal hypotension, cumulative hypotension episodes, and ephedrine dose (p = 0,625, p = 0,871, p = 0,460 respectively). Umbilical arterial pH and fetal Apgar scores at first and fifth minutes were higher in Group W than in Group RT (p = 0.013, p = 0.006 and p = 0.045 respectively). One fetus in Group RT but none in Group W had umbilical arterial pH lower than seven. Fetal birth weight and rectal temperature measurements were comparable in both groups (p = 0.639 and p = 0.675 respectively). Demographic data, patient characteristics, and surgery data were comparable between groups. Conclusions: Isothermic crystalloid coload strategy results in higher umbilical pH values and Apgar scores in parturients scheduled for cesarean section under spinal anesthesia. Keywords: Apgar score, Cesarean section, Fetal outcomes, Hypotension, Spinal anesthesi

Lumbar erector spinae plane block for postoperative analgesia after nephrectomy followed by emergent complication surgery

WOS: 000485879800017PubMed ID: 31064170

Correlation of actual epidural depth with ultrasound estimates in paramedian sagittal oblique and transverse median plane in parturients: a prospective cross-sectional study

WOS: 000466494200063Purpose: In this prospective, cross-sectional, observational study, the accuracy and precision of actual epidural depth (ND) with ultrasound estimates of epidural depth (ED) in the paramedian sagittal oblique plane (PSO) and transverse median plane (TM) in parturients was assessed. Methods: Ninety parturients scheduled for cesarean section asking for combined spinal epidural anesthesia were recruited. ED was assessed in PSO and TM planes with a 5-2 MHz curved array probe. The least possible pressure was applied on the probe during ultrasound examination. All epidurals were located by a midline approach at L3-4 level by an anesthesiologist blinded to ED but informed about the insertion point. ND was marked on the needle with a sterile marker. Precision between the measurements were assessed by Pearson correlation coefficient and Lin's concordance correlation coefficient (CCC). Bland-Altman test was used to assess the 95% limits of agreement (LOA) between measurements. Results: The mean (SD) ultrasound estimated ED in the PSO and TM plane and ND were 56.07 (9.31) mm, 55.99 (9.15) mm, and 56.17 (9.28) mm respectively. CCC between ND and US estimated ED in PSO plane was 0.9929, and 0.9928 in TM plane. Bland-Altman analysis showed -1.13-1.03 mm 95% limits of agreement between ND and ultrasound estimated ED in PSO plane and -1.15-0.98 mm in TM plane. There was a strong correlation between the ND and ultrasound estimates of epidural depth in PSO and TM planes. Conclusion: Both planes can be used interchangeably for preprocedural estimation of ED in parturients asking for labor epidurals

Abdominal girth has a strong correlation with ultrasound-estimated epidural depth in parturients: a prospective observational study

WOS: 000463163700011PubMed ID: 30734847BackgroundPreprocedural ultrasound examination of vertebral column guides to locate desired intervertebral space and provides a prevision of needle trajectory and estimated needle depth in parturients. The objective of this study was to assess the correlation between ultrasound-estimated epidural depth (ED) with abdominal girth (AG), body mass index (BMI), weight, height, and age.MethodsIn this prospective, observational study, ultrasound imaging was done at L3-4 interspace in transverse median plane (TP) and paramedian sagittal oblique plane (PSO) to obtain ultrasound estimates of skin to epidural space depth. Combined spinal epidural anesthesia was performed at L3-4 interspace. AG, BMI, age, height, and weight were recorded for every parturient.ResultsData from 130 parturients were analyzed. Estimated ED was 56.59.5mm in TP, 57.5 +/- 9.3mm in PSO, and actual epidural depth was 57.9 +/- 9.4mm. Correlation coefficients between ED and AG were 0.797 in TP (95% CI 0.727-0.854, p<0.001) and 0.803 in PSO (95% CI 0.733-0.857, p<0.001). Correlation coefficients between ED and BMI were 0.543 in TP (95% CI 0.405-0.661, p<0.001) and 0.566 in PSO (95% CI 0.428-0.680, p<0.001). Correlation coefficients between ED and weight were 0.593 in TP (CI=0.466-0.695, p<0.001) and 0.615 in PSO (CI=0.500-0.716, p<0.001). Height and age had no significant correlation with ED.ConclusionsAbdominal girth has a strong correlation with ultrasound-estimated epidural depth in parturients

The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial

WOS: 000453423500003Background and objectives: Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods: In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 degrees C. Spinal anesthesia was performed at L3-L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results: There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 +/- 0.5 degrees C at baseline and decreased to 36.3 +/- 0.5 degrees C. for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 +/- 0.4 degrees C and decreased to 35.8 +/- 0.7 degrees C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions: Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming. (C) 2018 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda

The spread of spinal anesthesia in term parturient: effect of hip/shoulder width ratio and vertebral column length

WOS: 000391260800118Objective: This study aims to determine the effect of age, height, weight, BMI, hip/shoulder width ratio, and vertebral column length on the spread of spinal anesthesia in term parturient. In pregnant patients with a larger hip width and a relative narrow shoulder width, more cephalad spread of spinal anesthesia is observed with a fixed dose of hyperbaric bupivacaine. We hypothesized that the increase in cephalad spread of spinal anesthesia may be correlated with the increased hip/shoulder width ratio. Methods: Age, weight, height, body mass index, hip width, shoulder width, hip/shoulder width ratio, and vertebral column length were recorded for 75 term parturient. The L4-L5 interspace was introduced and 2 ml 0.5% hyperbaric bupivacaine was injected subarachnoid in 10 seconds without barbotage. Pearson and Sperman's Rho Correlation Tests were used for the analysis of correlation between patient characteristics and the cephalad spread of spinal anesthesia. Results: Hip/shoulder width ratio had a positive correlation with the cephalad spread of spinal anesthesia (P=0.037). Other patient variables in the present study did not have correlation with the cephalad spread of spinal anesthesia (P>0.05). Vertebral column length had correlation with patient height (P=0.01). Conclusions: The cephalad spread of spinal anesthesia is correlated with hip/shoulder width ratio in term parturient patients. Vertebral column length has no correlation with the spinal anesthesia spread but correlates with the height of the parturient. The hip/ shoulder width ratio may be more important than either patient height or vertebral column length in predicting the cephalad spread of spinal anesthesia for each parturient