MINISTRY OF EDUCATION AND TRAINNING - MINISTRY OF DEFENCE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCE NGUYEN THE LOC EFFECTIVENESS RESEARCH SPINAL ANESTHESIA WITH A MIXTURE OF 0,5% BUPIVACAINE HIGH DENSITY -SUFENTANIL – LOW DOSE MORPHINE FOR CESAREAN Specialty: Anesthesiology Code: 62. 72. 01. 22 SUMMARY OF DOCTORAL THESIS MEDICINE Hanoi – 2013 THE THESIS WAS DONE IN: 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCE Scientific instructors: 1. Ass Prof. PhD. Phan Dinh Ky 2. Ass Prof. PhD. Cong Quyet Thang Objection 1: Objection 2: Objection 3: This thesis will be presented at Institute Council at: Day Month Year The thesis can be found at: 1. National library 2. Library of 108 Institute of clinical medical pharmacological science 1 BACKGROUND Anesthesia, obstetric anesthesia, especially in caesarean section are more complicated because most cases of cesarean section was emergency surgery, preoperative preparation is not entirely as desired, required posed for anesthesia are: Ensuring safety for mother; ensure safety for the developing fetus and child after birth; maximum advantage for the surgeon conducting the operation . We're doing this study is titled "Study of effective spinal anesthesia with 0.5 % bupivacaine mixture of high density - sufentanil - low-dose morphine for caesarean section", in order to achieve two objectives: 1. Comparison of effects of spinal anesthesia in surgery and pain after cesarean delivery of 0.5 % bupivacaine 7.5 mg high proportion - 100mcg combined with morphine or fentanyl 20mcg sufentanil 2mcg. 2. Rating undesirable effects on mothers and fetuses when spinal anesthesia using the aforementioned drugs. NEW CONTRIBUTION OF THE THESIS - The theme suitable for specialized obstetric anesthesia. 2 - This topic has significant scientific and practical, applicable in many maternity hospitals. - Coordinate with sufentanil bupivacaine in spinal anesthesia for cesarean section is applied in Vietnam, combined with low-dose morphine 100mcg helps reduce postoperative pain lasted another 24 hours, very beneficial for women after surgery tongue. - Comparison of the two study groups for better pain outcomes in the study group. Analgesic effect fast and strong, few side effects. - No effect on the fetus. The structure of the thesis: 131 page thesis, apart from the question, conclusions and recommendations thesis consists of four chapters: chapter 1 overview page 39, chapter 2 subjects and research methods page 20, chapter 3 study results 35 chapter 4 discusses the page and page 31. Thesis has 40 tables, 14 charts, 9 photos and 139 references (document 44 Vietnamese, 77 English documents and 18 documents in French). 3 4 Chapter 1 OVERVIEW 1.1. Some characteristics of anatomy, physiology of pregnant women related to anesthesia Pregnancy as the mother's body changes important to adapt to new physiological conditions to ensure good for both mother and fetus. 1.1.1 . The spine , the spinal cavity and 1.1.2 . Changes in respiratory 1.1.3 . Changes in the circulatory system 1.1.4 . Changes in the digestive system 1.2 . A brief history of spinal anesthesia for caesarean section 1.3 . Regional anesthesia for caesarean section 1.4 . Physiology of pain 1.4.1 . Definition of pain According to the International Association for Research on Pain (IASP - International Association for the Study of Pain) definition: pain is an unpleasant situation in terms of feelings and emotions are caused by tissue damage existence (real or potential in the model depends on the cause and severity of her injuries). 1.5. The drugs used in spinal anesthesia for cesarean 1.5.1. Pharmacology anesthetic bupivacaine: 5 1.5.2. Sufentanil pharmacological drugs. 1.5.2.1. Pharmacokinetics - Sufentanil is fat soluble so similar pharmacokinetics of fentanyl . - Do sufentanil have a higher degree of ionization at physiological pH and level of protein binding in plasma is higher, so it has a smaller volume of distribution and half-life shorter than fentanyl . 1.5.3 . Pharmacology Fentanyl drug 1.5.4. Morphine pharmacological drugs (type no preservatives - Opiphin or Morphine sulphate Chapter 2 SUBJECTS AND METHODS 2.1 . Study subjects: The women indicated cesarean section alone. 2.2 . Selection criteria for the study subjects: - The women indicated cesarean standard ASA 1 and ASA 2, standards classification criteria of the American Association of anesthesia. - The women agreed to participate in this study. - There are no contraindications to spinal anesthetic. 6 2.3 . Exclusion criteria: - Pregnant women have spinal deformities. - Women who neuropathy. - Women who RLDM , anticoagulant treatment. - Women who together with cardiovascular disease. - Pregnant women are shocked. - The ill woman bleeding risk: young football vegetables, vegetables striker suspected uterine rupture. - Pregnant women who are allergic to anesthetics. - Pregnant women who have the infection back, full body. - Pregnant women who do not agree with this approach. 2.4 . Criteria included women from the study: - Pregnant women lose blood during surgery more > 1000ml - Spinal anesthesia failure, transfer of anesthesia - In surgical complications occur in surgery or anesthesia 2.5 . Sample size and study group: 2.5.1 . Sample sizes: [...]... 0.5 % bupivacaine mixture of high density - sufentanil - low-dose morphine and divide 2 groups: - Group I: high proportion of bupivacaine 0.5% with 7.5 mg morphine fentanyl 20 mcg and 100 mcg 30 - Group II: high proportion of 0.5% bupivacaine 7.5 mg morphine with sufentanil 2 mcg and 100 mcg I have obtained the following results: 1 Insensitivity in surgery and postoperative - The team has used sufentanil. .. types - Measure the height , the weight of the patient - Count the pulse, BP, respiratory frequency count 9 - Check -clinical tests - Patients with preoperative examination to exclude patients with contraindications to spinal anesthesia , especially medical conditions enclosed as heart, lung, liver and kidney that affects spinal anesthesia - Instructions for patients using VAS measurement of pain ( 0-1 0)... pain after 6 hours when using bupivacaine with fentanyl : an estimated 30 % p2: % of patients after 6 hours postoperative pain when used in combination with sufentanil bupivacaine and morphine: an estimated 10 % P = (p1 + p2) / 2 Z 1- /2: Coefficient of confidence at 95 % probability (= 1.96); Z 1- : Forces samples (= 80 %) calculated according to the formula : n1 = n2 = 56 - Thus the object of our study... analgesic Full time between spinal anesthesia with bupivacaine and fentanyl 20mcg coordinate with the coordination team with 2.5 mcg sufentanil: Full Time analgesic sufentanil group longer than the fentanyl group (175.0 ± 53.7 versus 140 ± 34.4 minutes ) [Aneth article Analg 1997 Sweden] Author N Vyas et al study comparing sufentanil with bupivacaine alone and bupivacaine in spinal anesthesia for cesarean... then the solution concentration 1 5 mcg / ml - Get a syringe (1 ml) 1ml smoking drug from solution 1, in this study only 2mcg sufentanil , should only take medications by 4 lines in 1mL syringe to mix with the local anesthetic bupivacaine, which is 2mcg sufentanil spinal anesthesia in this study * The solution to infusion of morphine 0.1 mg / ml: Get 1 ml morphine (0.01 g solution / ml) + 9 ml NaCl... distress Nausea - vomiting during and after surgery using sufentanil group was 11.7% higher than the fentanyl group was 3.3% Urinary retention sufentanil group only at the rate of 3.3% and fentanyl group does not meet the case Itching in the sufentanil group rate is 13.3% higher than the fentanyl group rate is 5.0% and not require treatment 2.2.Tren infant: - Results of the Apgar score used sufentanil group... Coordinate bupivacaine (marcain) 05% high density of 7.5 mg morphine with sufentanil 2 mcg and 100 mcg 2.6 Research Methodology 2.6.1 Study design: The study randomized clinical trials have compared 2.6.2 The means of monitoring and evaluation: 2.6.3 Methodology 2.6.3.1 Preparing patients before surgery - Check the records, medical records: name, address, and specify the operation - Exploit your... group - Selection criteria for homogeneity 8 2.5.2 Divide the team: Choose random draw method, visit the group consisting of 2 equal groups of 60 patients each Every woman would correspond to a start time to visit, catch the visiting public and classified comply with that method - Group I: Coordinate bupivacaine (marcain) 05 % high density of 7.5 mg morphine with fentanyl 20 mcg and 100 mcg - Group... spinal anesthesia study on 22 women with 200 mcg dose of morphine for postoperative pain relief results was 24 ± 0.2 hours Uchiyama A study on 80 women with 100mcg or 200 mcg dose of morphine results: time for postoperative pain relief lasted over 24 hours in both groups, but not the desired effect in the lower group 100mcg morphine group 200 mcg of morphine and the authors conclude: "100 mcg doses may... Rapid onset of anesthesia time than in the group using sufentanil, about 1 minute more using fentanyl compared with controls, although this difference was not statistically significant with p > 0.05 The findings of Nguyen Hoang Ngoc (fentanyl with bupivacaine coordinate): from 2 to 6 minutes The findings of Cardoso MM (in collaboration with bupivacaine morphine): from 2 to 5 minutes Time onset of pain killers . study is titled "Study of effective spinal anesthesia with 0.5 % bupivacaine mixture of high density - sufentanil - low-dose morphine for caesarean section", in order to achieve two objectives: . Pharmacology anesthetic bupivacaine: 5 1.5.2. Sufentanil pharmacological drugs. 1.5.2.1. Pharmacokinetics - Sufentanil is fat soluble so similar pharmacokinetics of fentanyl . - Do sufentanil have a. criteria: - Pregnant women have spinal deformities. - Women who neuropathy. - Women who RLDM , anticoagulant treatment. - Women who together with cardiovascular disease. - Pregnant women are shocked. -