2.5.2. Control Group
shivering, bradycardia, nausea,, hypotension
URETER, QUINCKE, COMPLICATIONS
60 people received one cc of normal saline (1 ml) as a placebo two minutes before changing from lithotomy to supine position.Each ephedrine syringe contained 50 mg of ephedrine diluted with 9 ml of distilled water in 10 cc syringes, each cc containing 5 mg of ephedrine. The placebo syringes were in the form of 10 cc syringes containing distilled water, and two minutes before changing the lithotomy position to the supine position, one cc of each was randomly injected intravenously into the patients in the study groups. The patients, surgeons, and anesthesiologists were blinded to the allocation of the patients to the studied groups. All aseptic precautions were conducted before performing the spinal anesthesia. Spinal anesthesia was performed with a #25 needle (SPINAL ANESTHESIA NEEDLE, Dr.J brand, made in Japan, Quincke type) in the sitting position from the third and fourth intervertebral space (midline approach) and by injecting 12.5 mg hyperbaric bupivacaine in the subarachnoid space. Then, the patients were placed in the supine position and received 4 liters of oxygen per minute during the operation through a simple face oxygen mask. Sensory levels were determined by the pinprick test after block (every 15–20 seconds for 3 minutes), and the motor blockade was evaluated using Bromage's criteria until the level of spinal anesthesia was raised to the T8 level.Cystoscopy was performed in lithotomy position, a ureteric catheter was entered into the upper ureter or renal pelvis and fixed with tape to the indwelling Foley catheter, and patients were placed in the supine position. The patient's supine position changed to the prone position, and renal access was conducted in the prone position under fluoroscopic guidance; superior and inferior bolsters were placed at the xiphoid process cartilage to support the lower rib cage, and at the symphysis pubis, vertical bolsters were put in the standard manner along the lateral sides of the chest.All vital parameters, including HR and NIBP, were recorded perioperatively the time before spinal anesthesia performing (T0), immediately after spinal anesthesia induction (T1), after the lithotomy position (T2), when lithotomy position changed to the supine position (T3), and then when the patient was placed in the prone position (T4). Afterward, vital signs were documented every 3 minutes for 60 minutes (T5–T25) and finally at the end of surgery time (Tf).If the systolic blood pressure was under 100 mmHg or less than 20% from the baseline, it was treated with 5 mg ephedrine and increased crystalloid speed. If the heart rate (HR) was under 50 beats/minute, it was treated with 0.75 mg of atropine. The incidence of hypotension, bradycardia, nausea, vomiting, shivering, and other complications were recorded.