Evaluation of a protocol of spinal anesthesia for Cesarean in Tunisian maternity: Hemodynamic repercussions and risk factors of hypotension
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Abstract
Aim: To evaluate hemodynamic repercussion of a protocol of spinal anesthesia (SA) for cesarean and release the predictive factors of maternal arterial hypotension post spinal anesthesia.
Methods: We included parturients proposed for Cesarean under SA. They were not included the women of statute ASA > II, preeclamptics, eclamptics and/or having counter-indications of SA. We excluded the cases where there were technical difficulties at the time of the realization of SA, a failure or a complication of this SA. We injected 10 Mg of bupivacaïne 0.5% isobar, 10 μg of fentanyl and 100 μg of morphine. The data were collected before the realization of SA (anthropometric parameters; antecedents; basic systolic and diastolic blood pressures (BSBP and DSBP) and basic heart rate (BHR)) and after SA (systolic and diastolic blood pressure (SBP and DBP), heart rate (HR); occurred or not of a sympathetic block (falls of the SBP of more than 20% of its basic value or a SBP<90 mm Hg); the time of installation of the sympathetic block and the duration of hypotension.
Results: The full number of parturients included was 1016 among whom 16 were excluded. Only 1000 parturients finished the study and were divided into 2 groups (group 1: 500 emergency cesarean and group 2: 500 elective cesarean). The incidence of the sympathetic block was of 44.2% as a whole and this block was significantly more frequent in group 2 (p=0.0001). There was a significant relation between the incidence of a sympathetic block and the advanced age of the parturient (p=0.0001), the important weight (p=0.047), high ASA statute (p=0.0001), the presence of hypertension (p=0.0001), diabetes (p=0.001) or cesarean (p=0.00015) in the antecedents and the low BSBP (p=0.015).
Conclusion: In spite of the beneficial effect of the reduction in the amounts of local anesthetic in the SA, the sympathetic block remains frequent after SA for Cesarean. Thus, it is essential to detect the highrisk women of occurred of sympathetic block after SA, and to propose strategies of prevention, monitoring and management for this population.
Methods: We included parturients proposed for Cesarean under SA. They were not included the women of statute ASA > II, preeclamptics, eclamptics and/or having counter-indications of SA. We excluded the cases where there were technical difficulties at the time of the realization of SA, a failure or a complication of this SA. We injected 10 Mg of bupivacaïne 0.5% isobar, 10 μg of fentanyl and 100 μg of morphine. The data were collected before the realization of SA (anthropometric parameters; antecedents; basic systolic and diastolic blood pressures (BSBP and DSBP) and basic heart rate (BHR)) and after SA (systolic and diastolic blood pressure (SBP and DBP), heart rate (HR); occurred or not of a sympathetic block (falls of the SBP of more than 20% of its basic value or a SBP<90 mm Hg); the time of installation of the sympathetic block and the duration of hypotension.
Results: The full number of parturients included was 1016 among whom 16 were excluded. Only 1000 parturients finished the study and were divided into 2 groups (group 1: 500 emergency cesarean and group 2: 500 elective cesarean). The incidence of the sympathetic block was of 44.2% as a whole and this block was significantly more frequent in group 2 (p=0.0001). There was a significant relation between the incidence of a sympathetic block and the advanced age of the parturient (p=0.0001), the important weight (p=0.047), high ASA statute (p=0.0001), the presence of hypertension (p=0.0001), diabetes (p=0.001) or cesarean (p=0.00015) in the antecedents and the low BSBP (p=0.015).
Conclusion: In spite of the beneficial effect of the reduction in the amounts of local anesthetic in the SA, the sympathetic block remains frequent after SA for Cesarean. Thus, it is essential to detect the highrisk women of occurred of sympathetic block after SA, and to propose strategies of prevention, monitoring and management for this population.
Keywords:
Post partum haemorrhage; disseminated intravascular coagulation; reanimation; transfusion.##plugins.themes.academic_pro.article.details##
References
- Ben-David B, Frankel R, Arzumonov T, et al. Minidose Bupivacaine-Fentanyl Spinal Anesthesia for Surgical Repair of Hip Fracture in the Aged. Anesthesiology. 2000; 92:6-10
- Russell IF. Levels of anaesthesia and intra operative pain at caesarean section under regional block. Int J Obstet Anesth. 1995; 4:71-7.
- Carpenter RL, Hogan QH, Liu SS, Crane B, Moore J. Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology. 1998; 89:24-9.
- Hartmann B, Junger A, Klasen J, et al. The Incidence and Risk Factors for Hypotension After Spinal Anesthesia Induction: An Analysis with Automated Data Collection. Anesth Analg. 2002; 94:1521-29.
- Tarkkila P, Isola J. A regression model for identifying patients at high risk of hypotension, bradycardia and nausea during spinal anesthesia. Acta Anaesthesiol Scand 1992; 36:554-8
- McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. Br J Anaesth 1993; 70:672-80
- McCulloch WJ, Littlewood DG. Influence of Obesity on Spinal Analgesia with isobaric 0.5 % Bupivacaine. Br J Anaesth 1986; 58: 610-14
- Taivainen T, Tuominen M, Rosenberg PH. Influence of Obesity on the spread of Spinal Analgesia after injection of plain 0.5 % Bupivacaine at the L3-4 or L4-5 Interspace. Br J Anaesth. 1990; 64: 5 542-46
- Racle JP, Poy JY, Haberer JP, Benkhadra A. A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. Reg Anesth. 1989; 14:66-71
- Lund-Johansen P. Haemodynamics in essential hypertension. Cli Sci 1980; 59:343S
- Aalkjaer C, Heagerty AM, Peterson KK, Slwales JD, Mulvany MJ. Evidence of increased media thickness and increased neuronal amine uptake, but depressed excitation-contraction coupling in isolated resistance vessels from essential hypertensives. Circ Res 1987; 61:181-86
- Echevarria M, Hachero A, Martinez A, et al. Spinal anaesthesia with 0.5% isobaric bupivacaine in patients with diabetes mellitus: the influence of CSF composition on sensory and motor block. Eur J Anaesthesiol 2008; 25: 1014-19