Changes in pulmonary function tests during spinal anaesthesia for caesarean section

Conn, David; Moffat, A. C.; McCallum, G.D.R.; Thorburn, J.

doi:10.1016/0959-289x(93)90023-b

Cited by 15 publications

(16 citation statements)

References 11 publications

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“…Diaphragmatic breathing and the manner in which epidural and spinal blocks produce sympathetic and sensory blockade several segments higher than motor block, account for this [2]. The profound and persistent changes in ventilatory parameters accompanying spinal blockade for Caesarean section are well tolerated in the healthy parturient but, in patients suffering from respiratory disease, the iatrogenic respiratory muscle weakness could cause retention of secretions with further deterioration in gas exchange.…”

Section: Discussionmentioning

confidence: 99%

“…An intra-operative deterioration in pulmonary function tests occurs as a result of the motor block which accompanies the sensory block of spinal anaesthesia [2]. Despite these respiratory changes and the knowledge that the partial pressure of oxygen in fetal arterial (UaPo,) and venous umbilical blood (UvPo,) increase in proportion to the maternal inspired oxygen concentration and maternal arterial oxygen partial pressure ( M P ao2) during Caesarean section under general anaesthesia and epidural anaesthesia, little attention has been directed towards the need for supplementary oxygen during Caesarean section under spinal anaesthesia [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Respiratory effects of spinal anaesthesia for Caesarean section

Kelly¹,

Fitzpatrick²,

Hill³

1996

Anaesthesia

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SummaryWe report the changes observed in a number of' pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow,.forced expiratory volume in one second,,forced tlitul capacity, ,forced expiratory volume in one second to ,forced vital capacity ratio and the maximal mid-expiratory flow. SigniJicant changes occurred that are consistent with a restrictive ventilatory defect. These changes persisted for ,four hours arfrer the induction of spinal anaesthesia. Administration of 35% oxygen by facemask ,failed to change significantly fetal umbilical vein pH or partial pressure of oxygen. Key wordsAnaesthesia; obstetric. Anaesthetic techniques regional; spinal.Spinal anaesthesia is an increasingly popular technique for elective Caesarean section [I]. An intra-operative deterioration in pulmonary function tests occurs as a result of the motor block which accompanies the sensory block of spinal anaesthesia [2]. Despite these respiratory changes and the knowledge that the partial pressure of oxygen in fetal arterial (UaPo,) and venous umbilical blood (UvPo,) increase in proportion to the maternal inspired oxygen concentration and maternal arterial oxygen partial pressure ( M P ao2) during Caesarean section under general anaesthesia and epidural anaesthesia, little attention has been directed towards the need for supplementary oxygen during Caesarean section under spinal anaesthesia [3,4].This study was designed to measure the changes in pulmonary function during spinal anaesthesia for Caesarean section and the recovery period and to determine if any difference in fetal oxygen delivery was made by the administration to the mother of 35% oxygen by mask. MethodsQueen's University Ethics Committee approval was obtained prior to commencement of the study and all patients gave written, informed consent. Thirty-six patients presenting for elective Caesarean section were invited to participate as volunteers. Patients with respiratory disease, weighing more than 100 kg, of a height of less than 1.52 m. of less than 37 weeks' gestation or having a history of fetal compromise were not studied.At the pre-operative visit the use of the Vitalograph Alpha was explained. The Vitalograph Alpha is a pneumotachograph-based spirometer capable of determining forced vital capacity (FVC), forced expiratory volume in one second (FEV,), peak expiratory flow (PEF) and the forced expiratory flow in the mid region of the forced vital capacity, i.e. the flow between 25 and 75% of expired volume (FEF25 75). The FEFx 7s is also known as the maximal mid-expiratory flow rate. Reference values were derived from nomograms based on height, weight and race. As patient effort is an important component of the accuracy of results, the best of three values was taken for each measurement [5]. Readings were taken in the sitting and left lateral position to mimic the patient's position during surgery and the pre-operative left lateral position was subsequently used as a control val...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Respiratory effects of spinal anaesthesia for Caesarean section

Kelly¹,

Fitzpatrick²,

Hill³

1996

Anaesthesia

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“…Although these parturients are particularly at risk for pulmonary complications resulting from changes induced by pregnancy and obesity, there are no reported controlled trials on the impairment of peri-operative respiratory function in this subgroup. There are some reports on the respiratory effects of SA and epidural anaesthesia for Caesarean section in normal weight parturients [12][13][14][15][16], and only a small study on the effect of SA in obese, albeit non-pregnant, patients [5]. Thus, the present prospective study was designed to evaluate both normal weight and obese parturients scheduled for elective Caesarean section.…”

Section: Discussionmentioning

confidence: 99%

Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section*

Ungern‐Sternberg¹,

Regli²,

Bucher³

et al. 2004

Anaesthesia

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SummarySpinal anaesthesia for Caesarean section has gained widespread acceptance. We assessed the impact of spinal anaesthesia and body mass index (BMI) on spirometric performance. In this prospective study, we consecutively assessed 71 consenting parturients receiving spinal anaesthesia with hyperbaric bupivacaine and fentanyl for elective Caesarean section. We performed spirometry during the antepartum visit (baseline), immediately after spinal anaesthesia, 10-20 min, 1 h, 2 h after the operation, and after mobilisation (3 h). Baseline values were within normal ranges. There was a significant decrease in all spirometric parameters after effective spinal anaesthesia that persisted throughout the study period. The decrease in respiratory function was significantly greater in obese (BMI > 30 kg.m )2 ) than in normal-weight parturients (BMI < 25 kg.m )2 ), e.g. median (IQR) vital capacity directly after spinal anaesthesia; )24 ()16 to )31)% vs. )11 ()6 to )16)%, p < 0.001 and recovery was significantly slower. We conclude that both spinal anaesthesia and obesity significantly impair respiratory function in parturients.

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“…6,7 Numerous publications have reported that spinal anaesthesia using bupivacaine significantly decreases dynamic pulmonary function parameters in the parturient. 2,3,5,8 It has been suggested that the newer local anaesthetics ropivacaine and levobupivacaine do not cause the same degree of motor block, [9][10][11] but the pulmonary effects of these drugs when used for spinal anaesthesia are unclear. For example, epidural and intrathecal levobupivacaine and ropivacaine were shown in vivo to elicit less motor block than bupivacaine.…”

Section: Introductionmentioning

confidence: 99%