Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Xu, Zhendong; Shen, Fei; Zhang, Yueqi; Tao, Yiyi; Chen, Xiubing; Liu, Zhiqiang

doi:10.1111/jog.13253

Cited by 16 publications

(14 citation statements)

References 28 publications

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“…Our finding is very close to the results of Chantal T. Crochetière et al who found a hypotension rate of 13.6% [32] . However, our result is different from some findings in previous studies [33] that found 72%,36%,40% with sitting, right lateral, and left lateral patients' position, respectively. Using the same LA and hypotension criteria, but in sitting position during epidural puncture, E. Bjornestad et al [29] found a hypotension incidence of 75%, and 50% with 2-chroroprocaine in epidural-use.…”

Section: Discussioncontrasting

confidence: 99%

“…Lateral position results in little vagal reflex and thus decreased hypotension rate. This view is supported by Fuyi Shen et al and Obasuyi and co-authors [30,33] who claimed a little hypotension rate with lateral position in ropivacaine combined epidural-spinal and bupivacaine spinal anesthesia for CS. With the same hypotension criteria like in our study, a SA study [28] resulted in more than 71% of hypotension incidence.…”

Section: Discussionmentioning

confidence: 76%

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Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

2021

GJACR

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Background: Cesarean section is a worldwide common surgery that requires anesthetic techniques. Many local anesthetics are being now used, but are associated with, dose- dependent and at different level, some side effects including toxicity. Hypotension was described as the first and threat side effect associated to neuraxial techniques. Despite many preventive strategies, it continues to challenge anesthesia providers around the world. Lidocaine was found to be less toxic compared with others commonly used and has been recommended for anesthesia procedures requiring large dose of local anesthetic including epidural anesthesia. The main purpose of this research was to determine the incidence of hypotension and identify the possible risk factors associated with it and thus, assess the efficacy and safety when lidocaine is applied together with epinephrine, in epidural anesthesia for elective cesarean delivery. Materials and methods: This retrospective observational institutional-based study, recruited 612 parturients who underwent elective cesarean section under epidural anesthesia with 2% lidocaine and 1/200000 epinephrine, at 1st affiliated hospital of Chongqing Medical University in 2019. Exclusion criteria included any contraindication to elective cesarean section delivery, general anesthesia, baseline systolic blood pressure < 100mmh and > 140 mm hg, gestational age < 37 weeks and > 42 weeks etc. SPSS 26.0 version and different appropriated tests were used for statistical analysis. P value < 0.05 was accepted as statistically significant. Results: The hypotension incidence was 13.2%, and identified factors associated with it were Baseline Systolic Blood Pressure < 120mmhg, gestational age < 40 weeks, maternal body weight ≤ 60 kg and duration of cesarean delivery (surgery) > 45 minutes. Conclusion: The variables in correlation with increased hypotension rate are baseline systolic blood pressure, gestational age, maternal weight, and surgery duration. 2%Lidocaine with epinephrine as adjuvant presented best outcomes towards both mother and neonates, was therefore efficacy and safe under the anesthetic conditions of our study.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 76%

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

2021

GJACR

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“…The incidence of spinal anesthesia-induced hypotension observed in this study was 21.88%. This result is consistent with previous studies that controlled sensory block level and ascension rate while administering isobaric ropivacaine in the rightlateral position (13,14).…”

Section: Discussionsupporting

confidence: 93%

“…The slow ascension rate of the sensory block level results in a low incidence of hypotension; this is because of the fact that a slower-onset sympathetic block allows more time for physiological compensation. Furthermore, body position, and the density of anesthetics delivered locally, are considered to represent important factors that are related to spinal anesthesia-induced hypotension (14). In this study, pregnant women received spinal-epidural anesthesia whilst lying in the right-lateral position.…”

Section: Discussionmentioning

confidence: 99%

Continuous cardiovascular hemodynamics monitoring with pressure recording analytical method in patients under spinal anesthesia for elective cesarean section: a pilot study

Zhang¹,

Xu²,

Jia³

et al. 2021

Ann Palliat Med

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Background: Pressure recording analytical method (PRAM) of MOSTCARE is a minimally invasive system based on mathematical analysis of arterial pressure profile changes and allows continuous recording of hemodynamic measurements. Herein, we aimed to use the MostCare system to investigate the hemodynamics of patients receiving spinal anesthesia during elective cesarean section.Methods: In this observational study, we recruited 17 patients scheduled for elective cesarean section.For each patient, we acquired continuous recordings of hemodynamic parameters at 14 key timepoints: surgical admission (two baseline parameters), immediately after the administration of spinal anesthesia, six subsequent time points (2, 4, 6, 8, 10, and 12 min after anesthesia), during peritoneum and uterine incision, during delivery, following the administration of oxytocin, and after surgery had been completed. Statistical analysis was carried out by repeated measures analysis of variance (ANOVA).Results: During a twelve min period after spinal anesthesia, we observed significant reductions in mean arterial pressure (MAP), dicrotic pressure (Pdic), cardiac index (CI), stroke volume index (SVI), dP/dt max , and cardiac cycle efficiency (CCE) (P<0.05 for all). However, systemic vascular resistance index (SVRI) was reversely correlated to CI and increased significantly after spinal anesthesia (P<0.05). These hemodynamic parameters return to near basal values after peritoneum incision. Furthermore, there were significant fluctuations in MAP, Pdic and CI after oxytocin administration (P<0.05).Conclusions: PRAM of MostCare system revealed significant changes in key hemodynamic parameters undergoing cesarean section with spinal anesthesia. It enables clinicians gain a much better understanding of hemodynamics of parturients and optimize clinical management strategies.

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“…Ngan reported a higher ED 95 of intrathecal ropivacaine than our results, even without phenylephrine infusion. [13] As we have known, the required dose of spinal anesthetic for cesarean section is influenced by several factors such as the maternal position during performing anesthesia, [14,15] speed of injection of intrathecal solution, [16] gravity of intrathecal solution, [17] race of parturients, [14] co-administration of intrathecal opioids [18] and so on. Between our present study and Ngan et al [13] study, there were several differences in maternal position during performing spinal anesthesia (lateral vs sitting), race, intrathecal opioids (without vs with fentanyl) existed.…”

Section: Discussionmentioning

confidence: 99%

ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine

Xiao²,

Zhang³

et al. 2018

Medicine

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Background:Studies have reported that the ED50 of intrathecal ropivacaine was increased when using prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. However, ED95 is more meaningful to clinical practice than ED50. Therefore, we conducted this study to determine the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine for cesarean section in parturients receiving prophylactic infusion of phenylephrine to prevent spinal-induced hypotension.Methods:A hundred of healthy parturients undergoing elective cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled in this randomized, double-blinded, dose-ranging study. Patients were randomly assigned to receive 7, 9, 11, 13 or 15 mg intrathecal hyperbaric ropivacaine respectively. The prophylactic phenylephrine infusion (50 μg/min) was initiated immediately at the same time of spinal injection. Successful spinal anesthesia was defined as a T5 sensory level achieved within 10 min after intrathecal drug administration and no epidural supplement was required during the surgery. The ED95 was calculated with Probit analysis.Results:The ED95 of intrathecal ropivacaine with 5 μg sufentanil for successful anesthesia was 15.2 mg (95%CI, 13.5–18.8 mg), when receiving prophylactic infusion of phenylephrine.Conclusion:Under the conditions of the present study, the ED95 of intrathecal hyperbaric ropivacaine for successful spinal anesthesia for cesarean section in healthy parturient receiving prophylactic infusion of phenylephrine was 15.2 mg.

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Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Abstract: As compared to the lateral positions, CSEA with hypobaric ropivacaine in the sitting position is more likely to cause hypotension and excessively high block level.

Cited by 16 publications

References 28 publications

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

Incidence of Hypotension and Associated-risk Factors in Epidural Anesthesia With 2% Lidocaine and Epinephrine During Elective Cesarean Section, Efficacy and Safety Assessment

Continuous cardiovascular hemodynamics monitoring with pressure recording analytical method in patients under spinal anesthesia for elective cesarean section: a pilot study

ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine

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