Continuous Invasive Blood Pressure and Cardiac Output Monitoring During Cesarean Delivery: A Randomized, Double-Blind Comparison of Low-dose versus High-Dose Spinal Anesthesia With Intravenous Phenylephrine or Placebo Infusion

Langesæter, Eldrid; Rosseland, Leiv Arne; Stubhaug, Audun

doi:10.1097/01.aoa.0000350635.88043.d2

Cited by 74 publications

(127 citation statements)

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“…What is more, the haemodynamic curves showed the most prominent decrease in SVRI with a concomitant increase in CI in the first 5 minutes after the spinal block in group H and group L, with a peak effect after approximately 4 minutes. Similar findings were published by Langesaeter et al, (20) who found maximal change in cardiac output and systemic vascular resistance 3 minutes after the spinal block, however, in their study a lower dose of isobaric bupivacaine was used.…”

Section: Discussionsupporting

confidence: 88%

“…(45,46) The drawback of lowering the doses (<5mg) was the increasing incidence of spinal block failures with pain, slower onset and shorter duration of the block and also the increasing rate of conversions into general anaesthesia. (42,44,47,48) In contrast to the above mentioned studies, Langesaeter et al (20) showed that there was a difference in the incidence of hypotension with the same sensory block level, but a different local anaesthetic dosage. According to the above described findings, the focus of our study was the level of spinal block as the underlying factor for the difference in haemodynamic parameters during a spinal anaesthesia excluding different doses and/ or baricities of local anaesthetic.…”

Section: Discussionmentioning

confidence: 97%

“…(41) In our patients (in group H) a higher spinal block was applied as would be required by the surgical procedure, however it was performed on ASA 1 population with a normal compensatory reserve, patients who could well tolerate haemodynamic shifts caused by high spinal anaesthesia. In most studies, different levels of spinal block were achieved through different dosages of local anaesthetic (19)(20)(21)(22)42,43) and/or different baricity of local anaesthetics. (44) The conclusion of majority of studies was that with a lower dose of the local anaesthetic patients were more haemodynamically stable and that it was most probably the consequence of a different level of sympathetic block.…”

Section: Discussionmentioning

confidence: 99%

“…(1,3,4,19) The correlation between hypotension and an intrathecal dose of local anaesthetics was found with low doses resulting in less hypotension, vasopressor requirement, and nausea, presumingly because of a lower cephalic spread of local anaesthetic and a lower reduction of systemic vascular resistance. (20,22) Over 60 years ago, the difference in haemodynamic parameters between a high and low spinal anaesthesia was already noticed (the limit was Th4 dermatome), but no statistical analysis was performed. (23) In a study by Asehnoune et al (19) a significant difference in the change in CO was seen between two groups of patients with different sensory block levels: 6th and 8th thoracic vertebra.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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“…8 All the recent studies also show that cardiac output remains more or less unchanged despite the onset of the sympathetic block, as long as parturients do not receive phenylephrine infusions. [9][10][11][12] Therefore, these data contradict the concept that spinal anaesthesia causes a major decrease in cardiac output.…”

Section: The Physiology Of Maternal Hypotension Revisitedmentioning

confidence: 96%

La prise en charge des liquides et des vasopresseurs pour la césarienne effectuée sous rachianesthésie

Loubert

2012

Can J Anesth/J Can Anesth

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Purpose The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. Principal findings Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 lgÁmin -1 ) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In preeclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended.Conclusion A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Describe the main hemodynamic changes induced by spinal anesthesia in a pregnant woman undergoing a scheduled Cesarean delivery. 2. Recognize the clinical implications of those hemodynamic changes in the mother and fetus. 3. Explain the various strategies of vascular loading, and their main hemodynamic repercussions. 4. Assess the impact of using phenylephrine and ephedrine for the prevention and treatment of maternal hypotension. 5. Plan the fluid and vasopressor therapy in the case of an urgent Cesarean delivery.The increased popularity of regional anesthesia in clinical practice has led to a decrease in maternal mortality and morbidity related to complications in airway management. Spinal anesthesia is now the most popular technique for Cesarean delivery as it is easy to perform and provides a rapid onset, dense surgical block. It is not associated with a maternal or fetal risk of toxicity to local anesthetics. However, spinal anesthesia is often associated with significant maternal hypotension, with potentially significant consequences on maternal comfort, organ perfusion, and fetal well-being. Several studies suggest that the traditional approach that con...

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Prophylactic norepinephrine infusion for postspinal anesthesia hypotension in patients undergoing cesarean section: A randomized, controlled, dose‐finding trial

Chen

Zou

et al. 2021

Pharmacotherapy

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Continuous Invasive Blood Pressure and Cardiac Output Monitoring During Cesarean Delivery: A Randomized, Double-Blind Comparison of Low-dose versus High-Dose Spinal Anesthesia With Intravenous Phenylephrine or Placebo Infusion

Cited by 74 publications

References 0 publications

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

La prise en charge des liquides et des vasopresseurs pour la césarienne effectuée sous rachianesthésie

Prophylactic norepinephrine infusion for postspinal anesthesia hypotension in patients undergoing cesarean section: A randomized, controlled, dose‐finding trial

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