Frequency of electrocardiographic changes indicating myocardial ischemia during elective cesarean delivery with regional and general anesthesia: detection based on continuous Holter monitoring and serum markers of ischemia

Doğan, Rafi; Birdane, Alparslan; Bilir, Ayten; Ekemen, Serdar; Tanriverdi, Belkıs

doi:10.1016/j.jclinane.2008.03.005

Cited by 15 publications

(4 citation statements)

References 16 publications

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“…CK-MB can be found in the placenta and the serum concentration increases during labour, but not necessarily with caesarean delivery. 2,23,25 This likely explains why one patient in our study had a preoperative elevation of her CK-MB. Interestingly, the four patients in our study who had postoperative elevation of their CK-MB had minimal and inconsistent changes in LV and RV function.…”

Section: Discussionmentioning

confidence: 86%

Transthoracic echocardiographic assessment of the right ventricle before and after caesarean delivery: A preliminary investigation

Kumaresan

Shapeton

Yuan

et al. 2020

Anaesth Intensive Care

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Transthoracic echocardiographic evaluation of the right ventricle is more difficult than the left ventricle and has not been well characterised in the parturient during delivery. As a preliminary investigation, our goal was to use bedside transthoracic echocardiography to evaluate right ventricular myocardial function before and after caesarean delivery. Term parturients undergoing caesarean delivery under spinal anaesthesia were enrolled. Echocardiography was performed pre- and postoperatively. Assessment of myocardial function included longitudinal myocardial strain using 2D-speckle tracking for both ventricles, and fractional area change for the right ventricle. Troponin-T, creatine kinase-muscle/brain and brain natriuretic peptide were measured pre- and postoperatively. One hundred patients were enrolled; 98 completed the study. Adequate images from both timepoints (pre- and postoperatively) were obtained in 85 patients for left ventricle assessment, and 66 for the right ventricle. Right ventricular fractional area change (mean (standard deviation)) (24.9% (8.9%) to 24.9% (9.2%); P = 0.99) and strain (−19.7% (6.8%) to −18.1% (6.5%); P = 0.08) measurements suggested mild baseline dysfunction and did not change after delivery. Left ventricular strain values were normal and unchanged after delivery (−23.8% (7.4%) to −24.3% (6.7%); P = 0.51). One patient had elevated troponin-T and demonstrated worse biventricular function. Elevation of brain natriuretic peptide ( n=7) was associated with mildly decreased left ventricular strain, but creatine kinase-muscle/brain ( n=4) was not associated with consistent changes in cardiac function. Further investigations into peripartum right ventricular function are required to validate the findings in this preliminary study. Findings of baseline mild right ventricular dysfunction and functional changes associated with troponin-T and brain natriuretic peptide warrant rigorous investigation.

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Section: Discussionmentioning

confidence: 86%

Transthoracic echocardiographic assessment of the right ventricle before and after caesarean delivery: A preliminary investigation

Kumaresan

Shapeton

Yuan

et al. 2020

Anaesth Intensive Care

View full text Add to dashboard Cite

show abstract

“…10 Dogan et al did not find an association between brief ECG ST depression during elective cesarean delivery under neuraxial or general anesthesia and raised troponin T assays. 13 In the non-pregnant population, there is a significant association between perioperative myocardial ischemia and subsequent cardiovascular events, as well as increased in-hospital mortality. 14 High-risk non-pregnant patients undergo extensive preoperative cardiac evaluation, experience increased perioperative surveillance and postoperative risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Assessing the incidence of peripartum subclinical myocardial ischemia using the troponin T assay: an observational pilot study

Smith¹,

Silversides²,

Downey³

et al. 2015

International Journal of Obstetric Anesthesia

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“…These changes were more marked than those following intravenous ergometrine 0.2 mg. 19 One study employing Holter monitoring did not demonstrate clinically significant changes or elevations in markers of ischaemia during spinal or general anaesthesia for CS. 20 Another recent Holter investigation demonstrated significantly more frequent ST segment depression in healthy women during elective CS under spinal anaesthesia following a 10 rather than 5 IU bolus of oxytocin. 21 However, a dose of 10 IU is no longer the standard of care.…”

Section: Oxytocinmentioning

confidence: 98%

The use of uterotonic drugs during caesarean section

Dyer

Dyk

Dresner

2010

International Journal of Obstetric Anesthesia

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Frequency of electrocardiographic changes indicating myocardial ischemia during elective cesarean delivery with regional and general anesthesia: detection based on continuous Holter monitoring and serum markers of ischemia

Cited by 15 publications

References 16 publications

Transthoracic echocardiographic assessment of the right ventricle before and after caesarean delivery: A preliminary investigation

Transthoracic echocardiographic assessment of the right ventricle before and after caesarean delivery: A preliminary investigation

Assessing the incidence of peripartum subclinical myocardial ischemia using the troponin T assay: an observational pilot study

The use of uterotonic drugs during caesarean section

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