Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women

Lee, S.W.Y.; Khaw, Kim S.; Kee, Warwick D. Ngan; Leung, Thomas; Critchley, L.A.H.

doi:10.1093/bja/aes349

Cited by 96 publications

(55 citation statements)

References 30 publications

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“…8 Hypotension may be compounded by aortocaval compression during SA for CS, particularly if lateral tilt is not adequately applied. 9 In the present study, the odds of experiencing nausea with a minimum-recorded SBP less than 70% of baseline were 2.46 times higher than those in whom SBP was always higher than 70% of the baseline value. There was no difference in the incidence of hypotension between our two groups, and no difference in oxytocin use.…”

Section: Discussioncontrasting

confidence: 42%

Incidence of intraoperative nausea and vomiting during spinal anaesthesia for Caesarean section in two Cape Town state hospitals

Magni

Dyer

Dyk

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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Background: Intraoperative nausea and vomiting (IONV) during spinal anaesthesia (SA) for Caesarean section (CS) is unpleasant and may interfere with surgery. The incidence of IONV during elective CS was studied, as well as the influence of ethnicity on this outcome. Methods: A total of 258 healthy term patients undergoing SA for elective CS were recruited to this prospective observational study conducted at two Cape Town Level 2 hospitals. Standard practice was employed for SA for CS at the University of Cape Town: 2 ml hyperbaric bupivacaine plus 10 μg fentanyl at the L3/4 interspace, and 15 mL/kg crystalloid coload. Spinal hypotension was managed with phenylephrine boluses according to a standard protocol. Nausea and/or vomiting were treated by restoration of blood pressure, and metoclopramide. Intraoperative complaints of nausea, and vomiting, were noted. Patients were also interviewed postoperatively as to any experience of intraoperative or previous history of nausea. Results: Of the 258 patients enrolled in the audit, 112 (43.4%) were non-African and 146 (56.6%) were Black African patients. The overall incidence (95% CI) of nausea was 0.32 (0.27-0.38), with 20% occurring prior to and 11% after the delivery. The overall incidence of vomiting was 0.07 (0.05-0.11), with 3.2% occurring prior to and 3.8% after delivery. The incidence of nausea and/or vomiting was 0.33 (0.28 -0.40). Black Africans experienced significantly less nausea than non-African patients (36/145 [24.8%] vs. 47/112 [42.0%] respectively, p = 0.004). There was no significant difference in the incidence of vomiting (10/145 [6.8%] vs. 8/112 [7.1%] respectively). The odds of experiencing intraoperative nausea for patients with any blood pressure value < 70% of baseline were 2.46 (95% CI 1.40-4.33). Conclusions: Though in keeping with international standards, the clinically significant incidence of nausea and/or vomiting of 33% requires adjustments to the management protocol for spinal hypotension. The inclusion of ethnicity as a risk factor for nausea during SA for CS should be considered.

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Section: Discussioncontrasting

confidence: 42%

Incidence of intraoperative nausea and vomiting during spinal anaesthesia for Caesarean section in two Cape Town state hospitals

Magni

Dyer

Dyk

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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“…Kuo et al, observed that this biphasic shift towards augmented sympathetic tone in late pregnancy is in part attributed to aortocaval compression by the gravid uterus (16, 144, 145). In these cases, the gravid uterus compresses upon the maternal abdominal aorta and inferior vena cava, resulting in both a decrease in cardiac output and venous return, and eliciting compensatory changes in sympathetic tone (146). …”

Section: The Autonomic Regulation Of Cardiovascular Physiological Adamentioning

confidence: 99%

Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia

2016

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Preeclampsia (PE) is a form of gestational hypertension that complicates ~ 5 percent of pregnancies worldwide. Over 70 percent of the fatal cases of PE are attributed to cerebral edema, intracranial hemorrhage, and eclampsia. The etiology of PE originates from abnormal remodeling of the maternal spiral arteries, creating an ischemic placenta that releases factors that drive the pathophysiology. An initial neurological outcome of PE is the absence of the autonomically regulated cardiovascular adaptations to pregnancy. PE patients exhibit sympathetic overactivation, in comparison to both normotensive pregnant and hypertensive non-pregnant females. Moreover, PE diminishes baroreceptor reflex sensitivity (BRS) beyond that observed in healthy pregnancy. The absence of the cardiovascular adaptations to pregnancy, combined with sympathovagal imbalance and a blunted BRS leads to life-threatening neurological outcomes. Behaviorally, the increased incidences of maternal depression, anxiety, and post-traumatic stress disorder (PTSD) in PE are correlated to low fetal birth weight, intrauterine growth restriction (IUGR) and premature birth. This review addresses these neurological consequences of PE that present in the gravid female both during and after the index pregnancy.

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“…In parallel, there is a drop in peripheral vascular resistances. After the first trimester, the uterus-induced aortocaval compression decreases venous return and alters supine position tolerance [29].…”

Section: Physiological Changesmentioning

confidence: 99%

Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy

Zieleskiewicz

Chantry

Duclos

et al. 2016

Anaesthesia Critical Care & Pain Medicine

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Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women

Abstract: Patients with ACC can be identified by the CO changes from serial measurements between supine, 15°, or full lateral tilt. Our findings suggest that in non-labouring parturients, ACC is asymptomatic and can be effectively minimized by the use of a left lateral tilt of 15° or greater.

Cited by 96 publications

References 30 publications

Incidence of intraoperative nausea and vomiting during spinal anaesthesia for Caesarean section in two Cape Town state hospitals

Incidence of intraoperative nausea and vomiting during spinal anaesthesia for Caesarean section in two Cape Town state hospitals

Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia

Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy

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