Hemodynamic Changes Associated With Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia

Dyer, R.A.; Piercy, J; Reed, Anthony; Lombard, Carl; Schoeman, L; James, M. F. M.

doi:10.1097/01.aoa.0000337883.87911.be

Cited by 25 publications

(40 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…53 Except for the usual contra-indications of neuraxial anesthesia, spinal anesthesia involving usual clinical doses of bupivacaine is now regarded as a safe approach for pre-eclamptic patients requiring Cesarean delivery. [53][54][55][56][57] Experimental data show that the incidence of hypotension induced by the spinal anesthestic and the requirement for vasopressors are reduced in this population compared with healthy parturients. 54,55 Although spinal blockade is responsible for an approximately 20% decrease in systolic blood pressure, both in healthy parturients and pre-eclamptic patients, blood pressure values meeting the definition of arterial hypotension are seen less frequently in pre-ecamptic patients, therefore treatment is required less often.…”

Section: Pre-eclampsiamentioning

confidence: 94%

“…Moreover, sympathetic blockade causes only a modest decrease in peripheral vascular resistance in pre-eclamptic women, and this may explain the lower incidence of hypotension in these patients. 56 The consequence of this observation is that, contrary to healthy parturients, cardiac output in preeclamptic women does not increase after onset of spinal anesthesia. 56 There is no study that compares phenylephrine and ephedrine in these patients.…”

Section: Pre-eclampsiamentioning

confidence: 95%

“…56 The consequence of this observation is that, contrary to healthy parturients, cardiac output in preeclamptic women does not increase after onset of spinal anesthesia. 56 There is no study that compares phenylephrine and ephedrine in these patients. Considering a potential increased sensitivity to vasopressors in these patients, low to moderate doses of vasopressors (e.g., ephedrine 5 mg or phenylephrine 50 lg) given as boluses, are indicated to avoid hypotensive episodes.…”

Section: Pre-eclampsiamentioning

confidence: 95%

See 2 more Smart Citations

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

Loubert

2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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...

show abstract

Section: Pre-eclampsiamentioning

confidence: 94%

Section: Pre-eclampsiamentioning

confidence: 95%

Section: Pre-eclampsiamentioning

confidence: 95%

See 1 more Smart Citation

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

Loubert

2012

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…A várandós állapotának felmérése során az elrendelt laboratóriumi vizsgálatok segítségével (vér-kép, máj-és veseműködés, alvadási status) nyilvánva-lóvá válhat egyéb szervek esetleges érintettsége is. Ma már több vizsgálat is igazolta, hogy ebben a betegcsoportban is a neuraxialis érzéstelenítés a választandó eljárás, sőt a vazopresszort igénylő hypotensio előfordu-lása ritkább a normotensiós betegekhez képest [5,6,7]. Tromboelasztogramos vizsgálatok azt mutatták, hogy 100 000/μl thrombocytaszám felett nincs igazolható véralvadási zavar.…”

Section: Praeeclampsia/eclampsiaunclassified

“…Az utolsó elemzések ma azt mutatják, hogy jelentősen csökkent a légút-biztosítási problémákból eredő szö-vődmények száma is [6,7]. Elektív műtéteknél mindent elkövetünk az aspiráció megelőzése érdekében.…”

Section: Az Anesztéziából Eredő Anyai Halálozásunclassified

Obstetrical aspects of perioperative medicine

Hupuczi

Gál

2014

Orvosi Hetilap

View full text Add to dashboard Cite

Napjainkban a világon a leggyakrabban végzett sebészi beavatkozás a császármetszés. Alapvető feltétel, hogy a műté-tet szövődménymentesen lehessen végezni és a gyermekágyasok gyors posztoperatív felépülése biztosítható legyen, hiszen az anya-újszülött kapcsolatot már a műtét napján lehetővé kell tenni. A császármetszések mortalitása az elmúlt évtizedekben lényegesen csökkent, ez jelentős teammunka eredménye, valamint köszönhető a széles körben elterjedt gerincközeli érzéstelenítő eljárásoknak. A perinatológusteam tagja a szülészen és a neonatológuson kívül az aneszteziológus is, aki a páciens perioperatív ellátásáért felel. A szövődmények megelőzésének és korai eredményes kezelésé-nek a feltétele, hogy az aneszteziológus már a terhesség során ismerkedjék meg a várandós nő állapotával, hogy megtervezhesse a perioperatív ellátást. A szerzők ismertetik a nagy kockázatú szülőnők csoportjait, a leggyakoribb anyai halálokokat és a preventív, valamint terápiás lehetőségeket. Orv. Hetil., 2014, 155(29), 1147-1151.Kulcsszavak: epiduralis és spinalis anesztézia, anyai mortalitás, praeeclampsia/eclampsia, szülészeti vérzések, szülé-szeti szepszis, obesitas, perioperatív fájdalomcsillapítás Obstetrical aspects of perioperative medicineRecently the most frequently applied surgical procedure worldwide has been Cesarean section. It is essential to perform the operation without any complication. In addition, a fast postoperative recovery must be provided, because all mothers must have the chance for being together with their newborn infant even on the fi rst day. The maternal mortality rates of Cesarean section signifi cantly decreased in the last decades due to the planned team work as well as the widely applied regional (spinal and epidural) anesthetic procedures. Apart from the obstetrician and neonatologist the anesthesiologist is the member of the perinatal team, too, who is responsible for the patient's perioperative care. To prevent complications and have an early successful treatment the anesthesiologist should be informed by the pregnant woman' s health status in time in order to be able to plan the perioperative management. The high-risk groups of pregnant women, the most common causes of maternal death and possibilities of prevention and treatment are discussed.Keywords: epidural and spinal anesthesia, maternal mortality, preeclampsia/eclampsia, obstetric hemorrhages, obstetric sepsis, obesity, perioperative pain relief Az elmúlt két évtizedben a szülészeti gyakorlat alapvető változásainak lehetünk tanúi és részesei. Évek óta tapasztalható a gyermekvállalási kedv csökkenése, az első gyermek vállalása egyre idősebb anyai életkorban történik. A várandósgondozás fejlődésével ma már súlyosabb anyai betegségek sem képezik terhesség kiviselésének el-

show abstract

Preliminary study of the effects of furosemide on blood pressure during late‐onset pre‐eclampsia in patients with high cardiac output

Tamás

Hantosi

Farkas

et al. 2016

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

Hemodynamic Changes Associated With Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia

Cited by 25 publications

References 0 publications

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

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

Obstetrical aspects of perioperative medicine

Preliminary study of the effects of furosemide on blood pressure during late‐onset pre‐eclampsia in patients with high cardiac output

Contact Info

Product

Resources

About