Incidence of Electrocardiographic Changes During Cesarean Delivery Under Regional Anesthesia

Abstract

Serial electrocardiograms were obtained on 93 healthy ASA physical status I and II term parturients during nonemergent cesarean delivery under regional anesthesia. Electrocardiographic changes occurred in 44 of the 93 patients (47.3%); in 35 of these 44 patients, the changes were characteristic, or suggestive, of myocardial ischemia. Symptoms of chest pain, pressure, and dyspnea occurred in 15 of the 44 patients with electrocardiographic changes; no patient without electrocardiographic change developed symptoms of chest pain, pressure, or dyspnea. Small but statistically significant differences were noted in heart rate, diastolic and systolic arterial pressures, and rate-pressure product between the patients with electrocardiographic changes and those without. The authors speculate that myocardial ischemia is a likely cause of both the electrocardiographic changes seen in these patients and of the symptoms of chest pain and dyspnea that they sometimes experience.

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

“…11,26 The total incidence rate of ST depressions in the present study is comparable with previous reports, but studies are generally difficult to compare as there is variety in the numbers of subjects included, anaesthetic methods as well as different doses and administration routines regarding oxytocin. [1][2][3] In previous studies, most of the ST depressions have occurred after delivery, which is the time period, when oxytocics are given. 1,2,4 Oxytocin as a causative agent has not been discussed in detail in previous studies and is sometimes not mentioned at all.…”

“…[1][2][3] In previous studies, most of the ST depressions have occurred after delivery, which is the time period, when oxytocics are given. 1,2,4 Oxytocin as a causative agent has not been discussed in detail in previous studies and is sometimes not mentioned at all. 2,3 The association between ST depression and oxytocin administration is in agreement with the results by Svanstrom et al, 5 who in a double blind, randomised controlled trial studied effects of oxytocin bolus on ECG in comparison with methylergometrine, in patients undergoing elective CS under spinal anaesthesia.…”

“…28 Overall, symptoms were much less frequent compared with frequencies reported in previous studies. 1,4 Palmer et al 1 reported all complaints and, in the study by Moran et al, 4 patients were asked for symptoms per-operatively, which could explain differences besides the differences in doses and in the way the drug was administered. The incidence of symptoms is known to be lower when the investigator waits for spontaneous complaints and thus, the incidence may have been underestimated in our study.…”

“…[1][2][3][4] An association with oxytocin administration has recently been described in a randomised trial using 10 units of oxytocin. 5 Oxytocin, given as an intravenous bolus, causes transient hypotension, a reflex tachycardia and an increase in cardiac output, in healthy women undergoing caesarean section under spinal anaesthesia.…”

Cardiac enzymes in patients undergoing caesarean section

“…These complaints are similar to those made by symptomatic cardiac patients with myocardial ischaemia. Palmer et al 1 found that ECG changes occurred in 47% of parturients. In fact, these investigators speculated that myocardial ischaemia was the likely cause of both the ECG changes and the chest pain that develops in these patients.…”