Spinal anaesthesia for Caesarean section

Corke, B. C.; Datta, Sanjay; Ostheimer, Gerard W.; Weiß, Joseph; Alper, Milton H.

doi:10.1111/j.1365-2044.1982.tb01278.x

Cited by 187 publications

(44 citation statements)

References 12 publications

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“…Uteroplacental perfusion is an important determinant of fetal wellbeing and untreated hypotension due to subarachnoid blockade is detrimental [28]. Hence, the benefit of HES in decreasing the incidence of hypotension is valuable.…”

Section: Discussionmentioning

confidence: 99%

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

et al. 2016

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Background Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. Methods We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). Results Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intra-operative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. Conclusions Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.

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Section: Discussionmentioning

confidence: 99%

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

et al. 2016

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“…A lower incidence and lesser degree of hypotension (which can be easily corrected with intravenous boluses of ephedrine) can theoretically confer benefits to the fetus. The clinically significant level of hypotension to appropriately trigger a correction is controversial and arbitrary [5,11]. In this study, we arbitrarily defined hypotension as a systolic blood pressure below 90 mmHg.…”

Section: Discussionmentioning

confidence: 99%

The effect of 10° head‐up tilt in the right lateral position on the systemic blood pressure after subarachnoid block for Caesarean section

Loke

Chan²,

Sia

2002

Anaesthesia

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SummaryForty women presenting for elective Caesarean section under spinal anaesthesia were randomly assigned to have anaesthesia induced in the right lateral position either in the horizontal position or with 108 head-up tilt. Hyperbaric bupivacaine 2 ml 0.5% with 0.1 mg of morphine was injected intrathecally before the parturients were placed in the supine position with 158 left lateral tilt. Blood pressure and heart rate were monitored every minute and the sensory level (loss of sharp sensation to pinprick) was monitored every 3 min until clamping of the umbilical cord. Ephedrine 6 mg was given every minute that the systolic blood pressure decreased below 90 mmHg. The mean systolic blood pressure during the first 5 min after induction of spinal anaesthesia was lower in the control group compared to the tilted group (99 mmHg vs. 109 mmHg; p 0.043). The upper limit of block was higher in the control group compared to the tilted group (p 0.002). The use of 108 head-up tilt resulted in a reduced incidence of hypotension initially and less extensive sensory block.

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“…This raises concern for the effect of nifedipine and epidural anesthesia on maternal blood pressure in the normotensive parturient when maternal hypotension is well-known as a common complication after epidural block. Decreases in maternal blood pressure have been related to fetal hypoxia and acidosis [14]. Many studies demonstrated that hypotension secondary to nifedipine given for preterm labor in normotensive patients were minimal [15–17], but severe hypotension resulting in fetal death from nifedipine has been reported [18].…”

Section: Commentmentioning

confidence: 99%

“…The relationship of intraoperative maternal hypotension and fetal hypoxia/acidosis has been demonstrated in the parturient undergoing cesarean section [14]. Unlike a healthy full-term fetus undergoing cesarean section, the second-trimester fetuses undergoing SFLP are usually sick with cardiovascular compromise, related to anemia in the donor twin and cardiomyopathy in the recipient twin.…”

Section: Commentmentioning

confidence: 99%

Maternal Hypotension during Fetoscopic Surgery: Incidence and Its Impact on Fetal Survival Outcomes

Ngamprasertwong

Habli

Boat

et al. 2013

The Scientific World Journal

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In this retrospective cohort study, we aimed to determine the incidence of intraoperative maternal hypotension during fetoscopic surgery for twin-twin transfusion syndrome (TTTS) and to evaluate the impact of intraoperative hypotension on fetal survival. A total of 328 TTTS patients with recipient twin cardiomyopathy who underwent fetoscopic surgery under epidural anesthesia were included. The exposure of interest was maternal medical therapy with nifedipine for the treatment of fetal cardiomyopathy. We found that intraoperative hypotension occurred in 53.4% (175/328 patients). There was no statistically significant difference in incidence of hypotension between nifedipine exposure and nonexposure groups (54.8% versus 50.8%, P = 0.479). However, the nifedipine exposure group received a statistically significant higher dose of phenylephrine (7.04 ± 6.38 mcg/kg versus 4.70 ± 4.14 mcg/kg, P = 0.018) and higher doses of other vasopressor, as counted by number of treatments (6.06 ± 4.58 versus 4.96 ± 3.42, P = 0.022). There were no statistically significant differences in acute fetal survival rate (within 5 days) and fetal survival rate at birth between hypotensive and nonhypotensive patients. We concluded that preoperative exposure to nifedipine resulted in increased intraoperative maternal vasopressor requirement during fetoscopic surgery under epidural anesthesia. In patients who had intraoperative maternal hypotension, there was no correlation between the presence of maternal hypotension and postoperative fetal survival.

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Spinal anaesthesia for Caesarean section

Abstract: SummaryThe

Cited by 187 publications

References 12 publications

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

The effect of 10° head‐up tilt in the right lateral position on the systemic blood pressure after subarachnoid block for Caesarean section

Maternal Hypotension during Fetoscopic Surgery: Incidence and Its Impact on Fetal Survival Outcomes

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