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Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.

ABSTRACT: Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB.A prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 150, and 300 left lateral positions) before SAB, after SAB, and after delivery of the fetus.Before SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (150 and 300).Changing position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (150 and 300).clinicaltrials.gov ( NCT02828176 ) retrospectively registered.

SUBMITTER: Hasanin A

PROVIDER: S-EPMC5769501 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.

Hasanin Ahmed A Soryal Remoon R Kaddah Tarek T Raouf Sabah Abdel SA Abdelwahab Yaser Y Elshafaei Khaled K Elsayad Mohamed M Abdelhamid Bassant B Fouad Reham R Mahmoud Doaa D Hassabelnaby Yasmin Y

BMC anesthesiology 20180115 1

<h4>Background</h4>Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB.<h4>Methods</h4>A prospective observational study ...[more]

PMID: 29334907

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Project description:BACKGROUND:Spinal anesthesia is a form of regional anesthesia frequently used in various lower abdominal, orthopedic, obstetric operations such as a cesarean delivery. The most common local anesthetic used for spinal anesthesia in obstetric and non-obstetric surgery is bupivacaine which can be utilized as an isobaric or hyperbaric solution, producing differences in maternal hemodynamic changes. Against this backdrop, the study aims to compare the effects of isobaric and hyperbaric bupivacaine on maternal hemodynamic alterations after administering spinal anesthesia for elective cesarean delivery at Gandhi Memorial Hospital, Addis Ababa, Ethiopia. METHODS:A hospital-based prospective cohort study design was employed for the period December 1, 2017 to January 30, 2018. A total of 100 parturient were involved, with one group exposed to isobaric bupivacaine and the other to hyperbaric bupivacaine to observe their effects on maternal hemodynamic changes post spinal anesthesia. The participants were selected through systematic random sampling. Data analysis was performed using SPSS (version 20) through descriptive statistic, independent sample t-test, Mann-Whitney U-test, Fisher's exact test, and Chi-square test were used. P values of <0.05 was assumed as statistically significant for all tests. RESULTS:The incidence of hypotension was found to be greater in isobaric than hyperbaric groups (82% vs. 60% respectively; p = 0.015). No statistical significant differences were found in mean arterial pressure value at baseline, but, statistically significant changes were observed among the groups (p <0.05) at all study timing after spinal anesthesia, except at 30thmin. No statistically significant differences were seen in the mean heart rate variability after spinal anesthesia at all periods, except the 15th minute (p = 0.033). A greater rate of vasopressor was used in the isobaric group as compared to the hyperbaric group (36% vs. 14% respectively; p = 0.011). CONCLUSION:Baricity is a significant factor in maternal hemodynamic changes in the parturient for elective cesarean section. Isobaric bupivacaine produces greater change in blood pressure and incidence of hypotension and entails a greater vasopressor requirement than hyperbaric bupivacaine after spinal anesthesia for elective cesarean section.

Project description:Background Maternal hypotension is a common problem during spinal anesthesia resulting in adverse maternal and fetal outcomes. According to theoretical knowledge, it is more common in severe preeclamptic parturients undergoing cesarean section with spinal anesthesia. Objective To compare fetomother outcome in normotensive and severe preeclamptic parturients undergoing elective cesarean section under spinal anesthesia. Methodology A prospective cohort study was conducted from Novembers to May 30, 2019 on 84 ASA II and III pregnant mothers. After preloading with 500 ml–1000ml crystalloids, a 0.5%isobaric bupivacaine of 10 mg–12.5 mg was administered for spinal anesthesia. Vital signs (SBP, DBP, MAP and HR) were recorded every 3 min till 30 min, every 5 min then after. Neonatal Apgar scores at one and 5 min after birth and intraoperative fluids consumption were recorded. Data distribution was checked by Shapiro walk's test. Chi-square test was used to calculate the incidence of hypotension between groups; both paired and unpaired t-tests were also used to calculate the percent fall in blood pressure and heart rate from baselines of each group and intergroup respectively, and P-value less than 0.05 were considered statistical significance. Results The incidence of hypotension (over a period of 30 min after spinal anesthesia) in the preeclamptic patients (31%) was less than that of the healthy parturients (59.5%). There was no statistically significant difference in heart rate of both groups before and after induction of spinal anesthesia. The 5th minute Apgar score recordings were also comparable between the groups. Conclusion This study showed that the incidence and magnitude of spinal anesthesia-induced hypotension was less in severely preeclamptic parturient than healthy parturient who underwent elective cesarean delivery under spinal anesthesia and fetal outcome was comparable. Highlights • Peak sensory block level was similar in both groups and no patients complained intraoperative pain and analgesics were not required supplemental.• Base line SBP, DBP and MAP were significantly higher in severe preeclamptic group (p = 0.01).• Mean gestational age of the fetus was significantly low in severe preeclamptic group (p = 0.01).• Apgar score at 1st min(7–8 vs,8–9),volume of intra operative fluid use were statistically significant with p < 0.05

Dataset Information

Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.

Publications

Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study.

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