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Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia.

ABSTRACT: BACKGROUND:Pregnancy-induced changes in cardiovascular status make women more susceptible to pulmonary edema. During cesarean section, to counterbalance the effect of hypotension caused by spinal anesthesia, anesthesiologists must choose between two fundamental approaches to maintain the hemodynamic state-intravenous fluids or vasopressors-and this choice will depend upon their particular opinions and experience. We aim to assess for any correlations between thoracic ultrasound A- and B-line artifacts, brain natriuretic peptide (BNP) levels, and the amount of intraoperative fluids administered. RESULTS:From December 2016 to August 2018, at the University-Hospital of Udine, we enrolled 80 consecutive pregnant women undergoing cesarean section. We observed a statistically significant difference in the volume of fluids administered in the first 24 h (p?=?0.035) between the patients presenting B-lines in at least one basal area of their thoracic ultrasound and patients with no evident B-lines (AUC 66.4%; IC 0.49-0.83). Dividing the population on whether their BNP levels were higher or less than 20 pg/mL, no statistically significant difference was revealed with regard to fluids administered in the first 24 h (p?=?0.537). CONCLUSIONS:Thoracic ultrasound is a non-invasive and easy-to-use tool for detecting fluid intolerance in pregnant women undergoing cesarean section. BNP levels were slow to rise following the cesarean section and did not show any clear correlation with fluid volumes administered.

SUBMITTER: Vetrugno L

PROVIDER: S-EPMC7058737 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia.

Vetrugno Luigi L Dogareschi Teresa T Sassanelli Rossella R Orso Daniele D Seremet Ludmilla L Mattuzzi Lisa L Scapol Sara S Spasiano Alessandra A Cagnacci Angelo A Bove Tiziana T

The ultrasound journal 20200306 1

<h4>Background</h4>Pregnancy-induced changes in cardiovascular status make women more susceptible to pulmonary edema. During cesarean section, to counterbalance the effect of hypotension caused by spinal anesthesia, anesthesiologists must choose between two fundamental approaches to maintain the hemodynamic state-intravenous fluids or vasopressors-and this choice will depend upon their particular opinions and experience. We aim to assess for any correlations between thoracic ultrasound A- and B- ...[more]

PMID: 32140875

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Project description:BACKGROUND:Anticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section. METHODS:This was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section. 37 parturients withdrew, and finally parturients received spinal anesthesia using 27gauge pen type fine spinal needles (experimental group, n?=?110) and 22gauge traditional spinal needles (control group, n?=?92). The primary efficacy outcomes included low back pain (LBP) and postdural puncture headache (PDPH) after delivery. Secondary efficacy outcomes included visual analogue scale during subarachnoid puncture (VASdural), difference between visual analogue scale (VAS) during peripheral venipuncture and VASdural (?VAS), VAS of back puncture point 24, 48 and 72?h after operation (VASdural-24?h, VASdural-48?h and VASdural-72?h, respectively), maternal satisfaction and hospitalization stay. RESULTS:No parturient had PDPH and was suspected with spinal or intracranial haematoma in two groups. There was no significant difference in VASlbp-24?h, VASlbp-48?h and VASlbp-72?h (P?=?0.056; P?=?0.813; P?=?0.189, respectively) between two groups. In experimental group, VASdural (P?=?0.017), ?VAS (P?=?0.001) and VASdural-24?h (P?<?0.0001) were lower, whereas maternal satisfaction was higher (P?=?0.046). There was no significant difference in VASdural-48?h, VASdural-72?h, urination function, strength recovery and hospitalization stay (P?=?0.069; P?=?0.667; P?=?0.105; P?=?0.133; P?=?0.754, respectively) between the two groups. CONCLUSIONS:Minimally invasive spinal anesthesia provided lower VASdural, VASdrual-24?h and a higher maternal satisfaction. Hence, it is considered as a safe, reliable and reasonable option for cesarean section parturients during maternal anticoagulation therapy with normal platelet count and coagulation time. TRIAL REGISTRATION:This study was registered at www.ClinicalTrials.gov at November 11th, 2016 ( NCT02987192 ).

Project description:BackgroundNorepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.MethodsIn this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth.ResultsIn total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008).ConclusionIn patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.Trial registrationClinicalTrials.gov, NCT02542748; https://clinicaltrials.gov/ct2/show/record/NCT02542748.

Dataset Information

Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia.

Publications

Thoracic ultrasound evaluation and B-type natriuretic peptide value in elective cesarean section under spinal anesthesia.

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