Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing

Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing

Authors

  • Michele Zasa
  • Eleonora Conci
  • Alessandro Marchignoli
  • Rita Pini
  • Lorenzo Passeri
  • Guido Fanelli
  • Andrea Cornini

Keywords:

anesthesia, spinal, complication, hypotension, Cesarean section, neonatal outcome, ephedrine

Abstract

Background: Maternal hypotension during spinal anaesthesia for Caesarean delivery is a common event, with potential detrimental consequences. We led a prospective, randomized study to compare the effects of two strategies on neonatal and maternal wellbeing. Methods: Parturients scheduled for elective Caesarean section in spinal anaesthesia were preoperatively studied with a supine stress test. Those with a positive test were enrolled in the study and received a solution of 0.5% hyperbaric bupivacaine 12.5 mg and 0.02% morphine 200 µg intrathecally. Patients received a 37.5 mg/h preventive intravenous (IV) infusion of ephedrine (Pharmacologic Group), or a 15° left lateral tilt (Non-Pharmacologic Group). In Pharmacolgic Group hypotension was treated for 20% drops in systolic blood pressure; in Non-Pharmacolgic Group only severe hypotension – defined as a 40% drop in systolic blood pressure – was treated. Results: Thirty-six patients were studied. Study groups were statistically similar in terms of demographic variables and intraoperative times. No statistical differences were found in terms of umbilical arterial blood base excess [-1.4 (-3.7 to -0.3) mEq/l Pharmacologic Group vs. -1.7 (-2.7 to -1.0) mEq/l Non-Pharmacologic Group; p=0.815] and other umbilical blood gas values. Apgar scores were statistically similar between study groups. Treatment for hypotension was required by 13 (72.2%) patients in Pharmacologic Group and 9 (50%) patients in Non-Pharmacologic Group (p=0.171). No differences were found at the analysis of serial changes in vital signs. Conclusions: Both studied strategies guaranteed a comparable safe outcome in terms of maternal and neonatal wellbeing. (www.actabiomedica.it)

Author Biographies

Michele Zasa

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)- 

Clinica Mobile nel Mondo, World Motorbike Championship (MotoGP & WSBK) Medical Division, Parma, Italy

Eleonora Conci

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Alessandro Marchignoli

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Rita Pini

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Lorenzo Passeri

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Guido Fanelli

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Andrea Cornini

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

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Published

27-04-2015

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Section

ORIGINAL ARTICLES

How to Cite

1.
Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing. Acta Biomed [Internet]. 2015 Apr. 27 [cited 2024 May 27];86(1):45-52. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/4192

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