The effect of baricity of intrathecal bupivacaine for elective cesarean delivery on maternal cardiac output: a randomized study |
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| Affiliation: | 1. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;2. Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona;3. Shape Medical Systems, Inc., Saint Paul, Minnesota;1. Department of Anaesthesia & Pain Medicine, Royal Perth Hospital, Perth, Australia;2. School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia;3. Dept of Pharmacology, Vanderbilt University, Nashville, USA;4. Department of Anaesthesia, Fremantle Hospital, Fremantle, Western Australia, Australia;1. Department of Anaesthesia and Intensive Care Medicine, Femme–Mère–Enfant Teaching Hospital, hospices civils de Lyon, Claude-Bernard Lyon 1 University, 59, boulevard Pinel, 69677 Bron, France;2. Department of Anaesthesia, Ben Vien Tu Du Hospital, Ho Chi Minh City, Viet Nam;3. Department of Anaesthesia and Intensive Care Medicine, Lyon Sud Teaching Hospital, hospices civils de Lyon, Claude-Bernard Lyon 1 University, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France;4. Department of Anaesthesia, University College London Hospital NHS Foundation Trust, London, UK;1. APHP, Department of Genetics, Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, University Hospital Pitié-Salpêtrière, Paris, France;1. Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt;2. Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura, Egypt |
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| Abstract: | BackgroundHemodynamic instability during spinal anesthesia for cesarean delivery is associated with adverse maternal and fetal outcomes. Plain and hyperbaric bupivacaine are commonly used for cesarean delivery, however, their distinctive pharmacologic properties may affect maternal hemodynamic profiles differently. The aim of this study was to compare hemodynamic profiles using a suprasternal Doppler cardiac output (CO) monitor in healthy term parturients randomized to receive plain or hyperbaric bupivacaine for cesarean delivery.MethodsOne hundred-and-sixty-eight healthy parturients scheduled for elective cesarean delivery were randomly assigned to receive 10.9 mg of intrathecal 0.5% plain or hyperbaric bupivacaine, both with 0.2 mg morphine. The primary outcome was CO change after spinal anesthesia. Secondary outcomes were the incidence of hypotension, vasopressor use, and conversion to general anesthesia.ResultsThe mean (±SD) CO at baseline, 1 min and 5 min after spinal anesthesia, and after placental delivery was 4.6 ± 1.2, 5.4 ± 1.3, 5.1 ± 1.4, and 6.4 ± 1.7 L/min in the plain bupivacaine, and 4.5 ± 1.1, 5.2 ± 1.3, 4.9 ± 1.3, and 6.2 ± 1.9 L/min in the hyperbaric bupivacaine group. There were no significant differences in CO, mean arterial pressure, or systemic vascular resistance. Incidences of hypotension, vasopressor and supplemental analgesic use, and conversion to general anesthesia, were not different between groups.ConclusionsCardiac output changes after plain or hyperbaric bupivacaine were not different in term parturients undergoing spinal anesthesia for cesarean delivery. Further studies comparing block quality and the rate of conversion to general anesthesia are required. |
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| Keywords: | Bupivacaine baricity Cardiac output Maternal hemodynamic Cesarean delivery Spinal anesthesia |
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