Changes in cardiac output during epidural anaesthesia for Caesarean section

Robson, S. C.; Hunter, Stewart; Boys, Richard J.; Dunlop, W.; Bryson, M.

doi:10.1111/j.1365-2044.1989.tb11372.x

Cited by 38 publications

(16 citation statements)

References 16 publications

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“…However, because of changes in peripheral resistance, changes in maternal BP do not necessarily reflect changes in maternal CO [7]. Significant correlation among decreases in maternal CO after spinal anesthesia, increased umbilical artery pulsatility index and umbilical arterial acidemia at delivery suggest that changes in these variables are better predictors of reduced uteroplacental perfusion than changes in maternal BP [8] .This is further supported by placental scintigraphy which showed no correlation between maternal BP and placental blood flow [9].…”

Section: Methodssupporting

confidence: 62%

Preloading Versus Coloading of Crystalloid Fluid to Control Hypotension Due to Spinal Anesthesia.

Reshan¹,

ART's²

2018

IJAR

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Section: Methodssupporting

confidence: 62%

Preloading Versus Coloading of Crystalloid Fluid to Control Hypotension Due to Spinal Anesthesia.

Reshan¹,

ART's²

2018

IJAR

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“…Many factors influence hemodynamics during cesarean section: 1) since patients remain awake during surgery, fear and anxiety may liberate endogenous catecholamines; 2) emotional factors surrounding childbirth can alter hemodynamics; 3) systemic hypotension produced by epidural anesthesia may elicit hemodynamic responses; 4) vasopressors such as ephedrine used for the treatment of systemic hypotension may elicit cardiovascular changes in their own right (6,15); 5) supine hypotension may further complicate the issue; 6) epidural anesthesia for cesarean section can produce significant hemodynamic changes because of sympathetic blockade (16), and 7) significant hemodynamic changes occur at delivery of the baby due to an increase in central blood volume.…”

Section: Discussionmentioning

confidence: 99%

The maternal hemodynamic effects of bupivacaine‐epinephrine mixture used for obstetrical anesthesia

Grant¹,

Ramanathan²,

Turndorf³

1990

Acta Anaesthesiol Scand

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The maternal hemodynamic effects of bupivacaine (0.5%)-epinephrine (5 micrograms/ml) mixture used for lumbar epidural anesthesia were studied with an impedance cardiograph and an automated blood pressure device in term gravidas undergoing elective cesarean section. Following i.v. hydration with 2000 ml Ringer's lactate solution, 16 patients received bupivacaine-epinephrine mixture and 16 patients plain bupivacaine in 5-ml increments to a T4 level. Measurements were made before anesthesia, at T10 and at T4 sensory levels. Results were analyzed using analysis of variance (ANOVA) and the least significant difference method at P less than 0.05. In the epinephrine group, at T10 level, the diastolic (D) and mean (M) pressures decreased significantly 11 +/- 3, and 10 +/- 1% (mean +/- s.e. mean) respectively with no significant change in the S pressure. No significant changes were seen in the plain group. At T4, the S, D and M pressures decreased significantly 8 +/- 2, 18 +/- 4 and 16 +/- 2% in the epinephrine group. In the plain group the decrease in each one of these pressures was less than 5% and was not significant. In the epinephrine group, S, D and M pressures decreased significantly more than they did in the plain group at T10 and T4. Systemic vascular resistance decreased significantly from control values by 19 +/- 6% at T4 in the epinephrine group with no significant changes in the plain group.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Cross-sectional and Doppler echocardiographic measurements were performed with the subject in the left semi-lateral (45°) position. The principles and techniques of aortic flow measurement using Doppler and cross-sectional echocardiography have been described previously [4,10]. Briefly, ascending aortic blood velocities were recorded with continuous wave Doppler ultrasound using a 2-MHz transducer (Vingmed) placed in the suprastemal notch.…”

Section: Methodsmentioning

confidence: 99%

“…The haemodynamic changes associated with regional anaesthesia represent the greatest potential hazard of these techniques for mother and fetus [2] and evidence suggests that hypotension and neonatal acidaemia are more common after spinal anaesthesia [3]. However, because of the changes in peripheral resistance, changes in maternal arterial pressure do not necessarily reflect changes in maternal cardiac output [4] and it is changes in the latter which may pose the greatest risk to the fetus. The poor correlation between the degree of hypotension after regional anaesthesia and umbilical acid-base status lends support to this suggestion [3,5].…”

mentioning

confidence: 99%

“…Relatively little is known about the changes in cardiac output during regional anaesthesia for Caesarean section. Studies during extradural anaesthesia have suggested that cardiac output does not decrease unless hypotension develops [4,6,7]. In two of these studies [6,7], cardiac output was measured by impedance cardiography, which has been shown to correlate poorly with stroke volume measured by thermodilution during Caesarean section [8].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Maternal and Fetal Haemodynamic Effects of Spinal and Extradural Anaesthesia for Elective Caesarean Section

ROBSON¹

1992

British Journal of Anaesthesia

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Serial haemodynamic investigations were performed in 32 women who were allocated randomly to receive either spinal or extradural anaesthesia for elective Caesarean section. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. Doppler flow velocity waveforms were recorded also from the umbilical artery. Preloading with Ringer lactate solution 1 litre increased cardiac output in both groups. After injection of bupivacaine, cardiac output remained increased in the extradural group, but decreased in the spinal group. This was associated with an increase in umbilical artery pulsatility index in the spinal group. Umbilical artery pH was less in the spinal group (7.22 vs 7.27), although no neonate was depressed at birth. The maximum percentage change in cardiac output and umbilical artery pulsatility index correlated with umbilical artery pH (r = 0.54, r = 0.72, respectively). There was no significant correlation with change in arterial pressure.

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Changes in cardiac output during epidural anaesthesia for Caesarean section

Abstract: Summary Serial haemodynamic investigations were performed in

Cited by 38 publications

References 16 publications

Preloading Versus Coloading of Crystalloid Fluid to Control Hypotension Due to Spinal Anesthesia.

Preloading Versus Coloading of Crystalloid Fluid to Control Hypotension Due to Spinal Anesthesia.

The maternal hemodynamic effects of bupivacaine‐epinephrine mixture used for obstetrical anesthesia

Maternal and Fetal Haemodynamic Effects of Spinal and Extradural Anaesthesia for Elective Caesarean Section

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