Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : This study was designed to investigate the effect of sedation on maternal hypotension in preoperatively anxious parturients underwent urgent category-1 Cesarean section (C/S) under spinal anesthesia (SA). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : After ethics committee approval, data of 1824 parturients underwent C/S were reviewed from the surgical database and patient charts. Parturients with high preoperative anxiety scores (VAS-A)≥70) underwent C/S under SA with thiopental 2 mg/kg (if necessary additional 50 mg) sedation until reaching Ramsay sedation score≥3 (Group S, n=49), and without any other type of sedation (Group NS, n=53) were included in the study. All parturients received SA with hyperbaric bupivacaine 0.5% 2.5 mL. Hemodynamic parameters and maximum systolic arterial pressure (SAP) reductions (%) from the baseline were recorded. Maternal hypotension (SAP≥30% decrease or <100 mmHg) and bradycardia (heart rate <55 beats/min) incidences, required ephedrine (5mg IV bolus) and atropine (0.5 mg IV bolus) doses, and newborn Apgar scores were also analyzed. R Re es su ul lt ts s: : Fifty-nine parturients' data (Group S: 29 and Group NS: 30) were analyzed. The maximum SAP reductions were 23±12.8% and 30.8±16.1% in Groups S and NS, respectively (p=0,044). Hypotension was observed in 5 (17,2%) parturients of Group S and 15 (50%) of Group NS (p=0.012, 95% CI 0,14-0,82; relative risk=0,344). Ephedrine requirement was 17±4,4 mg and 25±7,4 mg in Groups S and NS, respectively (p=0,04). Incidence of bradycardia, required atropine dose and newborn Apgar scores were similar in both groups (p>0,05). C Co on nc cl lu us si io on ns s: : The maximum SAP reduction, hypotension incidence and required ephedrine doses were lower in thiopental sedation used preoperatively anxious parturients who underwent category-1 C/S under SA. K Ke ey yw wo or rd ds s: : Cesarean section; anxiety; anesthesia, spinal; conscious sedation; thiopental Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışma, preoperatif dönemde anksiyöz olup spinal anestezi (SA) altında acil kategori-1 sezaryen (C/S) operasyonu geçiren gebelerde, sedasyonun hipotansiyona etkisini araştırmak için planlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Etik kurul onayı alındıktan sonra, C/S operasyonu geçiren 1824 gebenin verileri cerrahi arşiv ve hasta dosyaları aracılığıyla incelendi. Preoperatif anksiyete skoru (VAS-A)≥70) yüksek olup SA altında C/S geçiren gebelerden Ramsay sedasyon skoru ≥3 olacak şekilde tiyopental 2 mg/kg (gereğinde 50 mg ek doz) uygulanan hastalar (Grup S, n=49) ve herhangi bir sedasyon uygulanmayan hastalar (Grup NS, n=53) çalışmaya dahil edildi. Tüm gebelere, 2,5mL %0,5'lik hiperbarik bupivakain ile SA uygulandı. Hemodinamik parametreler ve bazale göre sistolik arteryal basınçtaki (SAB) maksimum düşüşler (%) kaydedildi. Maternal hipotansiyon (SAB'ın ≥%30 düşmesi veya <100 mmHg olması) ve bradikardi (kalp hızı <55 atım/dk) insidansları, efedrin gereksinimi (5 mg IV b...