Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia

Abstract

Spinal anesthesia in severe preeclampsia was associated with clinically insignificant changes in CO. Phenylephrine restored mean arterial pressure but did not increase maternal CO. Oxytocin caused transient marked hypotension, tachycardia, and increases in CO.

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“…Additionally, peripheral vascular resistance decreases moderately throughout gestation, followed by an increase in CO, HR, SV and aortic distensibility, a decrease in peripheral vascular resistance and an increase in left ventricular wall thickness from the second trimester to the end of pregnancy 28. Notably, Dyer et al17 found that CO remained stable throughout cesarean delivery, except for in the period after oxytocin bolus administration (2.5 U). In the present study, however, no significant effects regarding CO or other hemodynamic parameters (except for SVV) were observed after oxytocin administration.…”

“…In healthy patients, the maximum change in CO has been shown to correlate better to uteroplacental blood flow than to upper arm blood pressure 24. More recently, Dyer et al17 tested the hypothesis that continuous monitoring of CO in patients with severe preeclampsia during spinal anesthesia for cesarean delivery would give better information on the uteroplacental blood flow than determination of the mean radial artery blood pressure. It was found that CO, as inferred from pulse-wave analysis, did not decrease significantly from baseline if the mean radial artery blood pressure was maintained at baseline levels with intermittent vasopressors; therefore, it was concluded that spinal anesthesia was associated with clinically insignificant changes in CO.…”

“…It was found that CO, as inferred from pulse-wave analysis, did not decrease significantly from baseline if the mean radial artery blood pressure was maintained at baseline levels with intermittent vasopressors; therefore, it was concluded that spinal anesthesia was associated with clinically insignificant changes in CO. The study by Dyer and colleagues17 used the LiDCO™ system, a method based on aortic pulse-wave analysis, to examine rapid changes in cardiovascular variables associated with spinal anesthesia, vasopressors, and oxytocin during cesarean section. However, this method of CO assessment has not been recommended during hemodynamic instability and has been shown to produce CO assessment errors during cardiac surgery 25.…”

“…Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in CO and blood flow to the placenta 16,17. Prevention of hemodynamic instability during cesarean delivery during spinal anesthesia has been the aim of several studies aiming to minimize fetal and maternal morbidity.…”

“…Prevention of hemodynamic instability during cesarean delivery during spinal anesthesia has been the aim of several studies aiming to minimize fetal and maternal morbidity. Most studies have used noninvasive monitoring devices to evaluate hemodynamic responses related to spinal anesthesia in the obstetric setting 17,18. Consequently, the actual hemodynamic responses to spinal anesthesia for cesarean delivery (i.e., CO and systemic vascular resistance changes) are still poorly understood, especially in patients displaying cardiovascular disorders such as preeclampsia.…”