Influence of Volume Preloading on Uteroplacental and Fetal Circulation during Spinal Anaesthesia for Caesarean Section in Uncomplicated Singleton Pregnancies

Abstract

Objective: Effects of volume preloading during spinal anaesthesia for elective caesarean section on maternal blood pressure, feto-maternal circulation and fetal outcome. Patients and Methods: In a pilot study a randomised trial was performed in 22 healthy women with uncomplicated, singleton pregnancies at 36–40 weeks of gestation undergoing elective caesarean section under spinal anaesthesia. In the low volume group (group A) patients received 150 ml of crystalloid solution for preloading, in the high volume group (group B) they were given 15 ml/kg of crystalloid solution for preloading before the initiation of spinal anaesthesia. Maternal blood pressure was monitored intermittently. Hypotension was defined as a decrease in systolic pressure to less than 80% of the baseline value. The Doppler flow evaluation consisted of measurements from the uterine artery at the placental site, fetal umbilical artery and fetal middle cerebral artery. Pulsatility indices were derived before and after fluid preloading, and when spinal anaesthesia was established. The neonatal outcome was assessed by Apgar scores, arterial acid base status and neurologic and adaptive capacity scores (NACS). Results: The incidence of maternal hypotension in both groups was 45.5% (n = 10); 3 cases occurred in group A compared to 7 cases in group B (n.s.). There was no evidence that the high dose volume is useful in preventing maternal hypotension. The pulsatility indices of uterine arteries, umbilical arteries and middle cerebral arteries were not altered. Statistical analysis showed no changes in neonatal outcome concerning umbilical arterial pH, Apgar score and NACS (n.s.) between groups A and B. Conclusions: Our preliminary results suggest that high dose crystalloid volume preloading has no preventive function in the avoidance of maternal hypotension in healthy parturients undergoing elective caesarean section under spinal anaesthesia, and shows no harmful effects on neonatal outcome as long as maternal hypotension is corrected immediately. However, the statistical significance may reflect the small sample size, and larger series are needed before changing the current management.

Effect of Clonidine and/or Fentanyl in Combination with Intrathecal Bupivacaine for Lower Limb Orthopedic Surgeries in Spinal Anaesthesia

“…It increases the duration of analgesia, intensify the motor block and prolongs the duration of postoperative analgesia but it can cause hypotension and bradycardia. 8 The present study was underwent to combine two adjuvants to local anaesthetics with the purpose to improve the quality of subarachnoid block.…”

Low-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension

“…Spinal anaesthesia is the preferred anaesthetic technique for elective operative delivery and is also commonly used for unplanned Caesarean section [1]. Spinal-induced hypotension remains the most important side effect with a reported incidence between 20 and 100% [2][3][4]. Hypotension can cause maternal discomfort (nausea and vomiting) [2] and impaired utero-placental perfusion, resulting in fetal acidemia [5,6].…”

Düşük Doz Spinal Anestezi ile Varis Operasyonu

“…In maternal population, low-dose spinal anesthesia produces less maternal hypotension and fetal acidosis due to decreased uteroplacental blood flow compared with conventional dose regimes. Hypotension is the common complication with an incidence of 20%-100% in maternal population undergoing to caesarean section (5,13,14). Previous studies have shown that reduction at doses used for spinal anesthesia is related with increased hemodynamic stability and doses of intrathecal bupivacaine between 5 mg and 7 mg are sufficient to provide effective anaesthesia (1).…”