Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Emmett, RS; Cyna, Allan M; Andrew, M; Sw, Simmons

doi:10.1002/14651858.cd002251

Cited by 52 publications

(64 citation statements)

References 71 publications

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“…Their result is consistent with a recently published Cochrane Collaboration Systematic Review on the topic of preventing hypotension during spinal anesthesia for Cesarean section. 2 This persisting clinical problem has long been recognized (since the 1930's), however we carry it through into the 3 rd millennium.…”

mentioning

confidence: 99%

“…The concern for fetal well-being with spinal anesthesia-induced hypotension has largely been theoretical, as none of the techniques which reduce maternal hypotension have been shown to change indirect fetal outcomes, such as the proportion of neonates with acidosis (pH < 7.2) or Apgar scores < 8 at five minutes. 2,4 To evaluate the effect of various interventions on rare events (such as perinatal morbidity) would require clinical studies of thousands of women receiving spinal anesthesia. To date, the systematic reviews include 1,228 women and thus rare events such as neonatal morbidity and mortality are unlikely to occur.…”

mentioning

confidence: 99%

“…Le résultat cadre avec une revue méthodique publiée par le Centre de collaboration Cochrane sur la prévention de l'hypotension pendant la rachianesthésie pour césari-enne. 2 Ce problème clinique persistant, connu depuis les années 1930, existe donc toujours au 3e millénaire.…”

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Solving the problem of spinal-induced hypotension in obstetric anesthesia

Macarthur

2002

Can J Anesth/J Can Anesth

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confidence: 99%

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confidence: 99%

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Solving the problem of spinal-induced hypotension in obstetric anesthesia

Macarthur

2002

Can J Anesth/J Can Anesth

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“…Untreated, severe hypotension can also pose serious risks to both mother (unconsciousness, pulmonary aspiration, apnoea or even cardiac arrest) and baby (impaired placental perfusion leading to hypoxia, fetal acidosis and neurological injury. 18 The groups were comparable in age and physical characteristics. Indications for the caesarean section were comparable in all the 4 groups with majority of them being done for foetal distress.…”

Section: Resultsmentioning

confidence: 98%

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Minj

Beck

Kumar

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anaesthesia for cesarean section fails to obtain any sensory or motor block.Methods: This study is aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to caesarean section under spinal anaesthesia following preload with either crystalloid or colloid. This study was carried out on 100 healthy pregnant women with single term foetus and not in labor admitted at the labor room of Gynecological department of RIMS. Blood pressure, Pulse rate, O2 Saturation and episodes of hypotension were recorded every 5 minutes from the spinal block.Results: The study showed that maximum number of caesarean sections here performed for the indication of foetal distress which is seen in 44%, 48%, 52%, and 48% in Group A, Group B, Group C and Group D respectively. This is followed by scar tenderness and obstructed labour. In Group A maximum number of patients developed hypotension during 11-20 minutes duration which is 13 (61.9%) followed by 5 (23.8%) patients during first 10 minutes.Conclusions: The study concludes that the combined use of volume preloading to compensate for vasodilatation and vasopressor to counteract arterial dilatation is a very effective method in reducing the incidence, severity and duration of spiral hypotension. The combination group with decreased volume of preload and reduced dose of vasoconstrictor provides better haemodynamic stability when compared to preloading of vasoconstrictors alone.

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“…The routine measures used to maintain uteroplacental perfusion include left lateral tilt position, lower leg compressive stockings, and iv fluid loading. 116,117 Vasopressor therapy is reserved for the treatment of hypotension. Prophylactic use of ephedrine in one study 118 and therapeutic use in another 110 possibly contributed to fetal acidemia.…”

Section: Regional Anesthesia (Ra)mentioning

confidence: 99%

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

118

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P Pu ur rp po os se e: : To review the effects of maternal anesthesia and analgesia on the fetus and newborn.M Me et th ho od ds s: : An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : No one test clearly separates the effects on the fetus/newborn, if any, of maternally administered medication during labour and delivery, or during surgery for non-obstetric indications. Supposition in this regard is limited in part by methodology previously used to study the transplacental passage of various drugs. This work needs to be repeated using a human model. Routine maternal supplemental oxygen administration is being questioned in light of research showing that free radical generation and oxidative stress are implicated as the underlying mechanisms in several neonatal conditions. Maternal hypotension is associated with neonatal acidemia and base excess correlates with neonatal outcome. Common postpartum analgesics transfer minimally into breast milk. Maternal or fetal surgery conducted during pregnancy necessitates modification of both anesthetic and surgical approaches. The key to resuscitation of the fetus is resuscitation of the mother: intra-uterine maneuvers, including perimortem Cesarean section, aim to reverse treatable causes of fetal asphyxia, restore fetal oxygenation, and correct fetal acidosis.C Co on nc cl lu us si io on ns s: : The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn. Méthode : Une recherche informatisée en ligne des bases Medline et Embase et du Centre de collaboration Cochrane via PubMed a été réalisée. Des articles de langue anglaise ont été sélectionnés. Les bibliographies d'articles pertinents et du matériel additionnel d'autres publications ont été retenus et passés en revue. Constatations principales : Aucun test ne sépare clairement les effets sur le foetus/nouveau-né, si effet il y a, des médicaments administrés à la mère pendant le travail et l'accouchement ou pendant une intervention chirurgicale non obstétricale. Les hypothèses possibles

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Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Cited by 52 publications

References 71 publications

Solving the problem of spinal-induced hypotension in obstetric anesthesia

Solving the problem of spinal-induced hypotension in obstetric anesthesia

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

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