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Giannubilo SR, Amici M, Pizzi S, Simonini A, Ciavattini A. Maternal hemodynamics and computerized cardiotocography during labor with epidural analgesia. Arch Gynecol Obstet 2022; 307:1789-1794. [PMID: 35704115 PMCID: PMC10147743 DOI: 10.1007/s00404-022-06658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To analyze the mechanisms involved in the fetal heart rate (FHR) abnormalities after the epidural analgesia in labor. METHODS A prospective unblinded single-center observational study on 55 term singleton pregnant women with spontaneous labor. All women recruited underwent serial bedside measurements of the main hemodynamic parameters using a non-invasive ultrasound system (USCOM-1A). Total vascular resistances (TVR), heart rate (HR), stroke volume (SV), cardiac output (CO) and arterial blood pressure were measured before epidural administration (T0), after 5 min 5 (T1) from epidural bolus and at the end of the first stage of labor (T2). FHR was continuously recorded through computerized cardiotocography before and after the procedure. RESULTS The starting CO was significantly higher in a subgroup of women with low TVR than in women with high-TVR group. After the bolus of epidural analgesia in the low-TVR group there was a significant reduction in CO and then increased again at the end of the first stage, in the high-TVR group the CO increased insignificantly after the anesthesia bolus, while it increased significantly in the remaining part of the first stage of labor. On the other hand, CO was inversely correlated with the number of decelerations detected on cCTG in the 1 hour after the epidural bolus while the short-term variation was significantly lower in the group with high-TVR. CONCLUSION Maternal hemodynamic status at the onset of labor can make a difference in fetal response to the administration of epidural analgesia.
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Affiliation(s)
- Stefano Raffaele Giannubilo
- Department of Obstetrics and Gynecology, Marche Polytechnic University, Ancona, Italy. .,Department of Clinical Sciences, Polytechnic University of Marche Salesi Hospital, via Corridoni 11, 60123, Ancona, Italy.
| | - Mirco Amici
- Department of Anaesthesia and Intensive Care, Salesi Hospital, Ancona, Italy
| | - Simone Pizzi
- Department of Anaesthesia and Intensive Care, Salesi Hospital, Ancona, Italy
| | - Alessandro Simonini
- Department of Anaesthesia and Intensive Care, Salesi Hospital, Ancona, Italy
| | - Andrea Ciavattini
- Department of Clinical Sciences, Polytechnic University of Marche Salesi Hospital, via Corridoni 11, 60123, Ancona, Italy
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Sangroula D, Maggard B, Abdelhaleem A, Furmanek S, Clemons V, Marsili B, Stikes R, Hill M, Sigdel A, Clifford SP, Huang J, Akca O, Logsdon MC. Hemodynamic changes associated with neuraxial anesthesia in pregnant women with covid 19 disease: a retrospective case-control study. BMC Anesthesiol 2022; 22:179. [PMID: 35681119 PMCID: PMC9178224 DOI: 10.1186/s12871-022-01719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Neuraxial blocks is the recommended mode of analgesia and anesthesia in parturients with Coronavirus 19 (COVID-19). There is limited data on the hemodynamic responses to neuraxial blocks in COVID-19 patients. We aim to compare the hemodynamic responses to neuraxial blocks in COVID-19 positive and propensity-matched COVID-19 negative parturients. Methods We conducted retrospective, cross-sectional case–control study of hemodynamic changes associated with neuraxial blocks in COVID-19 positive parturients in a Tertiary care academic medical center. Fifty-one COVID-19 positive women confirmed by nasopharyngeal reverse transcription–polymerase chain reaction (RT-PCR), were compared with propensity-matched COVID negative controls (n = 51). Hemodynamic changes after neuraxial block were recorded by electronic medical recording system and analyzed using paired and unpaired T- test and Wilcoxon-Mann–Whitney Rank Sum tests. The primary outcome was ≥ 20% change in MAP and HR after neuraxial block placement. Results In the epidural group, 7% COVID-19 positive parturients had > 20% decrease in mean arterial pressure (MAP) from baseline compared to 15% COVID-19 negative parturients (P = 0.66). In the spinal group, 83% of COVID-19 positive parturients had a decrease in MAP more than 20% from baseline compared to 71% in control (P = 0.49). MAP drop of more than 40% occurred in 29% COVID positive parturients in the spinal group versus 17% in COVID-19 negative parturients (P = 0.5465). In COVID-19 positive spinal group, 54% required vasopressors whereas 38% in COVID-19 negative spinal group required vasopressors (P = 0.387). We found a significant correlation between body mass index (BMI) > 30 and hypotension in COVID ( +) parturient with odds ratio (8.63; 95% CI-1.93 – 37.21) (P = 0.007). Conclusion Incidence and severity of hypotension after neuraxial blocks were similar between COVID-19 positive and COVID-19 negative parturients. BMI > 30 was a significant risk factor for hypotension as described in preexisting literature, this correlation was seen in COVID-19 positive parturients. The likely reason for parturients with BMI > 30 in COVID negative patients not showing similar correlation, is that the sample size was small.
Supplementary information The online version contains supplementary material available at 10.1186/s12871-022-01719-0.
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Affiliation(s)
- D Sangroula
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA. .,Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
| | - B Maggard
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - A Abdelhaleem
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - S Furmanek
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - V Clemons
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - B Marsili
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - R Stikes
- Center for Women, and Infants, University of Louisville Hospital, 530 S. Jackson Street, Louisville, KY, 40202, USA
| | - M Hill
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - A Sigdel
- Department of Surgery, University of Louisville School of Medicine, 530 S. Jackson, Louisville, KY, 40202, USA
| | - S P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - J Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - O Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA.,Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - M C Logsdon
- School of Nursing, University of Louisville, 555 South Floyd Street, Louisville, KY, 40292USA, USA
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Raimann FJ, Baldauf HP, Louwen F, Jennewein L, Fischer D, Zacharowski K, Weber CF. Granisetron reduces the need for uterotonics but not sympathomimetics during cesarean delivery. Int J Gynaecol Obstet 2019; 145:361-366. [PMID: 30932170 DOI: 10.1002/ijgo.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/04/2018] [Accepted: 03/29/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the effect of a 5-hydroxytryptamine-3 receptor antagonist (granisetron) on the use of sympathomimetic (cafedrine/theodrenaline) and uterotonic (oxytocin) agents after spinal anesthesia during cesarean delivery. METHODS A retrospective observational analysis was conducted using intraoperative records (n=240) created at a single hospital in Germany between November 1, 2016, and July 31, 2017. The granisetron group (n=120) had received 3 mg of granisetron immediately before induction of spinal anesthesia. The control group (n=120) had not received granisetron. The primary endpoints were the intraoperative requirements for sympathomimetic and uterotonic agents. The secondary endpoints were parameters of intraprocedural maternal hemodynamic and clinical states. RESULTS More patients in the granisetron group than in the control group received intraoperative cafedrine/theodrenaline (P=0.045), with the cumulative intraoperative dosage also increased in the granisetron group (P=0.016). By contrast, the cumulative intraoperative dose of oxytocin was lower in the granisetron group than in the control group (P<0.001). Decreases in heart rate and mean arterial blood pressure were lower in the granisetron group versus the control group (P=0.015 and P=0.002, respectively). CONCLUSION Treatment with granisetron immediately before cesarean delivery did not reduce the perioperative requirement for sympathomimetics but did reduce the need for uterotonics. REGISTERED AT CLINICALTRIALS.GOV (NCT03318536).
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Affiliation(s)
- Florian J Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Henrica P Baldauf
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank Louwen
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Jennewein
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Dania Fischer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian F Weber
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Asklepios Hospital Wandsbek, Hamburg, Germany
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