1
|
Lyu W, Zhang Z, Li C, Wei P, Feng H, Zhou H, Zheng Q, Zhou J, Li J. Intravenous initial bolus during prophylactic norepinephrine infusion to prevent spinal hypotension for cesarean delivery: A randomized controlled, dose-finding trial. J Clin Anesth 2024; 97:111562. [PMID: 39047530 DOI: 10.1016/j.jclinane.2024.111562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 07/01/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Previous studies have shown that a 0.05 μg/kg/min of norepinephrine infusion in combination with an initial bolus reduces the incidence of spinal hypotension during cesarean delivery. The initial norepinephrine bolus influences the incidence of spinal hypotension during continuous norepinephrine infusion; however, the ideal initial bolus dose for 0.05 μg/kg/min of continuous infusion remains unknown. METHODS This randomized, controlled, dose-finding study randomly allocated 120 parturients scheduled for elective cesarean delivery to receive initial bolus doses of 0, 0.05, 0.10, and 0.15 μg/kg of norepinephrine, followed by continuous infusion at a rate of 0.05 μg/kg/min. The primary outcome was the dose-response relationship of the initial norepinephrine bolus in preventing the incidence of spinal hypotension. Spinal hypotension was defined as systolic blood pressure (SBP) decreased to <80% of the baseline value or to an absolute value of <90 mmHg from intrathecal injection to delivery, and severe spinal hypotension was defined as SBP decreased to <60% of the baseline value. The secondary outcomes included the incidence of nausea and/or vomiting, hypertension, and bradycardia, as well as the Apgar scores and results of the umbilical arterial blood gas analysis. The effective dose (ED) 90 and ED95 were estimated using probit regression. RESULTS The per-protocol analysis included 117 patients. The incidence of spinal hypotension varied significantly among the groups: Group 0 (51.7%), Group 0.05 (44.8%), Group 0.10 (23.3%), and Group 0.15 (6.9%). The ED90 and ED95 values were 0.150 μg/kg (95% confidence interval [CI], 0.114-0.241 μg/kg) and 0.187 μg/kg (95% CI, 0.141-0.313 μg/kg), respectively. However, the ED95 value fell outside the dose range examined in this study. The incidence of severe spinal hypotension differed significantly (P = 0.02) among Groups 0 (17.2%), 0.05 (10.3%), 0.10 (3.3%), and 0.15 (0.0%); however, the incidence of hypertension and bradycardia did not. The incidence of nausea and/or vomiting decreased with an increase in the initial bolus dose (P = 0.03). The fetal outcomes were comparable among the groups. CONCLUSIONS An initial bolus of 0.150 μg/kg of norepinephrine may be the optimal dose for preventing spinal hypotension during cesarean delivery with a continuous infusion rate of 0.05 μg/kg/min, and does not significantly increase the incidence of hypertension but substantially reduces the risk of nausea and/or vomiting.
Collapse
Affiliation(s)
- Wenyuan Lyu
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China
| | - Zheng Zhang
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, PR China
| | - Chengwei Li
- Department of Anesthesiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, PR China
| | - Penghui Wei
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China.
| | - Hao Feng
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China
| | - Haipeng Zhou
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China
| | - Qiang Zheng
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China
| | - Jinfeng Zhou
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China
| | - Jianjun Li
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, PR China.
| |
Collapse
|
2
|
Hasanin AM, Zaki RM, Mostafa M. Hypotension in cesarean delivery: questions and answers. J Anesth 2024:10.1007/s00540-024-03400-x. [PMID: 39215824 DOI: 10.1007/s00540-024-03400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Ahmed M Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Rana M Zaki
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
3
|
Obiyo LT, Tobes D, Cole NM. Anesthetic recommendations for maternal and fetal safety in nonobstetric surgery: a balancing act. Curr Opin Anaesthesiol 2024; 37:285-291. [PMID: 38390901 DOI: 10.1097/aco.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery. RECENT FINDINGS Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety. SUMMARY These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.
Collapse
Affiliation(s)
- Leziga T Obiyo
- Department of Anesthesia & Critical Care, University of Chicago, Chicago, Illinois, USA
| | | | | |
Collapse
|
4
|
Fujita N, Higuchi H, Yonekura Y. MRI of caval compression during left-lateral tilt in singleton and twin pregnancies: A prospective cohort study. Eur J Anaesthesiol 2024; 41:122-128. [PMID: 38018902 DOI: 10.1097/eja.0000000000001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND It is unclear how different degrees of left-lateral tilt affect the volumes of the abdominal aorta and inferior vena cava (IVC) in pregnancy. OBJECTIVE To use magnetic resonance images to assess the volumes of the abdominal aorta and IVC in women with twin or singleton pregnancies in different degrees of left-lateral tilt. DESIGN Prospective cohort study. SETTING A single-centre university hospital. PATIENTS Women with singleton pregnancies (13) and twin pregnancies (13) at 32 to 38 weeks' gestation. MAIN OUTCOME MEASURES Comparison of abdominal aortic and IVC volumes measured by MRI in women with singleton and twin pregnancies while in the supine or left-lateral tilt position at 15°, 30° and 45°. RESULTS Supine, the mean aortic and IVC volumes were not significantly different between the women with singleton and twin pregnancies. In a left-lateral tilt position of 15 o compared with supine, the mean IVC volume was not increased in either group (singletons: 6.3 ± 6.6 ml, 95% CI, -2.4 to 0.4; P = 0.174; twins: 3.9 ± 2.4 ml, 95% CI, -2.6 to 0.4; P = 0.138). At tilt angles of 30° or 45°, the mean IVC volume significantly increased (singletons 30°: 9.7 ± 5.8 ml, 95% CI, -6.1 to -2.7; P < .001; singleton 45°:13.8 ± 5.0 ml, 95% CI, -11.3 to -5.7; P < .001; twins 30°: 5.7 ± 2.1 ml, 95% CI, -4.0 to -1.4; P < .001; twins 45°: 12.8 ± 9.4 ml, 95% CI, -17.2 to -2.6; P = 0.003). Aortic volume was not significantly increased in either group at any of the examined tilt angles compared with the supine. CONCLUSION IVC volume is significantly increased by 30° and 45° left-lateral tilt positions compared with supine in women with singleton and twin pregnancies. TRIAL REGISTRATION This study was registered in the University Hospital Medical Information Network (UMIN) clinical trial registration (# UMIN000031273).
Collapse
Affiliation(s)
- Nobuko Fujita
- From the Department of Anaesthesia, St. Luke's International Hospital (NF), Department of Anaesthesia, Tokyo Shinagawa Hospital (HH) and Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan (YY)
| | | | | |
Collapse
|
5
|
Vasile F, La Via L, Murabito P, Tigano S, Merola F, Nicosia T, De Masi G, Bruni A, Garofalo E, Sanfilippo F. Non-Invasive Monitoring during Caesarean Delivery: Prevalence of Hypotension and Impact on the Newborn. J Clin Med 2023; 12:7295. [PMID: 38068347 PMCID: PMC10707670 DOI: 10.3390/jcm12237295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The aim of our study was to investigate the prevalence of perioperative hypotension after spinal anesthesia for cesarean section using non-invasive continuous hemodynamic monitoring and its correlation with neonatal well-being. METHODS We included 145 patients. Spinal anesthesia was performed with a combination of hyperbaric bupivacaine 0.5% (according to a weight/height scheme) and fentanyl 20 μg. Hypotension was defined as a mean arterial pressure (MAP) < 65 mmHg or <60 mmHg. We also evaluated the impact of hypotension on neonatal well-being. RESULTS Perioperative maternal hypotension occurred in 54.5% of cases considering a MAP < 65 mmHg and in 42.1% with the more conservative cut-off (<60 mmHg). Severe neonatal acidosis occurred in 1.4% of neonates, while an Apgar score ≥ 9 was observed in 95.9% at 1 min and 100% at 5 min. CONCLUSIONS Continuous non-invasive hemodynamic monitoring allowed an early detection of maternal hypotension leading to a prompt treatment with satisfactory results considering neonatal well-being.
Collapse
Affiliation(s)
- Francesco Vasile
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
| | - Luigi La Via
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
| | - Paolo Murabito
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
| | - Stefano Tigano
- School of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.T.); (F.M.)
| | - Federica Merola
- School of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.T.); (F.M.)
| | - Tiziana Nicosia
- School of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.T.); (F.M.)
| | - Giuseppe De Masi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Santa Maria”, 05100 Terni, Italy;
| | - Andrea Bruni
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (A.B.); (E.G.)
| | - Eugenio Garofalo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (A.B.); (E.G.)
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
- Department of General Surgery and Medical—Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, 95123 Catania, Italy
| |
Collapse
|
6
|
Liang Z, Zhou T, Wang M, Li Y. Neonatal outcomes when intravenous esketamine is added to the parturients transferred from labor analgesia to emergency cesarean section: a retrospective analysis report. BMC Anesthesiol 2023; 23:168. [PMID: 37198555 DOI: 10.1186/s12871-023-02132-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES The use of intravenous analgesics during emergency cesarean section may lead to adverse neonatal outcomes. In our study, we investigated whether a single intravenous (i.v.) dose of 25 mg esketamine administered to parturients with inadequate analgesia during epidural anesthesia for cesarean section would affect the neonate. DESIGN We reviewed the records of parturients who were transferred from labor analgesia to epidural anesthesia for emergency cesarean section from January 2021 to April 2022. Parturients were grouped by whether they received esketamine infusions during the incision-delivery interval. Neonatal outcomes, including umbilical arterial-blood gas analysis (UABGA), Apgar score, and total days spent by the neonate in the hospital, were compared between the two groups. The secondary outcomes of this study included BP, heart rate (HR), SPO2 and the incidence of adverse effects in parturients during operation. SETTING China. RESULTS After propensity score matching, 31 patients remained in each of the non-esketamine and esketamine groups. There were no significant differences in neonatal outcomes, including UABGA, Apgar score, and total days in the hospital, between the two groups. Additionally, our study showed a similar hemodynamic performance in parturients between the two groups during operation. CONCLUSIONS Intravenous esketamine (25 mg) is safe for neonates when it is given to parturients transferred from labor analgesia to emergency cesarean section.
Collapse
Affiliation(s)
- Zhaojia Liang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Ting Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Mengxia Wang
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yalan Li
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| |
Collapse
|
7
|
Huang J, Wen G, Huang Q, Huang B. Anesthesia characteristic of an algorithm of bupivacaine dose based on height in caesarean section under spinal anesthesia: a retrospective cohort study. BMC Anesthesiol 2023; 23:146. [PMID: 37131191 PMCID: PMC10152727 DOI: 10.1186/s12871-023-02113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/26/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND An algorithm of bupivacaine dose based on height is applied to reduce maternal hypotension in caesarean section under spinal anesthesia. This study is designed to further verify whether the algorithm of bupivacaine dose based on height is suitable. METHODS The parturients were grouped according to height. The comparison of anesthesia characteristic among subgroups was carried out. The univariate and multivariate binary logistic regressions were executed to reanalyze the interference factor for the anesthesia characteristic. RESULTS When the dose of bupivacaine was adjusted by using the height based dosing algorithm, except for weight (P < 0.05), other general data did not present statistical changes with height (P > 0.05); the incidences of complications, characteristics of sensory or motor block, quality of anesthesia and neonatal outcome were of no statistical difference among parturients with different heights (P > 0.05); the height, weight and body mass index were not related with maternal hypotension (P > 0.05). When the dose of bupivacaine is constant, except for weight and body mass index (P > 0.05), the height was the independent risk factor for maternal hypotension (P < 0.05). CONCLUSIONS Except for weight and body mass index, the height has an influence on the bupivacaine dose. It is reasonable that the bupivacaine dose is adjusted by using this dosing algorithm based on height. TRIAL REGISTRATION This study was registered at http://clinicaltrials.gov (13/04/2018, NCT03497364).
Collapse
Affiliation(s)
- Jinxin Huang
- Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen City, Guangdong, 518033, PR China
| | - Gengzhi Wen
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen City, Guangdong, 518033, PR China
| | - Qiang Huang
- Department of Anesthesiology, ShenZhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen City, Guangdong, 518020, PR China
| | - Bowan Huang
- Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen City, Guangdong, 518033, PR China.
| |
Collapse
|
8
|
Brakke B, Sviggum H. Anaesthesia for non-obstetric surgery during pregnancy. BJA Educ 2023; 23:78-83. [PMID: 36844444 PMCID: PMC9947972 DOI: 10.1016/j.bjae.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/15/2023] Open
|
9
|
Massoth C, Kranke P, Wenk M. Der Mythos der 15°-Linksseitenlagerung zur Entlastung der Vena cava inferior. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:737-739. [DOI: 10.1055/a-1931-1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
AbstractPositioning the pregnant patient in her third trimester in a 15° left lateral tilt position with the rationale to reduce inferior vena cava (IVC) compression is a longstanding practice of
both obstetric and anesthesia care. Recent data from MRI imaging studies have challenged this traditional dogma, since the IVC was found to remain compressed at a 15° angle, with a tilt of
at least 30° necessary to provide a certain relief of the vessel. However, even the 15° tilt is regularly underestimated by visual judgement and improperly executed, but comes with several
disadvantages without adding any benefit on fetal outcome. Current evidence supports all efforts to cease the dogma of a 15° left lateral position for its lack of effectiveness and instead
put emphasis on proven measures, such as volume coloading and the timely administration of vasopressors.
Collapse
|
10
|
Liu T, Cheng Z, Zou S, Xu C, Pan S, Zeng H, Shan Y, Feng Y, Zhang H. Effect of Weight-Adjusted Phenylephrine, Norepinephrine, and Metaraminol for Elective Cesarean Delivery on Neonatal Acid–Base Status: A Randomized Controlled Trial. Drug Des Devel Ther 2022; 16:3215-3223. [PMID: 36172051 PMCID: PMC9511707 DOI: 10.2147/dddt.s381048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Many previous trials have compared the effects of different vasoactive drugs on cesarean section patients, but their infusion rate is based on experience rather than high-quality evidence. It is difficult to judge whether the effect of vasoactive drug comes from the better choice or a more appropriate at rates of vasoactive drugs. The effect of vasoactive drugs at the rates of the 90% effective dose needs to be verified and compared. Patients and Methods Women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomized to receive phenylephrine or norepinephrine or metaraminol infusion at the rate that was assumed to be the 90% effective dose. Anesthetic management was standardized and included fluid loading with 10 mL/kg of Ringer. The primary outcome was the umbilical artery pH. Results 78 patients were included. The umbilical artery pH was not significantly different among the three groups (phenylephrine group: 7.33 ± 0.03 vs norepinephrine group: 7.33 ± 0.04 vs metaraminol group: 7.33 ± 0.04, P = 0.99). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and nausea and vomiting among the three groups. The SBP of the phenylephrine group was significantly higher than that of the metaraminol group (adjustive P value = 0.005). Conclusion Phenylephrine (0.54 μg/kg/min) or metaraminol (2 μg/kg/min) or norepinephrine (0.08 μg/kg/min) administered to healthy patients with elective cesarean section after spinal anesthesia has no significant effect on the acid-base balance of the fetus.
Collapse
Affiliation(s)
- Tianyu Liu
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zhiyong Cheng
- Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China
| | - Shiya Zou
- Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, People’s Republic of China
| | - Chao Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shoudong Pan
- Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, People’s Republic of China
| | - Huabei Zeng
- Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China
| | - Yidong Shan
- Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China
| | - Yi Feng
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
- Correspondence: Yi Feng; Hong Zhang, Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, People’s Republic of China, Tel +86-13601083503; +86-13311281808, Email ;
| | - Hong Zhang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
| |
Collapse
|
11
|
van Dyk D, Dyer RA, Bishop DG. Spinal hypotension in obstetrics: Context-sensitive prevention and management. Best Pract Res Clin Anaesthesiol 2022; 36:69-82. [PMID: 35659961 DOI: 10.1016/j.bpa.2022.04.001] [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: 02/16/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022]
Abstract
Spinal hypotension during caesarean section remains a common complication, with important attendant maternal and fetal adverse outcomes. Research elucidating the mechanisms of spinal hypotension has led to the development and refinement of effective management strategies, with a particular emphasis on prophylactic vasopressor administration. This has proved effective in well-resourced settings, with maternal comfort and the elimination of nausea now considered the primary aim of treatment. In resource-limited settings, sophisticated strategies are not feasible due to insufficient equipment, staff, and expertise. Therefore, in these areas spinal hypotension remains an important cause of maternal and fetal morbidity and mortality. Translational, context-sensitive research in resource-limited settings has shown promise in implementing pragmatic strategies based on research from resource-rich environments. We review the current best practice for the prevention and treatment of spinal hypotension, with a special emphasis on effective strategies in resource-limited settings. We further suggest a research agenda to address the knowledge gap in specific contexts.
Collapse
Affiliation(s)
- Dominique van Dyk
- D23 Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa.
| | - Robert A Dyer
- D23 Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa.
| | - David G Bishop
- Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, South Africa; Department of Anaesthesia, Critical Care and Pain Management, University of KwaZulu-Natal, Grey's Hospital, Town Bush Road, Pietermaritzburg, 3201, South Africa.
| |
Collapse
|
12
|
Sonnino C, Frassanito L, Piersanti A, Giuri PP, Zanfini BA, Catarci S, Draisci G. Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study. BMC Anesthesiol 2022; 22:103. [PMID: 35410115 PMCID: PMC8996426 DOI: 10.1186/s12871-022-01640-6] [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: 12/07/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left uterine displacement (LUD) has been questioned as an effective strategy to prevent aortocaval compression after spinal anesthesia (SA) for cesarean delivery (CD). We tested if LUD has a significant impact on cardiac output (CO) in patients undergoing CD under SA during continuous non-invasive hemodynamic monitoring with Clearsight. METHODS Forty-six patients were included in the final analysis. We considered 4 timepoints of 5 min each: T1 = baseline with LUD; T2 = baseline without LUD; T3 = after SA with LUD; T4 = after SA without LUD. LUD was then repositioned for CD. The primary outcome was to assess if CO decreased from T3 to T4 of at least 1.0 L/min. We also compared CO between T1 and T2 and other hemodynamic variables: mean, systolic and diastolic blood pressure (respectively MAP, SAP and DAP), heart rate (HR), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), contractility (dP/dt), dynamic arterial elastance (Eadyn) at the different timepoints. Data on fetal Apgar scores and umbilical arterial and venous pH were collected. RESULTS CO did not vary from T3 to T4 (CO mean difference -0.02 L/min [95% CI -0.88 to 0.82; P = 1). No significant variation was registered for any variable at any timepoint. CONCLUSIONS LUD did not show a significant impact on CO during continuous hemodynamic monitoring after SA for CD. TRIAL REGISTRATION (retrospectively registered on 03/12/2021) NCT05143684 .
Collapse
Affiliation(s)
- Chiara Sonnino
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
| | - Luciano Frassanito
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Alessandra Piersanti
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Pietro Paolo Giuri
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Bruno Antonio Zanfini
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Stefano Catarci
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Gaetano Draisci
- Unit of Obstetric and Gynecologic Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| |
Collapse
|
13
|
Bradford V, Gaiser R. Preservation of Fetal Viability During Noncardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
14
|
Liu T, Gao X, Zou S, Xu C, Wang M, Niu Z, Guo L, Shi Z, Zhang J, Qi D. Randomised double-blind dose-response study of weight-adjusted infusions of metaraminol for preventing hypotension with combined spinal-epidural anaesthesia for elective Caesarean delivery in the supine position. Br J Anaesth 2021; 128:e20-e22. [PMID: 34782126 DOI: 10.1016/j.bja.2021.09.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tianyu Liu
- Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Xiuxiu Gao
- Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Shiya Zou
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Chao Xu
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Min Wang
- Department of Anesthesia, Jinshan Hospital of Fudan University, Shanghai, China
| | - Zheng Niu
- Department of Anesthesia, Affiliated Zhangjiagang Hospital of Soochow University, Soochow, Jangsu, China
| | - Lulu Guo
- Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Zeshu Shi
- Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Jing Zhang
- Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Dunyi Qi
- Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China.
| |
Collapse
|
15
|
Surgery in the Obese Pregnant Patient. Clin Obstet Gynecol 2021; 63:416-428. [PMID: 32224705 DOI: 10.1097/grf.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This chapter reviews issues which complicate surgery in obese pregnant patients. Maternal obesity is prevalent in the United States and is associated with numerous adverse health outcomes. When surgery is indicated during pregnancy, the presence of maternal obesity increases surgical risks for both the fetus and mother. Specific risks are identified and strategies to avoid them are evaluated. The prognosis and management of pregnant women who have undergone bariatric surgery is also discussed, and practical guidelines for obstetric management of these patients are presented.
Collapse
|
16
|
Supine hypotensive syndrome of pregnancy: A review of current knowledge. Eur J Anaesthesiol 2021; 39:236-243. [PMID: 34231500 DOI: 10.1097/eja.0000000000001554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the first description of supine hypotensive syndrome in the 1950s, its potentially detrimental effects on otherwise healthy women during late pregnancy have become a persistent challenge in obstetric practice. Establishing a 15° left lateral tilt during labour and caesarean section is a fundamental principle of obstetric care, universally adopted and upheld by current guidelines and recommendations. Reassessment of the original landmark studies in the light of current physiological and anatomical knowledge questions adherence to this standard in clinical practice. The modern practice of providing vasopressor support during caesarean delivery under neuraxial anaesthesia appears to negate any potential negative effects of a maternal full supine position. Recent MRI studies provide evidence as to the cause of supine hypotension and the physiological effects of different maternal positions at term. This review highlights current data on the acute supine hypotensive syndrome in contrast to traditional knowledge and established practice.
Collapse
|
17
|
Gagné MP, Richebé P, Loubert C, Drolet P, Gobert Q, Denault A, Zaphiratos V. Ultrasound evaluation of inferior vena cava compression in tilted and supine term parturients. Can J Anaesth 2021; 68:1507-1513. [PMID: 34212308 DOI: 10.1007/s12630-021-02051-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Hypotension is common following spinal anesthesia (SA) during elective Cesarean delivery (CD). Although common practice is to alleviate inferior vena cava (IVC) compression, limited evidence supports a 15° tilt for CD. We measured collapsibility of the IVC in supine and 15° left lateral tilt positions with ultrasound before and after SA and phenylephrine infusion in term parturients. METHODS Twenty term parturients scheduled for CD were recruited for this prospective study. Ultrasound measurements of the IVC were taken 1) supine before SA, 2) tilted 15° before SA, 3) supine after SA, and 4) tilted 15° after SA. A phenylephrine infusion was begun after injection of SA. The primary outcome was to evaluate the impact of position on the IVC collapsibility index (IVCCI): a measure of the difference between the maximum and minimum IVC diameter with respiration. RESULTS The mean (standard deviation) IVCCI (%) before SA was higher in the supine 19.5 (8.0) than in the tilted 15.0 (6.4) position (mean difference, 4.5; 95% confidence interval [CI], 0.1 to 8.9; P = 0.04). After SA, there was no significant difference between IVCCI (%) in the supine 17.8 (8.3) and tilted 14.2 (6.9) position (mean difference, 3.5; 95% CI, -0.9 to 7.9; P = 0.13). There was no correlation between the pre-spinal IVVCI measurements and the quantity of phenylephrine used during the surgery. CONCLUSION The IVCCI was lower in the 15° tilt position than in the supine position, but not after SA with a phenylephrine infusion. Ultrasound imaging can help identify IVC compression. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03410199); registered 18 January 2018.
Collapse
Affiliation(s)
- Marie-Pierre Gagné
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Christian Loubert
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Pierre Drolet
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Quentin Gobert
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - André Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada
| | - Valerie Zaphiratos
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal (CEMTL), University of Montreal, 5415 boul. de l'Assomption, Montreal, QC, H1T 2M4, Canada.
| |
Collapse
|
18
|
Mohammed AAEF, Salem E, Alshawadfy A. Role of left uterine placement in maternal care bundle for the prevention of spinal anesthesia-induced hypotension in cesarean section. AL-AZHAR ASSIUT MEDICAL JOURNAL 2021. [DOI: 10.4103/azmj.azmj_187_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
19
|
Liu T, Zou S, Guo L, Niu Z, Wang M, Xu C, Gao X, Shi Z, Guo X, Xiao H, Qi D. Effect of Different Positions During Surgical Preparation With Combined Spinal-Epidural Anesthesia for Elective Cesarean Delivery: A Randomized Controlled Trial. Anesth Analg 2020; 133:1235-1243. [PMID: 33350619 DOI: 10.1213/ane.0000000000005320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The intraoperative 15° left-tilt position during cesarean delivery has more recently been questioned regarding its effect on fetal acid-base balance and is a frequent source of complaints by surgeons. We hypothesized that a 30° left-tilt position during surgical preparation could improve the acid-base balance of the fetus compared with the 15° left-tilt or supine position during surgical preparation. METHODS Women undergoing elective cesarean delivery under combined spinal epidural anesthesia were randomized to a supine position, 15° left-lateral tilt position or 30° left-lateral tilt position; the position was changed to supine before the incision. Anesthetic management was standardized and included fluid loading with 10 mL/kg of normal saline followed by colloid loading. Hypotension (systolic blood pressure [SBP] reduction >20% baseline value or SBP <90 mm Hg) was treated with boluses of phenylephrine or ephedrine according to maternal heart rate. The primary outcome was umbilical arterial blood pH and the secondary outcomes included maternal SBP within 15 minutes after induction of anesthesia, the amount of vasoactive drug administered before end of the surgery, and the incidence of hypotension during cesarean delivery. RESULTS Seventy-five patients were included. After testing by analysis of variance, there was no significant difference in the umbilical arterial pH among the 3 groups (supine group: 7.31 ± 0.03 vs 15° group: 7.30 ± 0.04 vs 30° group: 7.31 ± 0.02, P = .28). The 30° group required significantly less phenylephrine (P = .007) and ephedrine (P = .005) before the end of surgery than the supine group; however, the only benefit observed in the 15° group was that the mean SBP at 3 minutes after spinal injection was significantly improved compared with the supine group. CONCLUSIONS Compared with the supine position, the 30° left-tilt position during surgical preparation did not significantly improve the fetal acid-base status, but it significantly reduced the use of phenylephrine and ephedrine and reduced the incidence of hypotension; however, these benefits were not observed in the 15° left-tilt group.
Collapse
Affiliation(s)
- Tianyu Liu
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Shiya Zou
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,The Affiliated Pizhou Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Lulu Guo
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Zheng Niu
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Min Wang
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Chao Xu
- Department of Anesthesiology, Peking University People's Hospital.,Peking University Health Science Center
| | - Xiuxiu Gao
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Zeshu Shi
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Xiaowei Guo
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Hanbing Xiao
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| | - Dunyi Qi
- From the Key Laboratory of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, Jangsu, China.,Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jangsu, China
| |
Collapse
|
20
|
Patel S, Wali A. Airway Management of the Obstetric Patient. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
21
|
Yeh PH, Chang YJ, Tsai SE. Observation of hemodynamic parameters using a non-invasive cardiac output monitor system to identify predictive indicators for post-spinal anesthesia hypotension in parturients undergoing cesarean section. Exp Ther Med 2020; 20:168. [PMID: 33093906 PMCID: PMC7571406 DOI: 10.3892/etm.2020.9298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
The administration of high-level spinal anesthesia for cesarean section may lead to significant hemodynamic changes. Bioreactance-based non-invasive cardiac output monitoring (NICOM™) provides an accurate monitoring system for parturients under spinal anesthesia. The present study hypothesized that baseline hemodynamic parameters obtained via the NICOM™ system could serve as predictive indicators for post-spinal anesthesia hypotension. Therefore, 80 full-term parturients with singleton pregnancies who underwent scheduled cesarean section were enrolled and allocated to either a supine position group or a 15˚ left tilt group. All parturients received standard pre-hydration with 750 ml of 0.9% saline. Baseline cardiac output index (CI), total peripheral resistance index (TPRI) and stroke volume (SV) were recorded using the NICOM™ system. Subsequently, spinal anesthesia with 2.4 ml of 0.5% hyperbaric bupivacaine, 10 µg of fentanyl and 0.2 mg of morphine was administered. Receiver operating characteristic (ROC) curves and multivariate logistic regression were used to analyze the data. A total of 40 parturients (51.9%) developed hypotension. The areas under the ROC curves were 0.666, 0.594 and 0.622 for the CI, TPRI and SV, respectively. The optimal cut-off value of the CI in predicting hypotension was 3.68 l/min/m2 (ROC, sensitivity=85.0%, specificity=48.6%). Furthermore, CI was considered as an independent factor for post-spinal anesthesia hypotension. In conclusion, the baseline CI obtained via the bioreactance-based NICOM™ system may serve as a predictor of post-spinal anesthesia hypotension in parturients regardless of patient position.
Collapse
Affiliation(s)
- Pin-Hung Yeh
- Department of Anesthesiology, Changhua Christian Hospital, Changhua City 50006, Taiwan R.O.C
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Centre, Changhua Christian Hospital, Changhua City 50006, Taiwan R.O.C
| | - Sheng-En Tsai
- Department of Anesthesiology, Changhua Christian Hospital, Changhua City 50006, Taiwan R.O.C
| |
Collapse
|
22
|
Hypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy. Curr Opin Anaesthesiol 2020; 33:291-298. [DOI: 10.1097/aco.0000000000000848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Tan HS, Habib AS. The optimum management of nausea and vomiting during and after cesarean delivery. Best Pract Res Clin Anaesthesiol 2020; 34:735-747. [PMID: 33288123 DOI: 10.1016/j.bpa.2020.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
Intraoperative and postoperative nausea and vomiting (IONV and PONV) afflict up to 80% of parturients undergoing cesarean delivery with neuraxial anesthesia. Preventing nausea and emesis is a top priority for women undergoing cesarean delivery and is included in the quality of recovery measures and enhanced recovery after cesarean delivery protocols. The majority of known perioperative emetic triggers can be avoided or mitigated by optimizing anesthetic and surgical management. IONV may arise from spinal anesthesia-induced hypotension, intraoperative pain, and medications such as uterotonics and antibiotics. Furthermore, uterine exteriorization and peritoneal irrigation increase IONV risk. Conversely, preventing PONV mainly focuses on optimizing analgesia through an opioid-sparing, multimodal strategy. In addition, combination prophylactic antiemetic therapy should be instituted in this high-risk population to further reduce the risk of IONV and PONV.
Collapse
Affiliation(s)
- Hon Sen Tan
- Department of Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
| |
Collapse
|
24
|
Chungsamarnyart Y, Wacharasint P, Carvalho B. Hemodynamic profiles with and without left uterine displacement: A randomized study in term pregnancies receiving subarachnoid blockade for cesarean delivery. J Clin Anesth 2020; 64:109796. [PMID: 32305794 DOI: 10.1016/j.jclinane.2020.109796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/11/2020] [Accepted: 03/14/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the effect of left uterine displacement (LUD) on maternal hemodynamic measures following subarachnoid blockade (SAB) for cesarean delivery (CD). The primary outcome was cardiac output (CO) differences between the LUD and non-LUD groups pre-delivery. DESIGN Prospective, randomized, controlled study. SETTING Obstetric operating room. MATERIALS AND METHODS We studied hemodynamic profiles in sixty healthy women with term pregnancies who underwent elective CD with SAB. Hemodynamics were measured using a non-invasive CO monitor, the Nexfin™. All women received a crystalloid 10 mL/kg preload, and hypotension was treated with ephedrine boluses. INTERVENTIONS Sixty women with term pregnancies were randomized into two groups: LUD group (received 15-30° LUD after SAB, n = 30) and non-LUD group (no LUD after SAB, n = 30). MEASUREMENTS Patient's hemodynamic variables including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), CO, systemic vascular resistance (SVR), and left ventricular contractility index (dP/dT) were measured continuously from pre-SAB until end of surgery. MAIN RESULTS In pre-delivery phase at 5 min after spinal anesthesia, the LUD group had significantly higher CO (7.20 ± 1.78 [95%CI 6.53-7.87] vs. 6.23 ± 1.44 L/min [95% CI 5.69-6.77]; p = 0.016) and higher dP/dT (784 ± 313 vs. 604 ± 241 mmHg/s; p = 0.020) than the non-LUD group. The LUD group had a lower incidence of maternal systolic hypotension at 5-min post-SAB (16.7% vs. 53.3% in non-LUD group, p = 0.003). CONCLUSIONS The study demonstrates modest hemodynamic advantages (higher CO, less hypotension, higher dP/dT) with pre-delivery LUD. The results support maternal hemodynamic benefits of LUD until delivery in women with term pregnancies undergoing CD with SAB.
Collapse
Affiliation(s)
| | - Petch Wacharasint
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA.
| |
Collapse
|
25
|
Singh S, Lumbreras-Marquez MI, Farber MK, Xu X, Singh P, Gorman T, Palanisamy A. Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study. Anesth Analg 2020; 129:162-167. [PMID: 30768454 DOI: 10.1213/ane.0000000000004064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery. METHODS Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns. RESULTS The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0-28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0-3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0-18.6 mm Hg*min) compared to controls (0; interquartile range, 0-1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01-1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural). CONCLUSIONS Our results suggest that the degree and duration of maternal SBP <90 mm Hg after neuraxial anesthesia during elective cesarean delivery are associated with transient tachypnea of newborns. Future prospective studies should further explore the effects of maternal hypotension, its prevention, and treatment for transient tachypnea of newborns.
Collapse
Affiliation(s)
- Shubhangi Singh
- From the Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Michaela K Farber
- From the Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Xinling Xu
- From the Department of Anesthesiology and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Prashant Singh
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Terri Gorman
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arvind Palanisamy
- Department of Anesthesiology, Washington University, St Louis, Missouri
| |
Collapse
|
26
|
Continuous haemodynamic effects of left tilting and supine positions during Caesarean section under spinal anaesthesia with a noninvasive cardiac output monitor system. Eur J Anaesthesiol 2019; 36:72-75. [PMID: 30520787 DOI: 10.1097/eja.0000000000000895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Lee A, Ngan Kee W. Effects of Vasoactive Medications and Maternal Positioning During Cesarean Delivery on Maternal Hemodynamics and Neonatal Acid-Base Status. Clin Perinatol 2019; 46:765-783. [PMID: 31653307 DOI: 10.1016/j.clp.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Maternal hemodynamics, positioning, and anesthesia technique for cesarean delivery influence neonatal acid-base balance; direct effects from drugs that cross the placenta also have an influence. Spinal anesthesia limits fetal exposure to depressant drugs and avoids maternal airway instrumentation, but is associated with hypotension. Hypotension may be prevented/treated with vasopressors and intravenous fluids. Current evidence supports phenylephrine as the first-line vasopressor. Fifteen degrees of lateral tilt during cesarean delivery has been advocated to relieve vena caval obstruction, but routine use may be unnecessary in healthy nonobese women having elective cesarean delivery if maternal blood pressure is maintained near baseline.
Collapse
Affiliation(s)
- Allison Lee
- Department of Anesthesiology, Columbia University Medical Center, Columbia University, 630 West 168th Street PH-5, New York, NY 10032, USA.
| | - Warwick Ngan Kee
- Department of Anesthesiology, Sidra Medicine, Al Gharrafa Street, Ar-Rayyan, Doha, Qatar
| |
Collapse
|
28
|
Zeuzem-Lampert C, Groene P, Brummer V, Hofmann-Kiefer K. [Cardiorespiratory effects of perioperative positioning techniques]. Anaesthesist 2019; 68:805-813. [PMID: 31713665 DOI: 10.1007/s00101-019-00674-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The supine position is still the most frequently used type of positioning during surgical procedures. Positions other than the supine position lead to physiological alterations that have a relevant influence on the course of anesthesia and surgery. As a matter of principle, hemodynamic stability is at risk because venous blood is pooled in the lower positioned body parts. In addition, head down positions (Trendelenburg position) may lead to an impairment of respiratory function by reducing lung volumes as well as lung compliance. Upright positions (beach chair position) are characterized by a relative hypovolemia accompanied by a reduction of mean arterial pressure, cardiac output and stroke volume, whereas pulmonary functions remain unchanged. Some severe adverse events have been described in the literature (e.g. intraoperative apoplexy, postoperative blindness). The pathophysiological principles and effects of hemodynamic alterations as well as potential strategies to avoid complications are presented and discussed in this lead article. Head down positions, especially the Trendelenburg position, cause a relative (intrathoracic) hypervolemia and an increase in cardiac preload that is usually well-tolerated in patients without heart problems; however, the Trendelenburg position, especially if combined with a capnoperitoneum, significantly impairs pulmonary function, can have a negative effect on intracerebral pressure and may reduce blood flow of intra-abdominal organs. The pathophysiological intraoperative changes caused by Trendelenburg positioning are described and approaches suitable for risk reduction are discussed. The prone position and lateral decubitus position have little influence on the intraoperative homeostasis. Nevertheless, there is an ongoing discussion concerning the efficacy of a 15° left lateral position during caesarean section, which is also discussed in a separate section of this review.
Collapse
Affiliation(s)
- C Zeuzem-Lampert
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - P Groene
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - V Brummer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - K Hofmann-Kiefer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland.
| |
Collapse
|
29
|
Fichter JL, Nelson KE. Optimal Management of Hypotension During Cesarean Delivery Under Spinal Anesthesia. Adv Anesth 2019; 37:207-228. [PMID: 31677657 DOI: 10.1016/j.aan.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer L Fichter
- Department of Anesthesiology, Wake Forest School of Medicine, 9th Floor Janeway Tower, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Kenneth E Nelson
- Department of Anesthesiology, Wake Forest School of Medicine, 9th Floor Janeway Tower, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| |
Collapse
|
30
|
Harrison JHN, Arnolds DE, Banayan JM, Rana S, Schnettler WT, Neuburger PJ. Surgical Excision of a Left Atrial Myxoma During the Second Trimester of Pregnancy. J Cardiothorac Vasc Anesth 2019; 34:530-536. [PMID: 31818529 DOI: 10.1053/j.jvca.2019.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/11/2022]
Affiliation(s)
- John-Henry N Harrison
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL.
| | - David E Arnolds
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Jennifer M Banayan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL
| | - William T Schnettler
- Division of Maternal-Fetal Medicine, TriHealth: Good Samaritan Hospital, Cincinnati, OH
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, NY
| |
Collapse
|
31
|
Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, Lok CAR, Maggen C, Morice P, Peccatori F, Poortmans P, Van Calsteren K, Vandenbroucke T, van Gerwen M, van den Heuvel-Eibrink M, Zagouri F, Zapardiel I. Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting. Ann Oncol 2019; 30:1601-1612. [PMID: 31435648 DOI: 10.1093/annonc/mdz228] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
Collapse
Affiliation(s)
- F Amant
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - P Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - I A Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Cardonick
- Department of Obstetrics and Gynecology, Cooper University Health Care, Camden, USA
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - M Fumagalli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - M J Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Hasenburg
- Department of Obstetrics and Gynecology, Mainz University Medical Center, Mainz, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Lambertini
- Department of Medical Oncology, IRCCS Policlinico San Martino Hospital, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C A R Lok
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands
| | - C Maggen
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - P Morice
- Department of Gynecologic Surgery, Institute de Cancérologie Gustave Roussy, Villejuif, France
| | - F Peccatori
- Department of Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Department of Radiation Oncology, Institut Curie and Paris Sciences & Lettres - PSL University, Paris, France
| | - K Van Calsteren
- Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | | | - M van Gerwen
- Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek and Amsterdam University Medical Centers, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - F Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, Athens, Greece
| | - I Zapardiel
- Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
| |
Collapse
|
32
|
Park YW, Lee IH. Effects of fetal position on maternal hemodynamics after spinal anesthesia for cesarean delivery. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yeon Wook Park
- Department of Anesthesiology and Pain Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea
| | - In Ho Lee
- Department of Anesthesiology and Pain Medicine, Cheil General Hospital & Women’s Healthcare Center, Seoul, Korea
| |
Collapse
|
33
|
|
34
|
Fujita N, Higuchi H, Sakuma S, Takagi S, Latif MAHM, Ozaki M. Effect of Right-Lateral Versus Left-Lateral Tilt Position on Compression of the Inferior Vena Cava in Pregnant Women Determined by Magnetic Resonance Imaging. Anesth Analg 2019; 128:1217-1222. [PMID: 31094791 DOI: 10.1213/ane.0000000000004166] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite the existing dogma that women undergoing cesarean delivery under spinal anesthesia should be positioned with a 15° left-lateral tilt, the patients were actually positioned in a right-lateral tilt position in several of the original studies. The superiority of right versus left positioning for optimal inferior vena cava volume is unknown. We used magnetic resonance imaging to compare the effects of right-lateral and left-lateral tilt positions on abdominal aortic and inferior vena cava volumes in pregnant women. METHODS Thirteen women with singleton pregnancies and gestational age 31-39 weeks underwent magnetic resonance imaging while in the supine position, and in the left-lateral (15° and 30°) and right-lateral tilt (15° and 30°) positions, which were maintained by placing a 1.5-m-long piece of polyethylene foam under either side of the body. Abdominal aorta and inferior vena cava volume were measured between the L1-L2 disk and L3-L4 disk levels using magnetic resonance images. RESULTS Aortic volume did not differ significantly among any of the positions examined. Mean inferior vena cava volume was significantly greater in the 30° left-lateral tilt position than in the 15° right-lateral tilt (10.7 ± 7.5 vs 5.9 ± 5.1 mL; mean difference, 4.8; 95% CI, 1.2-8.5; P = .002) and 30° right-lateral tilt (10.7 ± 7.5 vs 5.9 ± 2.5 mL; mean difference, 4.8; 95% CI, 1.2-8.4; P = .002) positions. Mean inferior vena cava volume in the 15° left-lateral tilt position did not differ significantly from that in the 15° right-lateral tilt (mean difference, 0.4; 95% CI, -3.2 to 4.0; P = 1.000) or 30° right-lateral tilt (mean difference, 0.4; 95% CI, -3.3 to 4.0; P = 1.000) positions. Mean inferior vena cava volume in the supine position only differed significantly from that in the 30° left-lateral tilt position (5.2 ± 3.8 vs 10.7 ± 7.5 mL; mean difference, 5.5; 95% CI, 1.8-9.1; P < .001). The greatest inferior vena cava volume was observed in the 30° left-lateral tilt position in 9 of 13 subjects (70%), and in the 30° right-lateral tilt in 3 subjects (23%). CONCLUSIONS The 30° left-lateral tilt position most consistently reduced inferior vena cava compression by the gravid uterus compared with the supine position. Mean inferior vena cava volume in pregnant women was not increased at either angle of the right-lateral tilt position compared with the 30° left-lateral tilt position. However, in a subset of patients, the 30° right-lateral tilt position achieved the optimal inferior vena cava volume. Further investigation to understand this variability is warranted.
Collapse
Affiliation(s)
- Nobuko Fujita
- From the Department of Anesthesia, St Luke's International Hospital, Tokyo, Japan
| | - Hideyuki Higuchi
- Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shiori Sakuma
- Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunichi Takagi
- Department of Anesthesiology, Nihon University School of Medicine, Tokyo, Japan
| | - Mahbub A H M Latif
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
35
|
Shatalin D, Weiniger C, Buchman I, Ginosar Y, Orbach-Zinger S, Ioscovich A. A 10-year update: national survey questionnaire of obstetric anesthesia units in Israel. Int J Obstet Anesth 2019; 38:83-92. [DOI: 10.1016/j.ijoa.2018.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/07/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
|
36
|
Habib A. What’s new in obstetric anesthesia in 2017? Int J Obstet Anesth 2019; 38:119-126. [DOI: 10.1016/j.ijoa.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
|
37
|
Ramage S, Armstrong S, Fernando R. Update on Vasopressors for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
d’Arby Toledano R, Madden HE, Leffert L. Anesthetic Management of Nonobstetric Surgery during Pregnancy. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00314-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
39
|
Xu C, Liu S, Qian D, Liu A, Liu C, Chen Y, Qi D. Preventive intramuscular phenylephrine in elective cesarean section under spinal anesthesia: A randomized controlled trial. Int J Surg 2019; 62:5-11. [PMID: 30639574 DOI: 10.1016/j.ijsu.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/02/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Phenylephrine is the first-line vasoactive drug in the cesarean section under spinal anesthesia. The rate of hypotension remains high after intravenous preventive use of phenylephrine. However, few studies have investigated the effect of preventive intramuscular phenylephrine via a longer period of usage on fetal and maternal outcomes. METHODS A total of 99 healthy parturients undergoing elective cesarean delivery were randomly allocated into three groups: M group (preventive intramuscular use of 5 mg phenylephrine), V group (preventive intravenous use of 100 μg phenylephrine), and P group (0.9% normal saline placebo). Rescue phenylephrine, ephedrine and atropine were used intraoperatively to adjust blood pressure and heart rate. The primary outcome was umbilical artery pH. RESULTS Significant differences in umbilical artery pH (M group: 7.32 ± 0.05 versus V group: 7.25 ± 0.04 versus P group: 7.21 ± 0.03, P < 0.05), fetal acidosis (M group: 3% [n = 33] versus V group: 15% [n = 33] versus P group: 30% [n = 33], P = 0.01) and maternal intraoperative hypotension (M group: 12% [33] versus V group: 39% [33] versus P group: 73% [33], P < 0.0001) were identified among the groups. Multiple linear regression analysis demonstrated that treating arms, neonatal birthweight and the interval from the end of anesthesia to baby delivery were associated with umbilical artery pH. CONCLUSION Compared with the preventive intravenous use of phenylephrine and placebo, preventive intramuscular phenylephrine exhibited a better neonatal acid-base status and more stable maternal hemodynamics in elective cesarean under spinal anesthesia.
Collapse
Affiliation(s)
- Chao Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China
| | - Su Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China
| | - Dongchen Qian
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China
| | - Aohua Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China
| | - Chang Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China
| | - Yajie Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China
| | - Dunyi Qi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.
| |
Collapse
|
40
|
Left Uterine Tilt for Cesarean Delivery Significantly Improves Maternal Hemodynamics and Should Not Be Considered Outdated Dogma. Anesthesiology 2018. [DOI: 10.1097/aln.0000000000002093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
In Reply. Anesthesiology 2018. [PMID: 29533302 DOI: 10.1097/aln.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Daoud M. Neonatal Outcome after Maternal Supine Position for Elective Cesarean Delivery under Spinal Anesthesia: Was the Umbilical Cord Blood Sampling Procedure Reliable? Anesthesiology 2018. [PMID: 29533300 DOI: 10.1097/aln.0000000000002094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mahmoud Daoud
- Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| |
Collapse
|
43
|
Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Should Not Be Abandoned. Anesthesiology 2018. [PMID: 29533301 DOI: 10.1097/aln.0000000000002095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
|
45
|
|
46
|
Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia 2017; 73:71-92. [DOI: 10.1111/anae.14080] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Kinsella
- Department of Anaesthesia; St Michael's Hospital; Bristol UK
| | - B. Carvalho
- Department of Anesthesiology; Stanford University School of Medicine; Stanford CA USA
| | - R. A. Dyer
- Department of Anaesthesia and Perioperative Medicine; University of Cape Town; South Africa
| | - R. Fernando
- Department of Anaesthesia; Hamad Women's Hospital; Doha Qatar
| | - N. McDonnell
- Department of Anaesthesia and Pain Medicine; King Edward Memorial Hospital for Women; Subiaco Australia
| | - F. J. Mercier
- Département d'Anesthésie-Réanimation; Hôpital Antoine Béclère; Clamart France
| | - A. Palanisamy
- Department of Anesthesiology; Washington University School of Medicine; St. Louis MO USA
| | - A. T. H. Sia
- Department of Women's Anaesthesia; KK Women's and Children's Hospital; Singapore
| | - M. Van de Velde
- Department of Anesthesiology; UZ Leuven; Leuven Belgium
- Department of Cardiovascular Sciences; KU Leuven; Leuven Belgium
| | - A. Vercueil
- Department of Anaesthesia and Intensive Care Medicine; King's College Hospital NHS Foundation Trust; London UK
| | | |
Collapse
|
47
|
Yuan KM, Fu SY, Li J, Shangguan WN, Lian QQ. Bezold-Jarisch reflex occurred in a pediatric patient with giant intra-abdominal teratoma during induction of anesthesia: A case report. Medicine (Baltimore) 2017; 96:e8304. [PMID: 29019905 PMCID: PMC5662328 DOI: 10.1097/md.0000000000008304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Bezold-Jarisch reflex (BJR) occurs when the cardioinhibitory receptors in the walls of ventricles are activated by various stimuli, with typical features of bradycardia, vasorelaxation, and hypotension. This reflex usually happens in parturient intrathecal anesthesia, as a result of decreased venous return by compression of inferior vena cava, but it is only rarely reported during general anesthesia. PATIENT CONCERNS Severe bradycardia and hypotension, indicating BJR, occurred during the induction of general anesthesia in a 3-month-old female child with giant intra-abdominal teratoma. DIAGNOSES A giant intra-abdominal teratoma was detected by computed tomography scanning. The decreased left ventricular ejection faction along with increased troponin I and N-terminal pro-B-type natriuretic peptide indicated a preoperative mild cardiac dysfunction. BJR was diagnosed on the basis of the severe bradycardia and hypotension observed during the induction of general anesthesia, INTERVENTIONS:: Atropine failed to increase heart rate. Cardiopulmonary resuscitation was initiated immediately and epinephrine was injected intravenously because of sudden circulatory collapse. Soon after the return of spontaneous circulation, a central venous line was placed and invasive blood pressure was monitored. Vital signs and homeostasis were kept stable during teratoma resection. OUTCOMES The child was extubated after emergence from anesthesia in the operating room. Eleven days later, she had recovered without complications and was discharged. LESSONS General anesthesia should be induced with great care in patients with giant intra-abdominal masses, and the patient should be kept in the left-lateral table tilt position before induction.
Collapse
|
48
|
Barrus A, Afshar S, Sani S, LaBounty TG, Padilla C, Farber MK, Rudikoff AG, Hernandez Conte A. Acute Type A Aortic Dissection and Successful Surgical Repair in a Woman at 21 Weeks Gestational Pregnancy With Maternal and Fetal Survival: A Case Report. J Cardiothorac Vasc Anesth 2017; 32:1487-1493. [PMID: 29217246 DOI: 10.1053/j.jvca.2017.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Adam Barrus
- Department of Anesthesiology, University of Arizona, Banner University Medical Center, Tucson, AZ
| | - Sam Afshar
- Department of Anesthesiology, University of Arizona, Banner University Medical Center, Tucson, AZ
| | - Sara Sani
- Department of Medicine, University of Arizona, Banner University Medical Center, Tucson, AZ
| | - Troy G LaBounty
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI
| | - Cesar Padilla
- Division of of Obstetric Anesthesia, Department of Anesthesiology, Brigham & Women's Hospital, Boston, MA
| | - Michaela K Farber
- Division of of Obstetric Anesthesia, Department of Anesthesiology, Brigham & Women's Hospital, Boston, MA
| | - Andrew G Rudikoff
- Divisions of Cardiothoracic and Obstetric Anesthesiology, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Antonio Hernandez Conte
- Divisions of Cardiothoracic and Obstetric Anesthesiology, Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
| |
Collapse
|
49
|
|